![]() ![]() With the operator thumb in the infant armpit and middle finger along the arm, bring down the arm (Figure 6.4a). Pull the infant downward: insert one hand along the back to look for the anterior arm.Turn the infant 90° (its back to the right or to the left).Then do a 180° counter-rotation (back to the right or to the left) this engages the posterior arm, which is then delivered.Ħ.3a - Turning the infant to bring down the anterior shoulderĦ.3b - Downward traction and descent of shoulders along the midline (sacral-pubic) axisĦ.3c - Delivering the anterior arm and shoulder.Turn the infant 90° (back to the left or to the right), to bring the anterior shoulder underneath the symphysis and engage the arm.With thumbs on the infant's sacrum, take hold of the hips and pelvis with the other fingers.There are 2 methods for lowering the arms so that the shoulders can descend: 1 - Lovset's manoeuvre This can occur when the arms are raised as the shoulders pass through the mother's pelvis. The shoulders can become stuck and hold back the infant's upper chest and head. If the infant’s back is posterior during expulsion, take hold of the hips and turn into an anterior position (this is a rare occurrence). Monitor the position of the infant's back impede rotation into posterior position.Ħ.1.4 Breech delivery problems Posterior orientation.Once the umbilicus is out, the rest of the delivery must be completed within 3 minutes, otherwise compression of the cord will deprive the infant of oxygen.ĭo not touch the infant until the shoulder blades appear to avoid triggering the respiratory reflex before the head is delivered. The infant delivers unaided, as a result of the mother's pushing, simply supported by the birth attendant who gently holds the infant by the bony parts (hips and sacrum), with no traction.Presence of meconium or meconium-stained amniotic fluid is common during breech delivery and is not necessarily a sign of foetal distress.Episiotomy is performed when the perineum is sufficiently distended by the foetus's buttocks. Insert an IV line before expulsion starts.Note: if the dilation stales, transfer the mother to a CEmONC facility unless already done, to ensure access to surgical facility for potential caesarean section. If the uterine contractions are inadequate, labour can be actively managed with oxytocin.Do not rupture the membranes unless dilation stops. If contractions are of good quality, dilation is progressing, and the foetal heart rate is regular, an expectant approach is best.In this situation, the route of delivery depends on the number of previous births, the state of the membranes and how far advanced the labour is. The footling breech presentation is a very unfavourable position for vaginal delivery (risk of foot or cord prolapse). Normally progressing dilation during labour.A history of vaginal delivery (whatever the presentation).Deliver vaginally, if possible – even if the woman is primiparous.īreech deliveries must be done in a CEmONC facility, especially for primiparous women.įavourable factors for vaginal delivery are: If external version is contra-indicated or unsuccessful, the breech position alone – in the absence of any other anomaly – is not, strictly speaking, a dystocic presentation, and does not automatically require a caesarean section. The clinical diagnosis may be difficult: a hand may be mistaken for a foot, a face for a breech.īefore labour, external version (Chapter 7, Section 7.7) may be attempted to avoid breech delivery.After rupture of the membranes: the anus can be felt in the middle of the cleft a foot may also be felt.During labour, vaginal examination reveals a “soft mass” divided by the cleft between the buttocks, with a hard projection at end of the cleft (the coccyx and sacrum).The inferior pole is voluminous, irregular, less hard, and less mobile than the head.The cephalic pole is palpable in the uterine fundus round, hard, and mobile the indentation of the neck can be felt.In a footling breech presentation (rare), one or both feet present first, with the buttocks higher up and the lower limbs extended or half-bent (Figure 6.1c).In a frank breech presentation, the legs are extended, raised in front of the torso, with the feet near the head (Figure 6.1b).In a complete breech presentation, the legs are tucked, and the foetus is in a crouching position (Figure 6.1a). ![]() Presentation of the feet or buttocks of the foetus. ![]()
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