TEALE FENNING

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

You are at the antenatal clinic. 29 year old woman in her 3rd pregnancy presents at 39th week gestation. Previous pregnancy-she ahd a normal full term delivery and baby weighed 3750 gm. She wishes to talk to the doctor about her delivery plan and discuss options.

Abik · Posted: Sun May 06, 2007 11:24 am Post subject:

Breech?

History the other pregnancy?
this pregnancy - consultant led? scans? screening? breech by MW or scan?!! Wink

signs of labour
last labour details - SOL? IOL? what gestation? antenatal problems?
PMH - are you seeing your GP regularly for anything? a hospital doctor? any anaesthetics?
DH - ?

Examination - breech? engaged? tender uterus? liquor? presentation frank/footling etc. SFH. FMs FHHR

Investigations - scan if not had - presentation liquor attitude of foetal head? any reason placenta/fibroids?

discussion
options - ECV, 1% risk of foetal distress, 50% success (but probably less at 39 weeks) small risk of reverting to breech, increased risk of CTG problems and instrumentals even f successful.
- LSCS, if ECV fails or not wanted. Why not ECV? recommended since some stupid trial, oops sorry I mean a good RCT. Less risk of mortality and morbidity to baby, higher risk to mum.
- Vaginal breech - good chance of success, risks to baby, controlled and managed in hospital. ensure experienced birth attendents. not recommended (see above!!)

Your choice![/b]

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Abik and others

I have one small query here;
Should we (or shouldn't we!) discuss vaginal breech delivery with this lady?

Abik · Posted: Sun May 06, 2007 1:27 pm Post subject:

yes - it is her choice and she needs to know the evidence. What if she walks in tomorrow fully dilated? Never any need to withold information or lie to patients - be open and honest.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

i agree with abi ,

i always tell them in clinic that vag birth is also a mode of delivery.

i then explain the TBT and give pros n cons of ECV , LSCS. finally i tell them that if one did come in labour with breech on perineum some women do go for vag birth and that this may be an option depending on the clinical condition at the time and expertise available. i then give them pros n cons of vag breech deli.

they usually go for the ECV/LSCS.

we recently had one pt ( abi u may remember her) who wanted vag br deli as her 1st child was a vag breech, i had refered her to the consultant for a 2nd opinion and was booked for planned vag deli.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region