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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.
The Reproductive System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The process of giving birth is called parturition. This includes labor, which is divided into four stages, and delivery, the passage of the fetus and placenta from the genital canal into the external world. Terms associated with the birth process refer to presentation of the fetus (breech, vertex, transverse, face, cephalic, depending on which fetal structure faces the cervix) or to procedures involved (episiotomy, hysterotomy, Cesarean section). Immediately after delivery of the fetus, the secundines or "afterbirth," which includes the placenta and attached umbilical cord, are expelled as the final stage of labor. Lochia refers to the discharge of mucus, blood, and tissue debris that continues for a period of time following childbirth.
Obstetric history and examination
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
Presentation can either be cephalic (head down) or breech (bottom/feet down). Using a two-handed approach and watching the woman’s face, gently feel for the presenting part. The head is generally much firmer than the bottom, although even in experienced hands it can sometimes be very difficult to tell. At the same time as feeling for the presenting part, assess whether it is engaged or not. If the whole head is palpable and it is easily movable, the head is likely to be ‘free’. This equates to 5/5th palpable and is recorded as 5/5. As the head descends into the pelvis, less can be felt. When the head is no longer movable, it has ‘engaged’ and only 1/5th or 2/5th will be palpable (Figure 1.5). Do not use a one-handed technique, as this is much more uncomfortable for the woman.
Complex maternal congenital anomalies – a rare presentation and delivery through a supra-umbilical abdominal incision
Published in Journal of Obstetrics and Gynaecology, 2018
Samantha Bonner, Yara Mohammed
She had a spontaneous conception and booked at 9 weeks of gestation under consultant-led care. A scan confirmed the pregnancy was in the right uterus. She had no other significant medical history but did suffer from recurrent urinary tract infections and hence was on low-dose antibiotic prophylaxis. There was no sonographic evidence of hydronephrosis. Her body mass index (BMI) was 18 at the time of booking. Combined screening was low risk and she had a normal 20 week anomaly scan. She had serial growth scans which demonstrated a normal growth trajectory on a customised chart. The baby was consistently a cephalic presentation. She had multidisciplinary antenatal care, including specialist urologists, general surgeons, obstetricians and anaesthetists. An antenatal MRI scan had shown extensive adhesions over the lower segment of the uterus. She was extensively counselled regarding the mode of delivery and this was scheduled at 37 weeks of gestation to avoid the potential of spontaneous labour and an emergency Caesarean section.
Mode of birth in twins: data and reflections
Published in Journal of Obstetrics and Gynaecology, 2018
A. Reitter, B. A. Daviss, M. J. Krimphove, K. C. Johnson, R. Schlößer, F. Louwen, A. Bisits
Neonatal data were presented for all the available neonates (n = 1068). The presentation at birth was classified as (1) both cephalic, (2) first cephalic/second non-cephalic or (3) first non-cephalic and second cephalic or non-cephalic. The neonatal weight at birth was recorded for each twin separately.