OBSTETRIC CONDITIONS
Breech Presentation
The term “ breech ” refers to a baby with the feet or buttocks positioned closest to the birth canal . Most babies present head down ; only 3-4 % of women present in labor with their babies breech . Often the reason for the breech presentation remains unclear , and both the mother and baby are found to be normal at the time of birth .
For many years , breech babies were allowed to deliver vaginally . As the safety of the C-section has improved , the number of vaginal breech deliveries has declined . The largest part of a baby is its head . In a breech delivery , the head is the last thing to pass through the cervix . If the head is too large , it may become entrapped in the cervix , which can result in serious injury and even death . Umbilical cord prolapse – which occurs when the umbilical cord falls through the cervix – is more common in breech presentation . This results in compression of the cord , which deprives the baby of vital blood flow . It is impossible to identify which babies are likely to be injured .
In many cases , the baby can be turned to the head-down position using external cephalic version ( ECV ), a procedure that has a 50 % success rate in published studies . This is usually more successful when attempted before the baby engages into the pelvis .
Postdate Pregnancies
About 80 % of babies are born at 38-42 weeks of pregnancy . About 10 % extend beyond 42 weeks of pregnancy . Most of the babies born late will be healthy , but there is an increased rate of complications .
Complications that may occur include :
• Oligohydramnios – decreased amniotic fluid around the baby
• Meconium passage – fetal bowel contents in the amniotic fluid
• Fetal macrosomia – large babies
The major concern with postdate pregnancies is that the aging placenta cannot adequately nourish the baby , which affects the baby ’ s growth . The baby may be further stressed by labor contractions , which can lead to a lack of oxygen and subsequent passage of meconium . Inhalation of meconium prior to or during delivery may result in pneumonia for the newborn . Postdate pregnancies are more likely to develop oligohydramnios , which increases the chance of distress in the baby due to umbilical cord compression .
Several considerations must be weighed in determining the best management plan , including :
• Reliability of your due date
• Difficulty identifying which babies are likely to develop problems if left undelivered
Generally , we offer induction of labor at 39-41 weeks . We advise induction of labor for all women if they reach 42 weeks of gestation .
74 My Prenatal Care Book