Unplanned Breech in Labour

7/28/2019 Unplanned Breech in Labour

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Unplanned Vaginal Breech Birth 1 WACS ClinPro2.30Jan07

2.30-07WACS

Title: Unplanned Vaginal Breech Birth

Replaces:Description: Management of unplanned vaginal breech birthTarget Audience: Midwifery and Medical Staff, Queen Victoria Maternity UnitKey Words: Breech birth

Policy Supported:

Purpose:Breech presentation is the most common malpresentation occurring in about 4% of all

births. The diagnosis of breech presentation may occur late in the second stage and allstaff should be prepared for managing such an event.

Management

Call for help and prepare for neonatal resuscitation.

HANDS OFF THE BREECH.

Do not apply any traction to the baby as this may deflex the head.

KEEP THE BACK UPPERMOST if the babys back starts to rotate place twohands on the pelvic girdle (thumbs on bums) and gently rotate the baby so the backremains uppermost.

Hands off the breech - If birth is progressing then there is no need to intervene.

Active delivery of the legs is not required unless there is delay. The legs of a frankbreech may be delivered by inserting a finger behind the knee to flex the knee andabduct the thigh.

If the arms do not deliver spontaneously the Lovset manoeuvre maybe used. It isuseful when the arms are extended or a nuchal arm. Placing two hands on thepelvic girdle the body is rotated keeping the back upper most so the posterior armrotates anteriorly. The midwife can then splint the arm with her fingers and sweep itdown across the babys chest. Then the body is rotated back in the oppositedirection to deliver the second arm. Ensure the back is uppermost and allow thebaby to hang - HANDS OFF.

When the hairline is visible the head should be delivered by flexion to ensure themost favourable diameter. Controlled and gentle birth of the head is achieved by ausing a modified Mauriceau-Smellie-Veit manoeuvre. The babys body rests on theforearm and the index and middle fingers are placed on the maxilla. The otherhand is placed on the babys back and the middle finger placed on the occiput tokeep the head flexed. The head is delivered slowly keeping the babys body in aneutral position in respect to the head and then gently raised in a large arc so thatthe baby is delivered onto the mothers abdomen.

Active management of the third stage should follow birth.

Prepare for neonatal resuscitation

Womens & Childrens Services

Clinical Guidelines


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Complications of Vaginal Breech BirthCord prolapsePremature separation of the placentaFetal hypoxia

Complications for the baby

Erbs palsyFractures of the clavicle or humerusDislocation of the hips or shouldersInternal trauma or ruptured liver or spleen

Attachments

Attachment 1 Diagrams Lovset and modified Mauriceau Smellie Veit manoeuvre

Attachment 2 References

Performance Indicators: Evaluation of compliance with guideline to be achieved throughmedical record audit annually by clinical Quality improvementMidwife WACS

Review Date: Annually verified for currency or as changes occur, andreviewed every 3 years via Policy and Procedure working

group coordinated by the Clinical and Quality improvementmidwife. November 2009

Stakeholders: Midwives and medical staff WACS

Developed by: Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director(Nursing & Midwifery) Womens & Childrens Services

Dr A Dennis Sue McBeath

Co-Director (Medical) Co-Director (Nursing & Midwifery)Womens & Childrens Services Womens & Childrens Services

Date: _________________________


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APPENDIX 1

Lovset Maneouvre

The Modified Mauriceau Smellie Veit Manoeuvre

http://www.who.int/reproductive-health/impac/Procedures/Breech_delivery_P37_P42.html

Placing two hands on the pelvic girdlethe body is rotated keeping the backupper most so the posterior arm

rotates anteriorly.

The birth attendant can then splint thearm with her fingers and sweep itdown across the babys chest.

Then the body is rotated back in theopposite direction to deliver thesecond arm.

Ensure the back is uppermost andallow the baby to hang

The babys body rest on the forearmand the index and middle fingers areplaced on the maxilla.

The other hand is placed on the babysback and the middle finger placed onthe occiput to keep the head flexed.

The head is delivered slowly keepingthe babys body in a neutral position inrespect to the head and then gentlyraised in a large arc so that the baby isdelivered onto the mothers abdomen.


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APPENDIX 2REFERENCES

American Academy of Family Physicians 2000 Advanced life support in obstetrics (ALSO)course syllabus (4th edn). American Academy of Family Physicians, Kansas

Royal College of Obstetricians and Gynaecologist Clinical Green Top Guidelines 2001 Themanagement of breech presentations

Online: http://www.rcog.org.uk/index.asp?PageID=513

Womens Hospital Australasia Clinical Practise Guidelines 2005 Breech presentation.Online:http://www.wha.asn.au/index.cfm/spid/1_47.cfm
http://www.rcog.org.uk/index.asp?PageID=513http://www.rcog.org.uk/index.asp?PageID=513http://www.wha.asn.au/index.cfm/spid/1_47.cfmhttp://www.wha.asn.au/index.cfm/spid/1_47.cfmhttp://www.wha.asn.au/index.cfm/spid/1_47.cfmhttp://www.wha.asn.au/index.cfm/spid/1_47.cfmhttp://www.rcog.org.uk/index.asp?PageID=513

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Unplanned Breech in Labour