A birth breech occurs when the baby is born below first than the first head. About 3-5% of pregnant women at term (37-40 weeks pregnant) will have a breech baby.
Most babies in the buttocks are born by caesarean section because it is considered safer than being born normally.
Because most breech babies are born by Caesarean section in developed countries, doctors and midwives may lose the skills needed to help women safely deliver breech babies. Delivering all breech babies through caesarean section in a developing country may be very difficult to implement or even impossible because there is not always available resources to provide this service.
Video Breech birth
Cause
With regard to fetal presentation during human pregnancy, three periods have been distinguished.
During the first period, which lasts until the 24th week of pregnancy, the incidence of longitudinal lies increases, with the same proportion of breech presentation or cephalic of this lie. This period is characterized by frequent presentation changes. The fetus in the breech presentation during this period has the same probability for breech presentation and cephalic during delivery.
During the second period, which lasted from week 25 to week 35, the incidence of cephalic presentation increased, with a proportional decrease in breech presentation. The second period is characterized by a higher probability than random that the presentation of the fetus during this period will also be present at the time of delivery. This increased likelihood is gradual and identical for breech and cephalic presentations during this period.
In the third period, from the 36th week of pregnancy onwards, the incidence of cephalic and buttock presentation remained stable, ie the butt presentation was about 3-4% and the cephalic presentation was 95%. In the general population, the incidence of rump presentation in preterm is associated with the incidence of breech presentation when birth occurs.
Breech presentation during delivery occurs when the fetus does not switch to a cephalic presentation. Failure to change the presentation can result from endogenous and exogenous factors. Endogenous factors involve the inability of the fetus to move adequately, whereas exogenous factors refer to inadequate intrauterine space available for fetal movement.
The incidence of breech presentations between disease and medical conditions with the occurrence of breech presentation is higher than that in the general population, suggesting that the probability of breech presentation is between 4% and 50%. These data are related to: 1. a single series of medical entities; 2. series collection for certain medical entities; 3. data obtained from repeated observations under the same conditions; 4. a series of two concurrent medical conditions.
Rates in various medical conditions
Fetal Entities: First twin 17-30%; Second twin 28-39%; Stillborn 26%; Prader-Willi syndrome 50%, Werdnig-Hoffman syndrome 10%; Smith-Lemli-Opitz syndrome 40%; Fetal alcohol syndrome 40%; Potter anomaly 36%; Zellweger's syndrome 27%; Myotonic dystrophy 21%, trisomy syndrome 13 12%; 18 trisomy syndrome 43%; 21 trisomy syndrome 5%; de Lange syndrome 10%; Anencephalus 6-18%, Spina bifida 20-30%; Congenital Hydrocephalus 24-37%; Osteogenesis imperfecta 33,3%; Amyoplasia 33.3%; Achondrogenesis 33.3%; Amelia 50%; 8% craniosinostosis; Sacred agenesis 30.4%; Arthrogriposis multiplex congenita 33,3; Congenital hip dislocation 33.3%; Hereditary sensory neuropathy of type III 25%; Myoptati Centronuclear 16,7%; Some 50% pituitary hormone deficiency; Isolated 20% pituitary hormone deficiency; Ectopic posterior pituitary gland 33.3%; Congenital bilateral pericilvian syndrome 33,3; 40% symmetrical fetal growth barrier; Asymmetric fetal growth restriction 40%; Nonimmun hydrops fetalis 15%; Atresio ani 18.2%; Microcephalus 15.4%; Omphalocele 12.5%; Prematurity 40%
Placental and amniotic fluid entities: an amorphous membrane perpendicular to the placenta 50%; Implantation of cornual-fundus from placenta 30%; Placenta previa 12.5%; Oligohydramnios 17%; Polihidramnion 15.8%
Maternal entity: Uterus arcuatus 22,6%; Uterus unicornus 33,3%; Uterus bicornus 34.8%; Uterus didelphys 30-41%; Uterus septus 45,8%; Leimyoma uteri 9-20%; Spinal cord injury 10%; Carrier Duchenne muscle dystrophy 17%
The combination of two medical entities: The first twin in the uterus with two bodies 14.29%; The second twin in the uterus with two bodies 18.52%.
