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8/10/2019 Mechanism of Labor in Breech Presentation
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dr. Udin Sabarudin
Department of Obstetrics & GynecologyMedicine School of Padjadjaran University
Bandung
MECHANISM OF LABOR
INBREECH PRESENTATION
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Figure 21-2.Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrumanterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zumStudium der Geburtshilfe. Bergmann, 1922)
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PREDISPOSING FACTORS :
Prematurity
Uterine abnormalities : -Malformation;
-Fibroids
Fetal abnormalities : -CNS Malformations;
-Neck Masses
Multiple gestations Previous breech delivery
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Gestational age and frequency of breech birth
Gestational age in weeks % Breech
21-24 33
25-28 28
29-32 14
33-36 9
37-40 7
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DIAGNOSIS :
Palpation and ballottement
Ultrasound
Pelvic examination
X-Ray studies
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Leopold Maneuver
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MANAGEMENT DURING LABOR
Type of Delivery
Vaginal delivery:
Spontaneous
Partial breech extraction
Total breech extraction
Cesarean of delivery
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Management
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Three types of vaginal breech delivery exist
Spontaneous breech (rare) : No manipulation of theinfant is necessary, other than supporting the infant.
Partial breech extraction : Fetus descend
spontaneously to where umbilicus is at the vaginal
introitus; then, the fetus is extracted completely.
Total breech extraction : The entire body is extracted
This is indicated only if there is evidence of fetal
distress unresponsive to routine maneuvers and acesarean delivery is not possible.
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Conditions are unfavorable for breech delivery
Fetus weight more than 3500 g Unfavorable pelvis Breech delivery does not
allow sufficient time for molding of the fetal head;thus, a platypelloid or android pelvis decreases
ability fetal head to navigate maternal pelvis
Hyperextension of the head increases risk ofcervical spine injury
Footlings- incidence of umbilical cord prolapseincreases with coiling of the umbilical cord aroundthe legs of the fetus
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MORTALITY/MORBIDITY
Increased birth trauma: As duration ofumbilical cord compression increases deliverthe infant more rapidly increasing birth
trauma
Decreased birth weight may result frompreterm delivery/growth restriction
Incidence of prolapsed umbilical cord depends
on type of breech presentation : Footling 17%,Complete 5%, Frank 0,5%
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Mechanism of Labor in Breech Delivery
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Assisted Delivery of Frank Breech
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Assisted Delivery of Frank Breech
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Assisted Delivery of Frank Breech
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Assisted Delivery of Frank Breech
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Assisted Delivery of Frank Breech
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Assisted Delivery of Frank Breech
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Assisted Delivery of Frank Breech
M h i f L b i B h D li
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Mechanism of Labor in Breech Delivery
Figure 21-5.Maneuver for delivery of the head. The fingers of the left handare inserted into the infants mouth of over mandible; the right hand exertspressure on the head from above. (Modified and reproduced, withpermission, from Benson RC:Handbook of Obstetrics & Gynecology, 8thed.Lange, 1983)
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Mauriceau Maneuver
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Delivery of the Aftercoming Head
Piper forceps
Modified prague maneuver
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Mechanism of Labor in Breech Delivery
Figure 21-12.Application of Piper forceps, employing towel sling support. The forceps areintroduced from below, left blade first. Aiming directly and intended positions on sides ofthe head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics &Gynecology, 8thed. Lange, 1983)
F t Aft i H d
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Forceps to Aftercoming Head
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C l t I l t B h E t ti
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Complete or Incomplete Breech Extraction
C l t I l t B h E t ti
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Complete or Incomplete Breech Extraction
C l t I l t B h E t ti
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Complete or Incomplete Breech Extraction
Complete o Incomplete B eech E t action
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Complete or Incomplete Breech Extraction
Breech Extraction
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Breech Extraction
C Section Indication
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C-Section Indication
A large fetus ( > 3.500 gr )A Hyperextended fetus
Uterine dysfunction
Footling presentation
Any degree of contraction or unfavorableshape restriction
Previous perinatal death or children sufferingfrom birth trauma
COMPLICATIONS
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COMPLICATIONS
1. Perinatal morbidity and mortality from difficult deliver
2. Low birthweight from preterm delivery, growthrestriction, or both
3. Prolapsed cord
4. Placenta previa
5. Fetal, neonatal, and infant anomalies
6. Uterine anomalies and tumors
7. Multiple fetuses
8. Operative intervention, especially cesarean delivery
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