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    Breech Presentation Final

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    Harikrishna Elangovan
    This document presents a case of a 25-year-old woman, Mrs. Lakshmi, at 37 weeks of gestation who has presented for safe delivery of her pregnancy. On examination, she was found to have a single live fetus in breech presentation. Tests including ultrasound and fetal monitoring were done, confirming breech presentation. The patient will be managed through either external cephalic version or a planned vaginal breech delivery depending on the progression of labor and fetal position.

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    Breech Presentation Final

    Uploaded by

    Harikrishna Elangovan
    15 views22 pages
    This document presents a case of a 25-year-old woman, Mrs. Lakshmi, at 37 weeks of gestation who has presented for safe delivery of her pregnancy. On examination, she was found to have a single live fetus in breech presentation. Tests including ultrasound and fetal monitoring were done, confirming breech presentation. The patient will be managed through either external cephalic version or a planned vaginal breech delivery depending on the progression of labor and fetal position.

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    Breech presentation final

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    This document presents a case of a 25-year-old woman, Mrs. Lakshmi, at 37 weeks of gestation who has presented for safe delivery of her pregnancy. On examination, she was found to have a single live fetus in breech presentation. Tests including ultrasound and fetal monitoring were done, confirming breech presentation. The patient will be managed through either external cephalic version or a planned vaginal breech delivery depending on the progression of labor and fetal position.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    15 views22 pages

    Breech Presentation Final

    Uploaded by

    Harikrishna Elangovan
    This document presents a case of a 25-year-old woman, Mrs. Lakshmi, at 37 weeks of gestation who has presented for safe delivery of her pregnancy. On examination, she was found to have a single live fetus in breech presentation. Tests including ultrasound and fetal monitoring were done, confirming breech presentation. The patient will be managed through either external cephalic version or a planned vaginal breech delivery depending on the progression of labor and fetal position.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    A Case of Breech

    Presentation
    PATIENT DETAILS
    • Name : Mrs. Lakshmi

    • Age :25 years

    • Address :Triplicane

    • Occupation :Homemaker

    • Socioeconomic class : lower middle class

    • Obstetric code :G2P1L1

    • LMP :Feb 21, 2022

    • EDD : Nov 28, 2022

    BOOKED and IMMUNISED at Triplicane PHC


    Chief complaints

    • H/o 9 months of amenorrhea came for safe confinement of


    Pregnancy

    History of presenting Complaints

    • No H/o lower abdominal pain

    • No H/o bleeding or draining PV


    MENSTRUAL HISTORY
    • Attained menarche at 15 yrs of age
    • Regular cycles : 4/28 days – normal flow
    • Not associated with pain or clots

    MARITAL HISTORY
    • Married at 21 yrs of age
    • Non consanguineous marriage
    • No contraception used
    PAST OBSTETRIC HISTORY
    • Conceived spontaneously at 22 years of age
    • I,II,III Trimesters were uneventful
    • Gave birth to a term male baby weighing 3 kg via normal vaginal delivery in IOG egmore
    • Baby cried immediately after birth
    • Breastfed within one hour of delivery
    • Urine and meconium passed within 24 hrs of delivery
    • No postpartum complications
    • No NICU admission
    • Exclusively Breastfed for 6 months and continued till one year of age
    PRESENT OBSTETRIC HISTORY
    • Spontaneous conception
    • Last child birth: 3 yrs
    • Booked and immunized at Triplicane PHC
    • 2 doses of Td given at 3rd and 5th month

    1st TRIMESTER
    • Pregnancy was confirmed by urine pregnancy test after 2 weeks of missed period at Triplicane PHC
    • No H/O of nausea and vomiting
    • No H/O of fever with rashes
    • No H/O of radiation exposure
    • No H/O of burning micturition
    • No H/O Drug intake
    • Folic acid tablets taken
    • Dating scan and NT Scan were done
    • OGCT - normal and other blood investigations were done
    2ND TRIMESTER
    • Quickening felt at 5th month
    • No H/o of bleeding PV
    • No H/O of headache, blurring of vision ,pedal edema
    • No H/O of burning micturition
    • OGCT - normal
    • IFA tablets taken
    • Anomaly scan – normal
    3RD TRIMESTER
    • Able to perceive fetal movements well
    • No H/O fever
    • No H/o of bleeding PV
    • No H/O of headache, blurring of vision ,pedal edema
    • No H/O of burning micturition
    • Iron Folic acid tablets taken
    • Growth scans– normal
    PAST HISTORY
    • No history of DM,HT,TB,ASTHMA,EPILEPSY,THYROID DISEASE
    • No H/O of previous surgeries
    • No H/O of blood transfusion

