86 Obstetrics and Gynecology Board Review •••
❍ Examples of altered intrauterine contour or volume include?
- Uterine abnormalities.
- Fibroids.
Placental abnormalities - Multiparty.
- Abnormal fluid levels, both oligo and polyhydramnios.
❍ Factors associated with altered fetal mobility include?
Multiple gestation, neurologic impairment, short umbilical cord, and fetal asphyxia.
❍ Uterine/fetal abnormalities are associated with what % of breech presentations?
<15%.
❍ What percentage of infants with breech presentation will have congenital anomalies?
6% to 18% (whereas vertex presentation is 2–3%).
❍ If a patient’s first pregnancy was a term breech, is there an increased risk in future pregnancies?
Yes. 9% in next pregnancy, >20% if two breech presentations, >30% if three consecutive breech presentations.
❍ True or False: Perinatal mortality and morbidity is higher in breech presentation compared to cephalic
presentation.
True.
❍ Optimal conditions for a planned vaginal breech delivery include?
- No prior C/S.
- No contraindications to vaginal delivery, i.e., placenta previa.
- Estimated fetal weight >2000 to 2500 g, but < 4000 g.
- Gestational age >36 weeks.
- Fetal head is not hyperextend.
- Frank or complete breech.
- Spontaneous labor.
❍ True or False: Incomplete breech presentation is not a contraindication to attempt vaginal delivery.
False.
❍ Describe the three ways to deliver a breech vaginally.
Spontaneous—infant is delivered without traction or manipulation.
Assisted breech extraction—infant is delivered spontaneously to the umbilicus with the rest of the body
being extracted.
Total breech extraction—entire body of the infant is extracted.
❍ What is the best indicator of pelvic adequacy for a breech delivery?
Satisfactory progression of labor.