Breech delivery - Revision history

Rossdonaldson1 at 20:42, 11 December 2024

2024-12-11T20:42:43Z

← Older revision		Revision as of 20:42, 11 December 2024
Line 1:		Line 1:
	==Background==		==Background==
	[[File:Bumm 352 lg.jpg\|thumb]]		[[File:Bumm 352 lg.jpg\|thumb]]
	[[File:Twin breech.gif\|thumb\|~~Twin~~ breech.]]		[[File:Twin breech.gif\|thumb\|Twins with one in breech position.]]
	*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, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref>)		*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, Brea I, Mendez B, et al. 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 normal delivery, head dilates cervix and allows body to pass relatively easily.

Rossdonaldson1 at 20:42, 11 December 2024

2024-12-11T20:42:04Z

← Older revision		Revision as of 20:42, 11 December 2024
Line 8:		Line 8:

	==Clinical Features==		==Clinical Features==
			[[File:A textbook of obstetrics (1899) (14591559268).jpg\|thumb\|Incomplete ("footling") breech presentation.]]
	*Three Types<ref name="Silver" />		*Three Types<ref name="Silver" />
	**'''Frank''' - Buttocks deliver first, hips flexed, knees extended (most common type)		**'''Frank''' - Buttocks deliver first, hips flexed, knees extended (most common type)

Rossdonaldson1: /* Background */

2022-01-08T07:10:36Z

Background

← Older revision		Revision as of 07:10, 8 January 2022
Line 1:		Line 1:
	==Background==		==Background==
	[[File:Bumm 352 lg.jpg\|thumb]]		[[File:Bumm 352 lg.jpg\|thumb]]
			[[File:Twin breech.gif\|thumb\|Twin breech.]]
	*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, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref>)		*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, Brea I, Mendez B, et al. 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 normal delivery, head dilates cervix and allows body to pass relatively easily.

Rossdonaldson1: /* Background */

2022-01-08T07:05:26Z

Background

← Older revision		Revision as of 07:05, 8 January 2022
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Bumm 352 lg.jpg\|thumb]]
	*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, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref>)		*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, Brea I, Mendez B, et al. 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 normal delivery, head dilates cervix and allows body to pass relatively easily.

ClaireLewis: /* Management */

2019-05-27T21:15:49Z

Management

← Older revision		Revision as of 21:15, 27 May 2019
Line 21:		Line 21:
	*Immediate OB/Gyn consult		*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.		**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>		***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>, though is associated with increased risk of soft tissue damage and sepsis<ref>Gabbe, Steven G. Obstetrics : normal and problem pregnancies (6th ed.). Philadelphia: Elsevier/Saunders. p. 412</ref>
	*Place patient in lithotomy position		*Place patient in lithotomy position
	*Have assistant maintain fundal pressure throughout delivery		*Have assistant maintain fundal pressure throughout delivery

Anm464: /* Background */

2019-05-08T21:41:19Z

Background

← Older revision		Revision as of 21:41, 8 May 2019
Line 3:		Line 3:
	*In normal delivery, head dilates cervix and allows body to pass relatively easily.		*In normal delivery, head dilates cervix and allows body to pass relatively easily.
	**In breech delivery, body does not first maximally dilate cervix → higher risk of head entrapment, cord prolapse, and death.		**In breech delivery, body does not first maximally dilate cervix → higher risk of head entrapment, cord prolapse, and death.
			*Breech presentations occur most commonly in preterm infants (25-30% of preterm deliveries <28 wks gestation).

	==Clinical Features==		==Clinical Features==

Mholtz at 06:09, 27 December 2016

2016-12-27T06:09:04Z

← Older revision		Revision as of 06:09, 27 December 2016
Line 56:		Line 56:

	[[Category:OBGYN]]		[[Category:OBGYN]]
	~~[[Category:EMS]]~~

Neil.m.young: Text replacement - "==Diagnostic Evaluation==" to "==Evaluation=="

2016-07-28T02:45:25Z

Text replacement - "==Diagnostic Evaluation==" to "==Evaluation=="

← Older revision		Revision as of 02:45, 28 July 2016
Line 13:		Line 13:
	{{Emergency delivery DDX}}		{{Emergency delivery DDX}}

	==~~Diagnostic~~ Evaluation==		==Evaluation==
	*In ED precipitous delivery, this is a clinical 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.		*If time allows, ultrasound can reveal position of fetus, but often not possible in ED deliveries.

Neil.m.young: Text replacement - "5 mg" to "5mg"

2016-07-19T02:16:10Z

Text replacement - "5 mg" to "5mg"

← Older revision		Revision as of 02:16, 19 July 2016
Line 40:		Line 40:
	**If anterior arm and hand do not deliver spontaneously, grasp humerus and sweet downwards over thorax while maintaining downward traction on fetal body.		**If anterior arm and hand do not deliver spontaneously, grasp humerus and sweet downwards over thorax while maintaining downward traction on fetal body.
	*To deliver head, have assistant apply suprapubic pressure and rest fetal body on provider's forearm while reaching into vaginal canal to grasp fetal maxillae in order to flex head. (Mauriceau maneuver) - stabilize with other hand/forearm on fetal back and shoulders - avoid excessive angulation or traction of fetal body.		*To deliver head, have assistant apply suprapubic pressure and rest fetal body on provider's forearm while reaching into vaginal canal to grasp fetal maxillae in order to flex head. (Mauriceau maneuver) - stabilize with other hand/forearm on fetal back and shoulders - avoid excessive angulation or traction of fetal body.
	*If fetal head becomes entrapped, administer [[terbutaline]] (0.~~25 mg~~ SQ '''or''' 2.5-10 μg/min IV) to relax uterus		*If fetal head becomes entrapped, administer [[terbutaline]] (0.25mg SQ '''or''' 2.5-10 μg/min IV) to relax uterus
	**[[Nitroglycerin]] (50 to 200 mcg IV) is an alternative.		**[[Nitroglycerin]] (50 to 200 mcg IV) is an alternative.

Neil.m.young: Text replacement - "don't" to "do not"

2016-07-11T17:07:43Z

Text replacement - "don't" to "do not"

← Older revision		Revision as of 17:07, 11 July 2016
Line 34:		Line 34:
	**If between the legs, this must be reduced around the foot as it will definitely avulse if delivery continues		**If between the legs, this must be reduced around the foot as it will definitely avulse if delivery continues
	*Allow delivery to proceed spontaneously until fetal umbilicus is at perineum		*Allow delivery to proceed spontaneously until fetal umbilicus is at perineum
	*Once torso begins to deliver, hold legs in one hand and hold bony pelvis with other (~~don't~~ rupture spleen)		*Once torso begins to deliver, hold legs in one hand and hold bony pelvis with other (do not rupture spleen)
	*Allow delivery to progress until axilla is visible		*Allow delivery to progress until axilla is visible
	*If shoulders do not deliver spontaneously, apply gentle upward traction on fetal body using other hand to apply leverage and deliver posterior shoulder/arm/hand, then apply downward traction on fetal body to deliver anterior shoulder/arm/hand<ref name="Mercado" />		*If shoulders do not deliver spontaneously, apply gentle upward traction on fetal body using other hand to apply leverage and deliver posterior shoulder/arm/hand, then apply downward traction on fetal body to deliver anterior shoulder/arm/hand<ref name="Mercado" />