Also, women with prior caesarean delivery had a risk of breech presentation on double terms from women with previous vaginal delivery.
The highest breech presentation probability of 50% indicates that breech presentation is a consequence of intrauterine space random filling, with the same probability of breech presentation and cephalic in the longitudinal longitudinal uterus.
Maps Breech birth
Type
The breech types depend on how the baby's feet lie.
- A bright breech (otherwise known as a long breech) is where the baby's feet are next to his stomach, with his knees straight and legs beside his ears. This is the most common breech breed.
- A full breech (flex) breech is when the baby looks as if sitting cross-legged with the legs bent at the hip and knee.
- The breech is when one or both legs of the baby are born earlier than the pelvis. This is more common in babies born prematurely or before the due date.
In addition to the above, a breech birth where the sacrum is a fetal denominator can be classified according to the position of the fetus. Thus the sacro-anterior, sacro-transverse and sacro-posterior positions are all present, but leaving sacro-anterior is the most common presentation. Sacro-anterior indicates easier delivery than any other form.
Risk
Cord prolapse may occur, especially in complete breech, footing, or kneeling. This is due to the bottom of the baby not fully filling the widened cervical space. When water breaks down the amniotic sac, the cord may fall down and become compressed. This complication greatly reduces the flow of oxygen to the baby and the baby should be sent immediately (usually by cesarean section) so that he can breathe. If there is a delay in delivery, the brain can be damaged. Among the lower-head babies, cord prolapse is fairly rare, occurring at 0.4 percent. Among the frank breech babies, the incidence is 0.5 percent, between the complete curves of 5 percent, and between the legs of 15 percent.
The trap head is caused by a fetal head failure to negotiate the mother's midpelvis. In the full run, the fetal bitrochanteric diameter (distance between the outside of the hip) is almost the same as the biparietal diameter (transverse diameter of the skull) - just put the hip size equal to the size of the head. The relatively bigger ass enlarges the cervix as effectively as the head in a typical head-down presentation. Conversely, the relative head size of a premature baby is greater than that of the fetus's bottom. If the baby is premature, the baby's body may appear when the cervix is ​​not widening enough so that the head appears.
Because the umbilical cord - the supply of baby oxygen - is compressed significantly when the head is in the pelvis during the breech birth, it is important that the fetal delivery of the fetus to come will not be delayed. If the arm is extended beside the head, no delivery will occur. If this happens, LÃÆ'¸vset maneuver can be used, or the arm can be manually brought to the position in front of the chest. The LÃÆ'¸vset maneuver involves twisting the fetal body by holding the fetal pelvis. Twisting the body in such a way that an arm passes behind the shoulder, it tends to cross the face to a position where it can be reached by the obstetrician's finger, and taken to the position under the head. The same rotation in the opposite direction is made to give the other arm. To present the smallest diameter (9.5 cm) to the pelvis, the baby's head should be bent (chin to chest). If the head is in an unclear position, the risk of traps will increase. The contractions of the uterus and the muscle tone of the mother push the head to flex.
Oxygen deprivation can occur either from cord prolapse or prolonged compression of the umbilical cord during birth, as in the head trap. If prolonged lack of oxygen, may cause permanent neurological damage (eg, cerebral palsy) or death. It has been suggested that rapid vaginal delivery means the risk of stopping the baby's oxygen supply is reduced. However, there is not enough research to show this and fast delivery can cause more damage to the baby than the conservative approach to birth.
