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Re: breech in nulipara From: Peter V. Weston, M.D. (weston@ICSI.Net) Wed Dec 4 08:25:59 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: T Dubose: "Re: mac problem:docjoe2855@aol.com" Previous message: Mats Bergstrom: "Re: Uterine Fibroids" Maybe in reply to: RAUL DORBECKER: "breech in nulipara" Next in thread: bclaure: "Re: breech in nulipara" At 02:32 PM 12/3/96 -0600, you wrote: >Several participants in this discussion are stressing that >only full/complete breech should be allowed the vaginal >route (in the nullipara). Why is this? Or is there a misunderstanding >on my part of the English terminology? The double feet+breech (sitting >Bhudda) presentation is the most favourable regarding dilatation >of the cervix. Mats, The rationale for not attempting vaginal delivery with single or double footling breeches is because of several concerns. Firstly, cases of incompete breeches can predispose to cord prolapse because the presenting part does not fit snuggly against the cervix. Another concern is because the patient may start bearing down before complete dilatation of the cervix. The narrow wedge part of the fetus will deliver and predispose to entrapment of the head by the cervix. The premature bering down may be initiated by pressure on the posterior vaginal wall by the foot/feet. Yet another concern is that the fetus is more wedge shaped as an incomplete breech than if a frank breech. If the bituberous diameter does not allow descent of the fetus this is practical evidence of feto-pelvic disproportion and abdominal bypass should be considered. Talking personally, I have had to perform Duhrsen's (sp) incisions to releive a trapped head and that plays havoc with one's anal sphincter. These are theoretic concerns that have been carried down from one teacher to the next but if we do not heed the recommendations of our forefathers we should have good reasons for deviating from their advice. Despite the above comments I feel that frank breeches should be considered for vaginal delivery if the criteria that others have discussed are met. Regards, Peter Cap'n Pete -- Peter V. Weston, M.D. <weston@icsi.net> On Clear Lake, Texas Phone (281) 334-7480 ~v~ ^ ~v~ /| ~v~ ^ / |\ /| / | \ ~v~ / | / | \ _ /__|_/____| __\_ ~^~^^^^( Pearl /^~^~^~^ For the truth is that I already know as much about my fate as I need to know. The day will come when I will die. So the only matter of consequence before me is what I will do with my allotted time. I can remain on shore, paralyzed with fear, or I can raise my sails and dip and soar in the breeze. Next message: T Dubose: "Re: mac problem:docjoe2855@aol.com" Previous message: Mats Bergstrom: "Re: Uterine Fibroids" Maybe in reply to: RAUL DORBECKER: "breech in nulipara" Next in thread: bclaure: "Re: breech in nulipara"

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