Breech delivery

22 May

In the ED, assisted breech delivery methods should be used.

Total breech extraction only used in case of breech second twin delivery. Otherwise, cervix may not tolerate procedure.

Assisted breech delivery:

If available, clearly get anesthesia/pediatrics/OBGYN into ED.

Episiotomy may assist with delivery. (less popular nowadays)

Pinard maneuver:

  • Wait until baby umbilicus at level of perineum.
  • Then place pressure on popliteal area of fetal legs to flex and help clear vagina.
  • Mother exerts pressure while physician applies gentle downward and out pressure to baby until see scapula and axilla.
  • Wrap dry towel around hips, continue traction with assistant applying fundal pressure to keep fetal head flexed.
  • Rotate 90 degrees and apply pressure to inner aspect of arm to sweep out.
  • Then rotate 180 degrees and same to other arm.
  • Then rotate to baby with back anterior.
  • Then keep head flexed with physician applying upward pressure to maxillary processes of baby with assistant applying fundal pressure, and gently deliver head.

 

Submitted by J. Rothstein.

 

References: medscape article; picture

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