Injuries to the brain and skull can occur due to the rapid travel of the baby's head through the mother's pelvis. This causes rapid decompression of the baby's head. In contrast, babies who experience labor in a downward-head position usually undergo gradual molding (temporary skull reshaping) for several hours. This sudden compression and decompression in a breech birth does not cause any problems at all, but it can hurt the brain. This injury is more likely to occur in premature infants. The fetal head can be controlled by a special two-handed grip called the Mariceau-Smellie-Veit maneuver or the elective forceps application. This will be a value in controlling the sending rate of the head and reducing decompression. Associated with potential head trauma, researchers have identified a link between breech birth and autism.
Squeezing baby's stomach can damage internal organs. Positioning infants incorrectly when using forceps to release an incoming head can damage the spinal cord or spinal cord. It is important for birth attendants to be knowledgeable, skilled, and experienced with all variations of breech births.
Factors affecting security
- Skilled birth attendant (and experience with breech birth) - The skill of the doctor or midwife and the number of breech births previously assisted is very important. Many of the dangers in vaginal delivery for breech babies come from mistakes made by birth attendants. With the majority of breech babies born by caesarean section there is a greater risk that birth attendants will lose their skills in giving birth to breech babies and therefore increase the risk of harm to the baby during vaginal delivery.
- The breech presentation type - the bright breech has the most favorable outcome in vaginal delivery, with many studies showing no difference in outcomes compared with bowed babies. (Some studies, however, have found that a caesarean section planned for all breech babies improves outcomes.The difference may partly depend on the skill of the physician who gave birth to a baby in a different study.) A full breech presentation is the next most profitable position, sometimes shifts and becomes a breech during childbirth. Footwear and kneeling breech have a higher risk of cord prolapse and head traps.
- Parity - Parity refers to the number of times a woman gave birth earlier. If a woman gives birth normally, her pelvis has been "proven" large enough to allow a baby with the size of the baby to pass through. However, too frequent head heads often form (shifting the shape to fit the mother's pelvis) and thus can show a diameter smaller than the size of the baby being born. Research on this issue has been contradicted to the extent that vaginal breech birth is safer when the mother has given birth before, or not.
- The size of the fetus in relation to the size of the mother's pelvis - If the mother's pelvis is large and the baby is not large, it is advantageous for vaginal breech delivery. However, a prenatal estimate of infant size and pelvic size is unreliable.
- Hyperextension in the fetal head - this can be evaluated with ultrasound. Less than 5% of breech babies have their heads in a "staring" position, face is straight up and the back of the head rests against the back of the neck. Cesarean delivery is absolutely necessary, since normal birth with infant head in this position confers high risk of spinal cord trauma and death.
- Maturity of infants - Premature infants appear to be at higher risk of complications if born through the vagina than if delivered by caesarean section.
- Labor Progress - A spontaneous, normal, and straightforward childing that does not require intervention is a good sign.
- The second twin - If the first twin is born head down and the second twin is a breech, chances are the second twin can have a safe breech birth.
Management
As in labor with infants in a normal head-down position, uterine contractions usually occur at regular intervals and gradually begin to thin and open the cervix. In a more common breech presentation, the baby's bottom (not the leg or knee) is the first to go down through the mother's pelvis and out of the vagina.
At the beginning of labor, the baby is generally in a tilted position, facing the right or left side of the mother's back. The baby's bottom is the same size in baby terms as the baby's head. Such descent is for the present fetal head and delay in the offspring is a possible cardinal mark of the problem with head delivery.
To begin birth, the offspring of the podalic rod along with compaction and internal rotation need to occur. This occurs when the mother's pelvic floor muscle causes the baby to reverse so that it can be born with one hip right in front of the other. At this point the baby is facing one of the inner thighs of the mother. Then, shoulders follow the same path as the hips. At this time the baby usually turns to face the mother's back. Next comes an external rotation, that is, when the shoulder appears when the baby's head enters the mother's pelvis. The combination of maternal muscle tone and uterine contractions causes the baby's head to bend, the chin to the chest. Then the back of the baby's head appears and finally the face.
