breech

Case: Breech

Questions

a) Causes and complication of breech

b) Management, mode of delivery and time of delivery for breech.

c) ATT- Type of immune

Breech

It is the most common type of malpresentation. Presentation of the fetal buttocks and feet in labour

Incidence: 26W 40%, 30W 20%, term 3%

Type: Extended, Flexed, Footling

Causes

1) Multiparous woman with lax uterus and abdomen

2) Prematurity

3) Fetal structural anomalies; anencephaly, hydrocephalus

4) Uterine anomalies; uterus bicornu, fibroids

5) Multiple gestation; twins

6) Hydramnios; oligo or poly

7) Placenta previa

8) Contracted maternal pelvis

9) Pelvic tumours

Complication

1) PROM

2) Cord prolapsed [common in footling presentation and lesser in flexed breech presentation]

3) Difficulty in delivering the shoulder

4) Difficulty in delivering the head[ may lead to intracranial bleeding d/t tear of tentorium or delay delivery of head can cause prolonged compression of cord and asphyxia]

5) Birth trauma such as fracture, viscera damage, Erb Duchenne paralysis, dislocation of hip joint.

Mode and timing of delivery

<28>	SVD
28-32 weeks, weight 1.0 - 1.5 kg	LSCS
32-37 weeks Weight 1.5 – 2.5 kg	Depend on case 1) Assisted breech delivery for Extended and flexed 2) LSCS for footling breech
> 37 weeks	Preferably Caesarean section

ATT

Tetanus vaccine is an inactivated toxin (toxoid) made by growing the bacteria in a liquid medium and purifying and inactivating the toxin.

Type II Immune response

It is administer once the quickening felt and can be repeated 2-3 months after first injection in primid women as a booster injection. (Usually 5^th and 7^th months of pregnancy)

Notes: It is different from Anti tetanus human immunoglobulin which are preparation containing IgG immunoglobulin derived from plasma of donors sensitized to tetanus toxoid. it acts by The IgG antibodies acts to neutralize the free circulating exotoxisn of clostridium tetani and prevent its fixation in tissue and its consequences.