1. 2 2.5 3 3.5 4 kg BIRTH WEIGHT 50 10 all deliveries vaginal breech BREECH PRESENTATION PNMR HAZARDS PREMATURITY (IVH) ASPHYXIA TRAUMA CAESAREAN SECTION

2. AETIOLOGY OF BREECH PRESENTATION PREMATURITY FETAL ABNORMALITY MULTIPLE PREGNANCY POLYHYDRAMNIOS PLACENTA PRAEVIA UTERINE ABNORMALITY TYPES OF BREECH PRESENTATION EXTENDED (FRANK) FLEXED (COMPLETE) INCOMPLETE FOOTLING

3. MANAGEMENT OF BREECH PRESENTATION DIAGNOSIS > 34 WEEKS EXTERNAL CEPHALIC VERSION VAGINAL DELIVERY V CAESAREAN At 37 - 38 weeks estimated fetal weight 2.5 - 4 kg frank breech presentation pelvic measurements > 11 fetal abnormality excluded no serious medical or obstetric complications PREMATURE BREECH

4. TWINS 1 : 80 ( TRIPLETS 1 : 80 2 ) 1 : 320 UNIOVULAR TWINS WORLDWIDE SUPERFECUNDATION SUPERFETATION AETIOLOGY Nordics and Negroes 1 : 70 Mongoloid 1 : 150 Age Parity Previous binovular twins heredity

5. DIAGNOSIS OF TWINS PREGNANCY Large for dates Ultrasound lamda sign a FP selective fetocide MANAGEMENT REST ? ADMIT 28 - 32 WEEKS SERIAL ULTRASOUND + IOL AT 40 WEEKS TAPPING HYDRAMNIOS DEAD TWIN ASSESS PRESENTATION

6. PLACENTATION DIZYGOTIC Separate placental and amnion & chorion DIZYGOTIC day 23 %0 - 3 Totally separate 75 %4 - 7 Separate fetuses & amnion single chorion with vascular corrections 1 %7 - 11Mononamniotic & monochorionic < 1 %11+conjoined twins PRESENTATION CXCX45 % CXBR25 % BRCX10 % BRBR10 % TRTR ETC..10 %

7. HAZARDS OF MULTIPLE PREGNANCY risk pre - eclampsia ( X 3) pressure symptoms Anaemia Abortion ( disappearing sac ) Prematurity ( approx. 30% deliver < 37/40 ) Polyhydramnios, twin - twin transfusion Placenta praevia / APH / PPH Mal presentation mechanical problems cord entanglement ‘ locked ‘ twins PNMR X 4 ( + if uniovular ) second twin at risk

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9. AMNIOTIC FLUID Mainly fetal urine Some from extraplacental membranes 12 wks 50 mls 24 wks 500 mls 36 wks 1,000 mls OLIGOHYDRAMNIOS uterus small - for dates Baby easy to feel u/s - reduced liquor volume Placental insufficiencyRX Prenatal diagnosis urinary tract dysplasiaIntensive monitoring Early delivery

10. POLYHYDRAMNIOS An excess of liquor to such a degree that it is likely to influence the course or management of pregnancy. Large for dates Tense and uncomfortable Fluid thrill Difficult to feel fetus

11. aetMATERNALMULTIPARITY DIABETES P.E.T. INFECTION TOXO. CYTOMEG. FETALMACROSOMIA ANENCEPHALY/HYDRO. GUT ATRESIA MULTIPLE PREGNANCY CANT SWALLOW diaphragm hernia mediastinal tumour HYDROPS FETALIS Rhesus dis Infection Thal. major Heart disease

12. A complete breech presentation is best described by which of the following statements: a)the legs and thighs of the fetus are flexed b)the legs are extended and the thighs are flexed c)the arms, legs, and thighs are completely flexed d)the legs and thighs are extended e) none of the above

13. TRANSVERSE LIE 1 : 200 AT TERM MULTIGRAVIDAE PLACENTAL PRAEVIA / FIBROIDS POLYHYDRAMNIOS MULTIPLE PREGNANCY CONTRACTED PELVIS FETAL ABNORMALITY UTERINE ABNORMALITY MANAGEMENT Admit after 37 weeks Ultrasound Caesar if doesn’t turn

14. CORD PRESENTATION - intact membranes CORD PROLAPSE - ruptured membranes AETIOLOGY 1 : 300 80 % occur in multigravidae MALPRESENTATION T. LIE BREECH / TWINS HIGH HEAD OBSTETRIC INTERFERENCE ( ARM, FORCEPS) PREMATURITY

15. CORD PROLAPSE DIAGNOSIS Ultrasound Pelvic exam in labour CTG abnormality S.R.M. TREATMENT Dont panic Push up presenting part SIMS position or knee/chest CAESAR ( Forceps if fully)

16. VIT_MIN