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Orthopaedics and musculoskeletal system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
The aetiology of congenital dislocation of the hip is multifactorial. There are genetic factors and girls are more commonly affected than boys. It may be associated with other abnormalities such as talipes calcaneovalgus and myelomeningocoele. The association with breech birth is related to the position of the fetus in utero. The incidence has been shown to be less common in populations that carry their infants on the back in a sling with hips abducted, but is more common when carrying on a papoose board.
Pre-conceptual and antenatal care
Published in Helen Baston, Midwifery, 2020
As the pregnancy progresses the woman and the midwife may need to change the original plans to accommodate a change in need. The midwife may detect, during an antenatal check-up, that the fetus is no longer presenting head first but is presenting by the breech. The midwife would then need to explain the options available to the woman so that a new plan can be put in place. For example, women who have straightforward pregnancies but a breech presentation should be offered the option of having the baby turned, a procedure known as ‘External Cephalic Version’ (ECV). Performed at the maternity unit by a skilled practitioner, this should only be performed under scan guidance to prevent cord entanglement and to confirm that a cephalic presentation is not inadvertently turned to become a breech. There is also a small chance of bleeding or fetal distress so this should only be performed when the pregnancy is at full term and with the option of having an emergency caesarean section urgently should any complication arise. The woman would also need to know what would happen if ECV was not successful and in what circumstances a vaginal breech birth might be possible. Changes to the plan of care might need to be accommodated such as changing from a home birth to a planned caesarean section if a vaginal breech is contraindicated for some reason.
SBA Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
E Simultaneous easy passage of the fetal thighs and trunk through the pelvisA frank presentation is the best type of breech presentation for a successful vaginal birth followed by a complete breech. A footling or kneeling breech is a contraindication for a vaginal breech birth. If the baby’s trunk and thighs pass easily through the pelvis simultaneously, cephalic pelvic disproportion is unlikely. (Management of Breech Presentation. The Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20b, March 2017)
Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Anna Toijonen, Pia Hinnenberg, Mika Gissler, Seppo Heinonen, Georg Macharey
There were some differences between the two study groups. During the first pregnancy, women with an extremely preterm breech birth had significantly fewer caesarean sections than vaginal births. A possible explanation for this might be that the delivery started in many cases spontaneously and the cervix dilatated unexpectedly fast so that a caesarean section wasn´t an option anymore. Another difference between the two groups was an increased rate of preeclampsia and high blood pressure in the women with a prior preterm caesarean section. Preeclampsia is a condition with an increased risk of recurrence, and it might have been already during the first pregnancy, the reason for the caesarean section (Kim et al. 2010). Also, during the second pregnancy, it increases the risk to have another caesarean section (Kim et al. 2010). Preeclampsia and high blood pressure are also risk factors for foetal growth restriction and adverse neonatal outcome (Van Der Tuuk et al. 2015). Pre-gestational insulin-treated diabetes is also a risk factor for adverse neonatal outcome and is associated with a higher need of an instrumental delivery, like caesarean section (Sibai et al. 2000). For this reason, we adjusted the maternal and neonatal outcomes for preeclampsia, high blood, and pre-gestational insulin-treated diabetes with those variables.
Response to: vaginal birth in breech presentation in morbidly obese woman
Published in Journal of Obstetrics and Gynaecology, 2019
Stefanović et al.’s 2018 report of their common sense, obstetrically-skilled management of a breech birth is helpful. The authors describe the risks associated with a caesarean section in labour for a morbidly obese woman and their team’s decision to encourage the woman to adopt an ‘all fours’ position to assist the birth.
Vaginal birth in breech presentation in morbidly obese woman
Published in Journal of Obstetrics and Gynaecology, 2018
Milan Stefanović, Bojan Lukic, Ranko Kutlešić, Predrag Vukomanović
The breech birth poor outcomes might be the result of existing conditions caused by the breech presentation or various factors associated with the delivery. With the low rate of vaginal breech deliveries in the developed world, experience is being lost (Hannah et al. 2000).