Breech Birth

Chapter 199 Breech Birth



INTRODUCTION



Description: Breech birth is presentation of the fetal buttocks, one foot, or both feet at the cervix at the time of labor.

Prevalence: Three percent of term pregnancies, 13% of pregnancies at 30 weeks of gestation.

Predominant Age: Reproductive (maternal).

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Prematurity, fetal or maternal anomalies (e.g., fetal hydrocephalus, maternal uterine anomalies), multiple gestation.

Risk Factors: Prematurity, fetal or uterine anomalies, multiple pregnancies.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Fetal head located outside the pelvis on abdominal palpation (Leopold’s maneuvers)

• Fetal heart heard high in the uterus

• Buttock, one foot, or both feet palpable on cervical examination


DIAGNOSTIC APPROACH



Differential Diagnosis



• Fetal anomaly (hydrocephalus, anencephaly)

• Uterine anomaly (septum, duplication, leiomyomata)

• Multiple gestation

• Fetal macrosomia


Associated Conditions: Prematurity, placenta previa, placental abruption, premature rupture of the membranes, congenital anomalies (6% versus 2.5% in total population), intracranial hemorrhage, growth restriction, neurologic disorders and mortality, multiple pregnancy, and polyhydramnios.


Workup and Evaluation



Laboratory: No evaluation indicated beyond that usually considered for patients in labor.

Imaging: Ultrasonography may be used to confirm presentation.

Special Tests: Fetal heart rate and uterine activity monitoring.

Diagnostic Procedures: Physical examination (Leopold’s maneuvers), ultrasonography.


Pathologic Findings


None.



MANAGEMENT AND THERAPY



Nonpharmacologic


Related posts:

  1. Anemia
  2. Toxic Shock Syndrome
  3. Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus
  4. Cervical Cancer

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Breech Birth

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