Breech delivery: Difference between revisions
(Updated background, features, and management) |
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==Background== | ==Background== | ||
*3-4% of term deliveries.<ref name="Silver">Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.</ref> (Most common fetal malpresentation<ref name="Mercado">Mercado J. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref>) | |||
*In normal delivery, head dilates cervix and allows body to pass relatively easily. | |||
**In breech delivery, body first does not first maximally dilate cervix → higher risk of head entrapment, cord prolapse, and death. | |||
==Clinical Features== | ==Clinical Features== | ||
===Three Types of Breech Delivery<ref name="Silver" />=== | |||
*'''Frank''' - Buttocks deliver first, hips flexed, knees extended (most common type) | |||
*'''Complete''' - Buttocks deliver first, hips and knees flexed | |||
*'''Incomplete''' - (aka "footling") One or both feet deliver first | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*In ED precipitous delivery, this is a clinical diagnosis. | |||
*If time allows, ultrasound can reveal position of fetus, but often not possible in ED deliveries. | |||
==Management== | ==Management== | ||
* | *Immediate OB/Gyn consult | ||
**If OB/Gyn immediately available and delivery has not progressed, Zavanelli maneuver has been described for breech births and may be considered. | |||
***Zavanelli maneuver - pushing presenting fetal part back into vagina until C-Section can be performed<ref>Timothy F Kirn. To Handle Breech Births, Know Two Maneuvers. ACEP News May 2008. [http://www.acep.org/Clinical---Practice-Management/To-Handle-Breech-Births,-Know-Two-Maneuvers/ ACEP News] Accessed 08/03/15.</ref> | |||
==Disposition== | ==Disposition== | ||
*Admit to L&D. | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:OB/GYN]] | |||
[[Category:EMS]] | |||
Revision as of 08:06, 3 August 2015
Background
- 3-4% of term deliveries.[1] (Most common fetal malpresentation[2])
- In normal delivery, head dilates cervix and allows body to pass relatively easily.
- In breech delivery, body first does not first maximally dilate cervix → higher risk of head entrapment, cord prolapse, and death.
Clinical Features
Three Types of Breech Delivery[1]
- Frank - Buttocks deliver first, hips flexed, knees extended (most common type)
- Complete - Buttocks deliver first, hips and knees flexed
- Incomplete - (aka "footling") One or both feet deliver first
Differential Diagnosis
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
Diagnosis
- In ED precipitous delivery, this is a clinical diagnosis.
- If time allows, ultrasound can reveal position of fetus, but often not possible in ED deliveries.
Management
- Immediate OB/Gyn consult
- If OB/Gyn immediately available and delivery has not progressed, Zavanelli maneuver has been described for breech births and may be considered.
- Zavanelli maneuver - pushing presenting fetal part back into vagina until C-Section can be performed[3]
- If OB/Gyn immediately available and delivery has not progressed, Zavanelli maneuver has been described for breech births and may be considered.
Disposition
- Admit to L&D.
See Also
External Links
References
- ↑ 1.0 1.1 Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.
- ↑ Mercado J. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.
- ↑ Timothy F Kirn. To Handle Breech Births, Know Two Maneuvers. ACEP News May 2008. ACEP News Accessed 08/03/15.