Seminar №5. Breech presentation. Biomechanism childbirth. Admission Lovset and Maurice Smellie-Veit

 Gluteal (flexion) previa  Purely gluteal (incomplete) previa  Mixed (full) previa  Foot (extensor) previa  complete previa  incomplete previa  knee previa

 Maternal factors  Fetal factors  Placental factors

 Outside obstetric examination (method Leopold-Levitsky)  Listening the fetal heartbeat  Vaginal examination  Ultrasound Examination  ECG

 The first point - the internal rotation of the buttocks  The second point - lateral flexion lumbar spine fetus  The third point - internal and external rotation of the hanger torso rotation  The fourth point - lateral flexion cervical-thoracic spine  The fifth point - the internal rotation of the head  The sixth point - bending head

 In the first half of pregnancy:  Threat of termination (45%)  Vomiting of pregnancy (27.5%), and others.  In the second half of pregnancy:  Hypertensive state (35.6%)  The threat of termination of pregnancy (39.3%)  Fetal malnutrition (4.9%)  Cord entanglement (40.8%)  Oligohydramnios (25.3%) and others.

 In the first stage of labor:  Earlier or preterm rupture of membranes  Prolapse of the umbilical cord loops and small parts of the fetus with subsequent fetal hypoxia  Uterine inertia  In the second stage of labor:  Asphyxia and fetal death  compression of the umbilical cord  Birth injury to the fetus  Extension of the hands  extension of the head  Injuries to the mother (rupture of the cervix, vagina and perineum)

 If possible and time permits, perform ultrasound to confirm the position and previa, evaluate the position of the head, calculate the estimated fetal weight, estimate the volume of amniotic fluid, confirm the location of the placenta, to exclude the presence of fetal abnormalities, such as hydrocephalus  In the first stage of labor:  Electronic monitoring heartbeat  Must be satisfactory condition of the fetus  Recommend oxytocin stimulation - with caution  after the going away the water - vaginal examination for exclusion prolapsed cord

 At birth should be present in the resuscitation experienced neonatologist  Bladder mother if possible should be emptied immediately before delivery  In the 2nd stage of labor in / introduction of uterotonic agents for profilaktik weakness of attempts  Should be available for the release of the follow-tongs head  Complete pelvic extraction should not be performed for the birth of one child

 I. PREPARATION  1. Call help (experienced obstetrician, the team of neonatologists).  2. Prepare the necessary equipment  3. Tell the woman (and her accompanying persons), what will happen, listen to it carefully and answer her questions and concerns  4. Continue to provide emotional support and encouraging as possible  5. Ask breech  6. Do not open the bag of waters!  7. If the fetal membranes BREAK- should examine the woman to avoid loss of the umbilical cord.  8. Wear personal protective equipment

II. Birth of the buttocks and legs 1. When the cervix is fully dilated and buttocks will drop into the vagina, tell the woman that she made an effort during labor 2. Do not recommend push (supine, buttocks on the edge of the table). 3. Perform episiotomy, if necessary 4. Allow yourself to be born buttocks until both seem rear shoulder 5. Carefully grasp the buttocks with one hand, but do not pull 6. If the legs are not born alone, output queues on each foot, for this: - Push the rear knee to hip flexion - Grab your ankle and pull the pile and leg - Repeat the same for the other leg 7. Grab the newborn for hips

Birth hands 8. If the handles are crossed over his chest, give them the opportunity to be born on their own. Help only when necessary. After the birth of the first self-handles, lift the buttocks forward to the mother's abdomen to allow the handle to be born a second self. If the handle is not born alone, place 1 or 2 fingers on the elbow bend and bend the handle, pass it down through the child's face 9. If the handle of the head thrown back, or arranged around the neck, apply the technique Lovset: - Grab the child's hips and turn it a half turn, hold back on the top and at the same time sipping it down to the handle, which is at the back, would be the front and was able to be born under the pubic arch - Give birth handle, put 1 or 2 fingers on the upper part. Lower the handle down through the child's chest when your arm is bent with a brush held by a person - For the birth of the second child hands turn back half a turn, hold first hand and sipping it down, release the second handle in the same way from the symphysis pubis 10. If you turn the body of a newborn so was born the front handle, is not possible, print the first rear handle

The birth of the head 11. Remove the head, using the technique Mauriceau Smelli: - Put the child's body, face down on top of your hand and forearm - Place the index and ring finger of the hand on the child's cheekbones, and middle finger - in the mouth, pull the lower jaw down and bend your head - Use your other hand to grab the baby hangers - Two fingers of the upper arm gently bend the baby's head toward the chest until the applied pressure on the bottom jaw will not bring down the head of the fetus until the border of the hairy part of the forehead - Gently pull to the birth of the head Ask the assistant to put pressure above the vagina mother that will help keep the baby's head is bent 12. Perform the steps in the active management of the third stage of labor 13. Examine the soft tissues of the birth canal for breaks and Close the them if necessary. Close the region episiotomy if it was produced 14. Provide immediate postnatal care and newborn care, if necessary

III. OBJECTIVES After the procedure 1. Before taking off the gloves, remove the used material in leakproof container or plastic bag 2. Soak all used instruments in 0.5% chlorine solution for 10 minutes to decontaminate 3. Throw away used syringes and needles in a leakproof container 4. Remove the disposable gloves and immerse them in 0.5% chlorine solution 5. Wash your hands thoroughly. 6. Make a record in the history of childbirth

OBJECTIVES before the procedure 1. Wash your hands or use an antiseptic for treating hands and put on sterile gloves 2. Process the vulva with soap solution. 3. Cannulated bladder, if necessary

 transfer pregnancy  Unpreparedness of the birth canal at term  Malformations of the sexual organs  Anatomical narrow pelvis  Severe chronic fetal hypoxia  Fetal weight more than 3500 g and less than 2000  Extension of the head 3 degrees  Premature rupture of membranes with untrained birth canal or nonprogressive birth  The scar on the uterus  previa cord loops