Complication of breech delivery.

Complication following breech presentation

1. NEONATAL COMPLICATION OF BREECH DELIVERY. 1

2. Neonatal complication Intrapartum death. Asphyxia. Hypoxic ischemic encephalopathy. Intracranial haemorrhage . Trauma to liver , kidney or spleen. Dislocation of the neck , shoulder or hip. Cord prolapse. Occipital diastasis and cerebellar injury. 2

3. Brachial plexus injury. Fracture of long bone ( femur, humerus ). Fracture of clavicle. Separation of epiphyses of scapula, femur, humerus . Avulsion of upper cervical spine. Skull fracture- Intracerebral injury. Hematoma of sternocleidomastoid. 3 Fetal injuries,

4. Umbilical cord prolapse . May occur particularly in the footling or kneeling breech This is caused by the lower most part of the baby not completely filling the space of the dilated cervix. 4

5. When the water break the amniotic sac it is possible for the umbilical cord to drop down and become compressed. This can be severely diminished oxygen flow to the baby. Can detect by checking fetal HR-baby may have bradycardia (HR <120). 5

6. Or can conduct pelvic examination and may see the prolapse cord. Prolapse must be dealt w ith immediately , if find prolapse cord, have to move fetus away from the cord to reduce the risk of oxygen loss. In some case , then baby will have to be delivered immediately by cesarean section. 6

7. Intrapartum Asphyxia Oxygen deprivation may occur from ei cord prolapse or prolong compression of the cord during delivery. If there is a delay in delivery ,the brain can be damage. Oxygen deprivation ,can cause cerebral palsy, one of the most common type of brain damage is called hypoxic ischemic encephalopathy –its cause severe development and cognitive delays, or motor impairments that become more apparent as the child continues to develop. 7

8. Such impairment can include epilepsy , development delay, motor impairment, neurodevelopment delay and cognitive impairment. (in age of 3-4y can be identify). Oxygen deprivation prolong it may cause Death. 8

9. Trauma to liver kidney or spleen Squeezing the baby’s abdomen can damage internal organs. It is important for the birth attendant to be knowledgeable ,skilled and experienced with all variation of breech birth . 9

10. Injury to brain and skull Rapid passing of the baby’s head through the mother pelvis, cause rapid decompression of the babies head may leads to intracranial hemorrhage and cerebral injury . Rapid passing of head can causes rapid decompression of baby’s head ,in contrast ,a baby going through labor in the head-down position usually experiences gradual molding (temporary reshaping of the skull) over the course of few hours . 10

11. In breech birth this may cause no problem at all ,but it can injure the brain . This injury more likely in preterm babies . Related to potential head trauma, researchers have identified a relationship between breech birth and autism.(neurodevelopmental disorder) 11

12. Occipital Osteodiastasis is a prominent traumatic lesion in neonates born by breech, during delivery of after coming head. The lesion consists of traumatic separation of the cartilaginous joint between the squamous and lateral portion of occipital bone resulting posterior fossa subdural haemorrhage associated with laceration of the cerebellum. 12

13. Head entrapment Cause by the failure of the fetal head to negotiate the maternal mid pelvis. Fetal bitrochanteric diameter ( the distance between two greater trochanter of fetus) is about same as the biparietal diameter ( the transverse diameter of the skull of fetus). Simply put the size of the hip are the same as size of the head. Relatively larger buttocks dilate the cervix as effectively as the head does in the typical head down presentation. 13

14. In contrast , the relative head size of a preterm baby is greater than the fetal buttocks. If the baby is preterm it may be possible for the baby’s body to emerge while the cervix has not dilated enough for the head to emerge. It can leads to oxygen deprivation or head injury. If the arm is extended alongside the head delivery not occurs . If this occurs the loveset maneuvre may be employed . It involves rotating the fetal body by holdings the fetal pelvis. 14

15. Twisting the body such that an arm trails behind the shoulder ,it will tend to cross down over the face to a position where it can be reached by the obstetrician‘s finger ,and brought to a position below the head. 15

16. A similar rotation in the opposite direction is made to deliver the other arm. In order to present the smallest diameter (9.5cm) to the pelvis, the baby’s head must be flexed (chin to chest). If the head is in a deflexed position, the risk of entrapment is increased. 16

17. Birth injury Soft tissue injuries-laceration or abrasion due to forced obstetric maneuvers. Nerve injury-Facial nerve, brachial plexus (mostly) spinal cord injury. Scalp- laceration or abrasion. Dislocation of hip, cervical vertebrae. Skull-Fractures , cephalohaematoma . Intracranial haemorrhage . Bone fractures – fracture of clavicle , humerus ,femur. 17 Types of birth injuries that can happen in breech delivery .

18. Fractures Forced obstetric maneuvers been reported as a risk of soft tissue injury ,long bone fracture and related neonatal injury. Long bone fractures have been attribute to breech maneuvers during vaginal delivery . Fractures of femur is more common ( subtrochanteric and mid-shaft fractures) 18

19. Brachila plexus injury The cause is excessive traction on the head neck and arm during birth . Downward traction of an infant's arm during breech birth, may tear the roots of C5 and C6 . This will result in paralysis of deltoid , the short muscles of the shoulder , and of brachialis and biceps . The last two are both elbow flexors, and biceps is also a powerful supinator of the superior radio-ulnar joint. 19

20. 20 The arm therefore hangs by the side, with the forearm pronated and the palm facing backwards, like a waiter hinting for a tip ( Erb’s palsy). There is sensory loss over the lateral aspect of the upper arm.

21. References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722560 / http:// www.healthguideinfo.com/causes-of-autism/p90977/ https:// www.sciencedaily.com/releases/2009/04/090427091115.htm https:// en.m.wikipedia.org/wiki/Breech_birth 21

22. Thank You ! 22