Malpresentations and Positions & Operative Obstetrics
All prevent delivery of after coming head of fetus except (AIIMS Nov. 2011)
|D||incomplete dilatation of cervix|
1. Placenta Previa is indeed one of the causes of Breech presentations
2. Breech presentation occurs in 3%–4% of singleton pregnancies commencing
3. Labor, but has a much higher incidence in multiple gestations (e.g., ~25% of first twins and ~50% of second twins are breech).
Causes of breech presentations are
a. Earlier gestations (35% at ~28 weeks, 25% at 28–32 weeks, 20% at 32–34 weeks, 8% at 34–35 weeks, 2% –3% at ~36 weeks),
b. a prior breech (over 4-fold increase after one and up to 30-fold after three),
c. placental placement (i.e., placenta previa),
e. fetal congenital anomalies (e.g., hydrocephalus),
f. pelvic tumors impinging on the uterus or birth canal (e.g., leiomyomata),
g. uterine anomalies (e.g., bicornuate, septate uterus).
4. If most of the fetus has delivered vaginally when there was a placenta previa, then a placenta in the lower segment will not hinder the delivery of the after coming head.
5. Most primigravidas with placenta previa should be delivered by cesarean section.
6. Some multiparas with partial or low-lying placenta previa can be delivered safely from below unless hemorrhage is marked.
7. Electronic fetal monitoring should be employed in all labors involving placenta previa.
8. Usually, brief hospitalization and expectant management are essential because most gravidas are preterm and bedrest alone will be accompanied by cessation of bleeding within 24 h. The patient or her fetus almost never die during the first occurrence of bleeding (assuming no pelvic examination).