Pathophysiology of Breech Presentation in L&D

1. Assess for associated conditions such as placenta previa, hydramnios, fetal anomalies, and multiple gestation, trail labour for 4-6 hrs

2. Evaluation

2.1. Evaluate: pt. pain management, fetal outcomes, maternal outcomes, pt. education

2.2. Evaluate need for RhoGAM, evaluate need for episiotomy, evaluate postpartum trauma and risk for hemorrhage

3. Assessment

3.1. Assess: FHR, presenting part, Pt. V/S, 10 P's (passegeway, passenger, powers, psychological response, position [maternal], philosophy, partners, patience, patient preparation, pain management)

4. Diagnosis

4.1. Medical

4.1.1. U/S, placement of fetal HS, Leopalds maneuvers

4.1.2. Abdomen: inspection, fundal grip, lateral grip, pelvic grip, FHS. Sonography, radiology.

4.2. Nursing

4.2.1. Risk for fetal distress, risk for anxiety in pt. or pt.s family

4.2.2. Risk for alteration in labour progress

5. Planning

5.1. Plan for: NICU to come, C-section, hemorrhage

5.2. Ensure availability of piper focepts, warm sterile water, sterile OR towels, oxytocin 10u in 500 mL mixed labeled and hung with IV line primed, ensure plenty of time for Dr. to arrive

6. Interventions

6.1. Pain management (epidural, nitrous oxide, I.M. or I.V narcotics [watch FHR and pt. V/S with these meds]) pt. re-positioning, support for pt. and family, education

6.2. Vaginal examination, epidural prefered, assisted breech delivery, IV of RL, place pt. in larger delivery suite located closer to OR, obtain order for pelvemitry or U/S, assist with external cephalic version (ecv) possible after 36 weeks and administer tocolytics to assist with ecv

7. Relevant co-morbidities

7.1. Prematurity, multiple pregnancy, polyhydramnios, hydrocephaly, extended legs, preterm labour, uterine abnormalities, placenta praevia, short umbilical cord