O&G Cases · Intrapartum care — malpresentation and operative birth
Undiagnosed breech at full dilatation — emergency management station
Team-based emergency station: an undiagnosed footling breech delivering at full dilatation. Tests rapid recognition, the hands-off principle under pressure, the manoeuvre sequence in order, management of head entrapment with Dührssen incisions, closed-loop team leadership and the post-event conversation. Includes assessor timeline, marking domains and assessor key.
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Study tools
Target exams
Station brief
Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar in a birth suite room. A midwife and a student midwife are with you; the anaesthetist and neonatal team have been called; the consultant is 20 minutes away. The assessor runs the clock and feeds you new findings. [1]
Candidate instruction. Lead the management of an undiagnosed breech birth in progress. Verbalise your actions, your reasoning, your escalation triggers and your communication with the woman and the team. [1][5]
References6ShowHide
- [1]Royal College of Obstetricians and Gynaecologists (RCOG) Management of Breech Presentation: Green-top Guideline No. 20b BJOG, 2017.PMID 28299904
- [2]Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group Lancet, 2000.PMID 11052579
- [3]Berhan Y, Haileamlak A The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies BJOG, 2016.PMID 26234485
- [4]Bin YS, Roberts CL, Ford JB, Nicholl MC Outcomes of breech birth by mode of delivery: a population linkage study Aust N Z J Obstet Gynaecol, 2016.PMID 27339863
- [5]Kotaska A, Menticoglou S No. 384-Management of Breech Presentation at Term J Obstet Gynaecol Can, 2019.PMID 31331608
- [6]Whyte H, Hannah ME, Saigal S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial Am J Obstet Gynecol, 2004.PMID 15467555