Obstetrics

Question	Answer
Advanced maternal age	FETAL: Down's syndrome preterm delivery higher perinatal mortality stillbirth MATERNAL: PET GDM Placenta previa prolong labour
Breech facts	4% most common malpresentation 3 types: frank (70%) footling (20%) complete (10%) decrease with maturity - spontaneous version
Causes of breech	BY CHANCE MOM: uterine abnormality (bicornuate uterus) obstruction at lower pole: fibroid, placental previa FETUS: multiple fetus hydrocephalus preterm polyhydramnios
Breech risks	MOM: PP --> APH prolong labour birth canal injury needs C/S FETUS: fetal anomaly prematurity PROM cord prolapse birth injury - ICH, joint dislocate, long bone #, rupture viscera, nerve injury birth asphyxia
Breech counselling	1. cause of breech 2. risk to mother/ fetus 3. option of Mx - ECV or C/S
External cephalic version indication (ECV)	breech at term unstable lie, done before IOL non-cephalic second twin in 2nd stage of labour
C/I of ECV	MOM: PP/ fibroid/ uterine anomaly PET ROM established labour FETUS: multiple pregnancy poly/oligo-hydramnios cord around neck IUGR abnormal CTG - fetal compromise
MUSTS for ECV	at least 36 weeks no C/I normal fetal morphology RhD-ve moms given anti-D Ig
PROs of ECV	C/S available even failed ECV high success rate low Cx rate
ECV preps	USG: liquor, feral growth, uterus anomalies empty bladder tocolytics disengage breech grasp fetal poles and turn FU on Cx

Resource summary

	Created by wangyinlee almost 10 years ago