COMPLETE OR FRANK BREECH
DELIVERY OF THE
BUTTOCKS AND LEGS
Once the buttocks have
entered the vagina and the cervix is fully dilated, tell the woman she
can bear down with the contractions.
perineum is very tight, perform an episiotomy.
Let the buttocks deliver
until the lower back and then the shoulder blades are seen.
Gently hold the buttocks
in one hand, but do not pull.
If the legs do not
deliver spontaneously, deliver one leg at a time:
- Push behind the knee to bend the leg;
- Grasp the ankle and deliver the foot and leg;
- Repeat for the other leg.
not pull the baby while the legs are being delivered.
Hold the baby at the hips, but do not pull
DELIVERY OF THE ARMS
ARMS ARE FELT ON CHEST
ARE STRETCHED ABOVE THE HEAD OR FOLDED AROUND THE NECK
Allow the arms to disengage spontaneously one by one. Only assist if
delivery of the first arm, lift the buttocks towards the mother’s
abdomen to enable the second arm to deliver spontaneously.
arm does not spontaneously deliver, place one or two fingers in
the elbow and bend the arm, bringing the hand down over the baby’s
Use the Lovset’s manoeuvre
Hold the baby by the
hips and turn half a circle, keeping the back uppermost and applying
downward traction at the same time, so that the arm that was posterior
becomes anterior and can be delivered under the pubic arch.
Assist delivery of the
arm by placing one or two fingers on the upper part of the arm. Draw the
arm down over the chest as the elbow is flexed, with the hand sweeping
over the face.
To deliver the second
arm, turn the baby back half a circle, keeping the back uppermost and
applying downward traction, and deliver the second arm in the same way
under the pubic arch.
BABY’S BODY CANNOT BE TURNED
If the baby’s body cannot be turned to deliver the arm that is
anterior first, deliver the shoulder that is posterior (Fig
Hold and lift the
baby up by the ankles.
Move the baby’s chest
towards the woman’s inner leg. The shoulder that is posterior should
Deliver the arm and
Lay the baby back down
by the ankles. The shoulder that is anterior should now deliver.
Deliver the arm and
Delivery of the shoulder that is posterior
DELIVERY OF THE HEAD
Deliver the head by the Mauriceau Smellie Veit manoeuvre (Fig P-17) as
Lay the baby face down
with the length of its body over your hand and arm.
Place the first and
third fingers of this hand on the baby’s cheekbones and place the
second finger in the baby’s mouth to pull the jaw down and flex the
Use the other hand to
grasp the baby’s shoulders.
With two fingers of this
hand, gently flex the baby’s head towards the chest, while applying
downward pressure on the jaw to bring the baby’s head down until the
hairline is visible.
Pull gently to deliver
Note: Ask an assistant to
push above the mother’s pubic bone as the head delivers. This helps to
keep the baby’s head flexed.
The Mauriceau Smellie Veit manoeuvre
ENTRAPPED (STUCK) HEAD
Catheterize the bladder.
Have an assistant
available to hold the baby while applying Piper or long forceps.
Be sure the cervix is
Wrap the baby’s body
in a cloth or towel and hold the baby up.
Place the left blade of
Place the right blade
and lock handles.
Use the forceps to flex
the baby’s head and deliver the head.
If unable to use
forceps, apply firm pressure above the mother’s pubic bone to flex the
baby’s head and push it through the pelvis.
A footling breech baby (Fig P-18) should usually be delivered by caesarean section.
Single footling breech presentation, with one leg extended at hip and knee
- advanced labour with fully dilated cervix;
- preterm baby that is not likely to survive after delivery;
- delivery of additional baby(s).
- Grasp the baby’s ankles
with one hand;
only one foot presents, insert a hand (wearing high-level disinfected gloves) into the vagina and gently pull the other foot down;
- Gently pull the baby downwards by the ankles;
- Deliver the baby until the buttocks are seen;
Proceed with delivery of the arms.
- ampicillin 2 g IV PLUS metronidazole 500 mg IV;
- OR cefazolin 1 g IV PLUS metronidazole 500 mg IV.
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