SPECIAL PREGNANCY CASES The following sections will help you with understanding and coping with special pregnancy cases such as obesity, ectopic pregnancy, malpresentation, multiple gestation, grand multipara and others.

Breech Presentation in Pregnancy

It is a presentation in which the baby presents with any part of the body other than the vertex (head).

The presenting part is the legs which may be -

• Both legs flexed COMPLETE BREECH
• Both legs extended FRANK BREECH
• One leg extended FOOTLING OR INCOMPLETE BREECH

What are the chances of having this?

3-4 in 100 females have this and frank breech is the most common.

Who is more prone to get breech presentation?

• PREMATURITY at 28 weeks, 1 in 4 women can present with breech.
• Multiple pregnancy
• Congenital fetal malformations
• Fetal growth restriction
• Contracted pelvis
• Placental location (ex. Placenta praevia)
• Hydramnios
• Olighydramnios
• Pelvic tumors
• Female sex
• Those of you who are pregnant for the first time
• Congenital uterine malformations

FETAL/NEONATAL RISKS

1. There are more chances of perinatal and neonatal mortality. Prematurity and congenital malformations further contribute to this figure.
2. There is a threefold increase in birth trauma
3. The cesarean section rates and associated post operative problems are also more.
4. There are more chances of minimum brain damage in difficult deliveries in such kids
5. Birth asphyxia
6. Intracranial hemorrhage
7. Prolapse of the cord especially with complete breech presentation
8. Fracture of femur and humerus (hand and legs bones) may occur in the course of delivering legs and hands
9. ERB’S PALSY: it is a nerve palsy due to pull on the arms
10. KLUMPKE’S PALSY: due to extraction efforts to deliver an extended arms.

WHAT ARE THE RISKS THAT I MAY FACE?

1. immediate risk is because of increased operative interference

2. long term maternal morbidity is also increased because of operative interventions.

 
ANTENATAL MANAGEMENT

EXTERNAL CEPHALIC VERSION

It is process whereby the head has to be externally maneuvered to make the baby position cephalic at 36 weeks. There is a 60 % chance of reduction.

Contradiction:

• Vaginal bleeding in the late pregnancy is a contraindication to external cephalic version
• Ruptured membranes
• Oligohydramnios
• Fetal malformations
• Placenta praevia
• Contracted pelvis

Complications of external cephalic version

There are certain complications which may arise because of the external cephalic version

1. vaginal bleeding
2. placental abruption
3. rupture of membranes leading to premature labor

IF I HAVE A BREECH, HOW WILL IT BE MANAGED?

Vaginal delivery in a breech child will be favored only if the baby is a complete breech with a weight less tan 3.5 kg.If you are a first time mother, elderly mother, any medical complications if present can be reason enough for an elective cesarean section.

What if my baby is preterm?

Apart from the complications of a preterm child, additional problems like cord prolapse, intrapartum asphyxia, and entrapment of after coming head may occur. An elective cesarean section is preferable to a trial of normal labor.