••• Chapter 8^ Breech^87
❍ What is the only indication of total breech extraction?
Total breech extraction should be used only for a noncephalic second twin.
❍ Total breech extraction is associated with an injury rate in what percent for a singleton breech?
The injury rate is 25%.
❍ What is the mortality rate associated with total breech extraction of a singleton breech?
The mortality rate is approximately 10%.
❍ Describe the steps for a frank breech delivery.
- Episiotomy is generally performed.
- Spontaneous delivery of posterior hip, delivery of anterior hip, and delivery of legs.
- Fetal bony pelvis is grasped with both hands using a towel (with fingers resting on superior iliac crest and
thumbs on the sacrum). - Apply gentle downward traction until scapulas are visible.
- Once one axilla is visible, the anterior shoulder and arm should be delivered.
- Rotate trunk to deliver other shoulder and arm.
- The fetal head is then delivered by maintaining flexion with suprapubic pressure provided by an assistant
with simultaneous pressure on the maxilla by the operator.
❍ Staffing for an assisted vaginal breech delivery should include?
An obstetrician with an assistant, an anesthesiologist, and a pediatrician.
❍ The maneuver where the index and middle finder are placed over the maxilla to flex the head is termed?
Mauriceau-Smellie-Veit maneuver.
❍ If the Mauriceau maneuver cannot be easily accomplished, what type of forceps can be applied?
Piper forceps.
❍ This complication of the fetal head can occur during a vaginal breech delivery?
Head entrapment (88/1000), head circumference is greater than abdominal or thoracic circumference at about
36 weeks.
❍ If head entrapment is encountered, these two maneuvers can be performed to facilitate delivery?
(1) Duhrssen incisions.
(2) Abdominal rescue.
❍ Describe why and how to perform Duhrssen incisions.
If attempts to slip the cervix over the entrapped head are unsuccessful, cervical incisions are made at 2, 6,
and 10 o’clock.
❍ What are the two most common complications of Duhrssen incisions?
Maternal hemorrhage and extension into the lower uterine segment.