    FAMILY HISTORY
    • No significant family history

    PERSONAL HISTORY
    • mixed diet
    • Normal sleep pattern
    • Bowel and bladder habits are normal
    GENERAL EXAMINATION
    • Moderately built and nourished , comfortable at rest
    • No pallor
    • No icterus
    • No cyanosis
    • No clubbing
    • No pedal edema
    • No generalised lymphadenopathy
    • Breast , Thyroid , Spine & Gait – Normal

    • Anthropometry:
    • Height – 160 cm
    • Pre pregnancy weight – 52 kg
    • BMI – 20.3 kg/m2
    • Current weight – 62 kg
    • Weight gain during pregnancy = 10 kg
    Vitals :
    Pulse – 85 /min
    BP – 110 / 80 mm Hg measured in right upper arm in sitting position
    Respiratory rate – 14 / min
    Afebrile

    SYSTEMIC EXAMINATION
    CVS S1 S2 heard, no murmurs
    RS normal vesicular breath sounds heard
    CNS no focal neurological deficit
    Obstetric examination

    • The patient was asked to empty her bladder.


    • Consent was obtained and examined in supine position exposing from
    xiphisternum to pubic symphysis with thighs and legs semiflexed
    • The entire procedure was performed in the presence of a female attender.
    INSPECTION
    • The abdomen is longitudinally distended, Flanks are full.
    • Stria gravidarum and Linea nigra are seen
    • Umbilicus flushed to the surface
    • Hernial orifices free
    • No scars/ sinuses / dilated veins
    PALPATION
    After correcting dextrorotation
    • Fundal height corresponds to 32 weeks of gestation, flanks full
    • Symphysiofundal height : 32 cm
    • Abdominal girth : 108 cm
    Fundal grip:
    • Hard , round independently ballotable mass felt probably FETAL HEAD
    Umblical grip :
    • Right side :multiple small nodules felt- probably limb buds
    • Left side: smooth curve uniform resistance felt-probably spine
    1st Pelvic grip :
    • Broad, soft not independently ballotable mass felt probably BREECH
    2nd Pelvic grip :
    fingers are converging
    AUSCULTATION
    • FETAL HEART SOUND heard above umbilicus on left side
    • RATE: 130 beats/ min
    • Normal rhythm

    PER VAGINAL EXAMINATION not done


    SUMMARY
    A 24 year old Mrs.Lakshmi,G2P1L1 with 37 weeks of gestation, booked
    and immunised, with EDD on 21 November ,2022 has come to IOG for
    safe confinement of pregnancy .On examination , she has a single live
    fetus in breech presentation with good fetal heart sounds.
    Provisional diagnosis
    A case of Breech presentation at term admitted for safe confinement of
    pregnancy
    Investigations
    Complete blood count
    Peripheral smear
    Blood sugar, urea
    Blood grouping, Rh typing
    Urine sugar, albumin
    RFT
    TSH
    VDRL, HIV, HbsAg
    USG Abdomen
    Antepartum fetal surveillance – modified BPP (NST+AFI)
    USG abdomen
    i. confirms the clinical diagnosis.
    ii. detect fetal congenital abnormality
    iii. congenital anomalies of the uterus.
    iv. Type of breech. (complete or incomplete)
    v. It measures the biparietal diameter, gestational age and estimated weight
    of the fetus (fetal biometry).
    vi. localises the placenta.
    vii. Attitude of the head- flexion or hyperextension.
    viii.Assessment of liquor volume, which is important for external cephalic
    version
    Management
    • External cephalic version ( after 37 weeks till onset of labour)
    • Vaginal breech delivery
    Vaginal breech delivery

    • Spontaneous breech delivery


    • Assisted breech delivery
    • Breech extraction
    Based on Zatuchni Andros Scoring

    Techniques to deliver after coming head


    • Marshall burns technique
    • Mariceau-Smellie-Veit technique
    • Piper’s forceps

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