Thursday, August 5, 2010

BreecH BaBy!!!!!

Breech Baby-->>

Breech baby are those which enters the birth canal with the buttocks or feet first as opposed to the normal head first. This is known as breech presentation.There are either three or four main categories of breech births, depending upon the source:

§ Frank breech - the baby's bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.
§ Complete breech - the baby's hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.
§ Footling breech - one or both feet come first, with the bottom at a higher position. This is rare at term but relatively common with premature fetuses.
§ Kneeling breech - the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees. This is extremely rare, and is excluded from many classifications

Turning the baby to avoid breech birth

There are many methods which have been attempted with the aim of turning breech babies, with varying degrees of success:
 External cephalic version where a midwife or doctor turns the baby by manipulating the baby through the mother's abdomen. ECV has a success rate between 40 - 70% depending on practitioner.The fetal heart is monitored after the turn attempt, usually in the context of an institutional protocol. Studies show that turning the baby at term (after 36 weeks) is effective in reducing the number of babies born in the breech position. Complications from external cephalic version are rare. Studies have also shown that attempting to turn the baby prior to this point has no impact on the presentation at term.
Using hypothetical scenarios, a small study in the Netherlands found that few obstetric practitioners would attempt ECV in the presence oligohydramnios..A case report of treating oligohydramnios with amnioinfusion, followed by ECV, was successful in turning the fetus.Various manoeuvres are suggested to assist spontaneous version of a breech presenting pregnancy. These include maternal positioning or other exercises. A study has shown that there is insufficient evidence as to the benefit of maternal positioning in reducing the incidence of breech presentation.

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