Cephalic and Breech
Delivery of the infant is usually straightforward once the head is out. Follow similar maneuvers used in vaginal delivery for cephalic and breech presentations.
The anterior (A) and then the posterior (B) shoulder are delivered.
The operator guides the head through the incisions as the assistant applies pressure from the fundus.
If shoulders are difficult to delivery the posterior arm can be swept in front of the baby and delivered.
- Transverse lie is converted to breech by grasping one or both ankles
- Try to keep membranes intact until version is complete
- Intrapartum ultrasound with the transducer covered in a sterile plastic bag may be helpful to identify the position of the fetus
- Internal podalic version as the assistant applies transabdominal pressure on the head to aid fetal rotation
- Breech extraction
Transverse lie is a bit trickier and usually involves grasping the ankles and converting the lie to breech by internal podalic version. In other words, grasp the baby’s ankles and bring the feet into the vagina while an internal hand pushes the head toward the uterine fundus. (if having difficulty finding the heels/ankles the head can be pushed to the fundus first which often makes it easier to find the feet.). If necessary the uterine incision can be extended by clipping in the midline with bandage scissors creating a t incision.
The infant is delivered, dried and stimulated. The cord is clamped after appropriate delay and cut. The baby is passed to the childcare team.