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Breech Protocol From: Peter V. Weston, M.D. (weston@ICSI.Net) Wed Dec 20 16:47:20 1995 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DuBose: "Re: Prognosis of Ultrasonically Dx Cx Incompetance" Previous message: Geff Klein: "Hodgkin's Lymphoma in Pregnancy" Next in thread: John Robertson: "Re: Breech Protocol" Maybe reply: John Robertson: "Re: Breech Protocol" Maybe reply: DoctorJoe@aol.com: "Re: Breech Protocol" Maybe reply: charlie chambers: "Re: Breech Protocol" Maybe reply: Dr Eberhard W Lisse: "Re: Breech Protocol" I Name of the Protocol Vaginal Delivery of a Breech Presentation II Rationale for having the protocol To reduce the incidence of Cesarean section without increasing the risk to the baby. III Prerequisites a. Failed attempted External Cephalic Version (even if the patient is in labor), provided the membranes are intact. b. Frank breech c. Estimated fetal weight not more than 7 1/2 pounds (3.4 Kilograms) d. Pelvis adequate (Clinical, X-Ray or Ultrasound pelvimetry) e. Head flexed (U/S or XRay f. No contraindications to Vaginal delivery such as a previous Classical Cesarean scar. IV Contraindications a. Pelvis with questionable measurements or shape. b. Estimated fetal weight > 3,400 grams. c. Any presentation other than a frank breech. V Technique a. Hands off the baby until the buttocks are delivered. No vacuum extraction. b. Generous episiotomy. VI Controversial Areas (Relative contraindications) a. Primiparous. b. Morbid obesity. c. Previous Cesarean section. d. Multiple pregnancy. e. Induction of labor. f. Augmentation of labor. VII Documentation needed for retrospective evaluation of the protocol. a. Past obstetrical history. b. Duration of labor. c. Duration of rupture of the membranes. d. Oxytocin induction or augmentation. e. Baby - weight, Apgar scores, Cord blood gases. f. Indications for Cesarean (if performed). g. Adverse outcome - need to document. This is a starting place. Who wants to critique the hell out of this attempt? Specificallty the List needs to address the controversial areas. Have a happy holiday one and all. Peter -- Peter V. Weston, M.D. Private Practice, Gynecology, San Antonio. weston@icsi.net "More harm is done because you do not look Than from not knowing what is in the book" Zachary Cope Next message: DuBose: "Re: Prognosis of Ultrasonically Dx Cx Incompetance" Previous message: Geff Klein: "Hodgkin's Lymphoma in Pregnancy" Next in thread: John Robertson: "Re: Breech Protocol" Maybe reply: John Robertson: "Re: Breech Protocol" Maybe reply: DoctorJoe@aol.com: "Re: Breech Protocol" Maybe reply: charlie chambers: "Re: Breech Protocol" Maybe reply: Dr Eberhard W Lisse: "Re: Breech Protocol"

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