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O&G CasesIntrapartum care — malpresentation and operative birth

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.

resus6 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 27-year-old G2P1 arrives by ambulance in advanced labour at 39+6 weeks having had no third-trimester scan. On arrival she is fully dilated and pushing involuntarily. The midwife calls you: there is a fetal buttock and a single foot visible at the perineum. You are the registrar; the consultant is 20 minutes away and has been phoned. There is no time to move her to theatre before the birth.

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]

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References6ShowHide
  1. [1]Royal College of Obstetricians and Gynaecologists (RCOG) Management of Breech Presentation: Green-top Guideline No. 20b BJOG, 2017.PMID 28299904
  2. [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. [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. [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. [5]Kotaska A, Menticoglou S No. 384-Management of Breech Presentation at Term J Obstet Gynaecol Can, 2019.PMID 31331608
  6. [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
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