Due to increased pressure during labor and delivery, it is normal for the bruise's main hip and genitalia to become swollen. Babies who assumed a frankly breech position in the womb may continue to hold their feet in this position for several days after birth.
Cesarean or vaginal surgery
When the baby is born below first, there is more risk that birth will not be straight forward and the baby may be harmed. For example, when the baby's head passes through the mother's pelvis, the umbilical cord can be compressed which prevents oxygenated blood delivery to the baby. Because of this and other risks, babies in breech position are usually born with a caesarean section planned in a developed country.
Caesarean section reduces the risk of danger or death for the baby but increases the risk of harm to the mother compared with vaginal delivery. It is best if the baby's head position goes down so that they can be born normally with less risk to mother and baby hazards. The next section is to look at an external version of cephalic or ECV which is a method that can help the baby turn from a breech position to a downward head position.
Breast birth of a breech baby is at risk but caesarean section is not always available or possible, a mother may arrive at the hospital in the later stages of her labor or may choose not to undergo a cesarean section. In this case, it is important that the clinical skills necessary to deliver breech babies are not lost so that the mother and baby are as safe as possible. Compared with developed countries, planned caesarean sections have not produced good results in developing countries - it is suggested that this is due to more vaginal breech births performed by experienced and skilled practitioners in these settings.
Breech twins
In twin pregnancies, it is very common for one or both babies to be in a breech position. Most often twins do not have a chance to turn around because they are born prematurely. If both babies are in breech position and the mother has given birth early, caesarean section may be the best choice. About 30-40% of twin pregnancies produce only one baby in a breech position. If this is the case, the baby can be born normally. After the first baby who is not in the breech position is delivered, the infant served in the breech position can be turned on its own, if this does not happen another procedure can be done called a breech extraction. Breech extraction is a procedure involving an obstetrician who holds the twin legs and pulls them into the birth canal. This will help give birth to the second twin normally. However, if the second twin is larger than the first, a complication by giving birth to a normal second twin may arise and a cesarean section should be performed. Sometimes, the first twin (the twin closest to the birth canal) can be in a breech position with the second twin in the cephalic (vertical) position. When this happens, the risk of complications is higher than usual. In particular, serious complications known as Locked twins. This is when both babies lock their chin during labor. When this happens a cesarean section should be done immediately.
Playing baby
Changing the baby, technically known as an external cephalic version (ECV), is when the baby is rotated gently pressing the mother's abdomen to push the baby from the first position down, to the first head position. ECV does not always work, but it increases the chances of the mother to deliver the baby through the vagina and avoid cesarean section. The World Health Organization recommends that women should undergo a planned caesarean section only if the ECV has been tried and unsuccessful.
Women who have ECV when they are 36 to 40 weeks pregnant are more likely to deliver vaginally and are less likely to have a caesarean section than those who do not have ECV. Changing the baby before this time makes the first birth more likely but ECV before the due date can increase the risk of premature or premature birth that can cause problems in the baby.
There are usable treatments that may affect ECV success. The drug called beta-stimulant tocolytics helps the female muscles to relax so that pressure during ECV does not have to be so great. Giving the woman these drugs before the ECV increases her chances of giving birth normally because her baby is more likely to turn around and keep her head down. Other treatments such as voice use, painkillers such as epidurals, increase fluid around the baby and increase the amount of fluid for women before the ECV can affect all of its success but there is not enough research to make this clear.
The technique of turning the mother home at home is referred to Spontaneous Cephalic Version (SCV), this is when the baby can change without medical help. Some of these techniques include; knee to the chest, breech and moxibustion breasts, this can be done after 34 weeks pregnant women. Although there is not much evidence to support how well these techniques work, it has worked for some mothers.
People born breech
See also
- Asynclitic birth, another abnormal birth position
References
External links
- Breast birth controversy in Great Britain
- The GLOWM video demonstrates the delivery technique of the vaginal butt
Source of the article : Wikipedia
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