Dystocia in breech presentation

　　The possibility of not turning into a cephalic presentation by 30 weeks of gestation may be related to the following factors:

　　4. Fetal development factors.The incidence of congenital malformations such as microcephaly, anencephaly, hydrocephalus, etc., presenting as breech presentation, is significantly higher than that in normal children.

　　2. Limited or excessively large space for fetal movement.Abnormal uterine shape, narrow pelvis, uterine or pelvic tumor blocking the pelvis, relaxed abdominal wall in multiparas, excessive amniotic fluid, and other factors are prone to cause breech presentation.

　　The most common complications of breech presentation during pregnancy include preterm birth, premature rupture of membranes, umbilical cord prolapse, prolonged labor, perineal laceration, uterine rupture, puerperal infection, and intrauterine growth restriction of the fetus. Breech presentation has a significant impact on the prognosis of both the mother and the baby and is considered a high-risk category.

　　Prolonged labor at the time of delivery is very harmful to the health of both the mother and the baby. Therefore, it is necessary to do a good job of prenatal examination. If any abnormalities are found, they should be corrected and treated in a timely manner. The most effective preventive method is to go to regular hospitals for prenatal examination as required. Conduct pelvic measurement in the late pregnancy period so that the doctor can have a comprehensive understanding of the condition of both the mother and the baby.

　　The main examination methods for this disease are as follows:

　　1. Abdominal examination

　　The four-step palpation of the uterus is oval in shape, and the round and hard fetal head can be felt at the fundus, and there is a distinct floating ball sensation when pressed. If it has not engaged, the fetal heart sound is most clear when listened to at the upper left or upper right of the umbilicus; if it has engaged, the fetal heart sound is most clear when listened to at the umbilicus.

　　2. Digital rectal examination

　　If the abdominal examination cannot definitely determine whether it is a head or breech presentation, a digital rectal examination can be performed. If the pelvis is empty and the round and hard fetal head cannot be felt, instead, a soft and irregular fetal buttocks that is higher in position or the fetal feet can be felt, or the fetal feet can be palpated, it can be diagnosed as breech presentation.

　　3. Vaginal examination

　　If digital examination cannot determine the situation, vaginal examination is necessary. If the amniotic membrane has been broken, the fetus's anus, ischial tuberosities, and sacrum can be directly touched, and at this time, attention should be paid to distinguish from the facial features. If it is the fetal buttocks, the anus and two ischial tuberosities can be felt in a straight line, and there is a contraction sensation when the finger is inserted into the anus, and the fetal meconium can be seen on the finger glove when it is taken out; if it is the face, the mouth and two zygomatic bones are prominent to form a triangle, and the gingiva and mandible can be touched when the finger is inserted into the mouth.

　　4. Ultrasound examination

　　Type B ultrasound examination can not only determine breech presentation but also clarify whether the fetus has any malformations, and can measure the fetal head circumference and abdominal circumference to estimate the size of the fetus.

　　After 3-4 days of surgery, after the patient has passed gas through the anus, it indicates that the intestinal function is beginning to recover, and at this time, a small amount of liquid food can be given. After 5-6 days, it can be changed to semi-liquid food with less residue. It is forbidden to eat chicken, ham, pigeon meat, and soups of various vegetables. It is forbidden to eat greasy foods. It is forbidden to eat dog meat, mutton, sparrow meat, sparrow eggs, bamboo shoots, scallions, pumpkins, beef, coriander, smoked fish, smoked meat, chili, chives, garlic sprouts, and sea vegetables, etc.

　　Different treatment methods should be adopted at different stages of the disease.

　　1. Pregnancy periodBefore 30 weeks of pregnancy, most cases of breech presentation can turn to cephalic presentation on their own without any treatment. If breech presentation persists after 30 weeks of pregnancy, active correction should be carried out. The commonly used correction methods are as follows.

　　1. Kneel on the chest position：The pregnant woman should empty her bladder, loosen her belt, assume a knee-chest position, 2-3 times a day, each for 15 minutes, and then review after a week of continuous application. This position can change the fetal center of gravity to help the fetal buttocks exit the pelvic cavity and turn into a vertex presentation.

　　2. External Version of the Fetus：If the above methods are ineffective and there is no nuchal cord around the neck, external version of the fetus can be performed between 32-34 weeks of gestation. If the fetus is found to have frequent and severe movements or an abnormal fetal heart rate during the operation, the rotation should be stopped and returned to the original position, and close observation should be made until normalcy is restored.

　　Second, Labor Period：In the early stages of labor, a correct judgment should be made based on the age of the mother, the number of deliveries, the type of pelvis, the size of the fetus, whether the fetus is alive, and whether there are developmental abnormalities, the type of breech presentation and whether there are complications, etc., to determine the mode of delivery.

　　1. Indications for Cesarean Section：Narrow pelvis, abnormal soft birth canal, fetal weight > 3500g or biparietal diameter of the fetal head > 9.5cm, fetal head flexion, incomplete breech presentation, primiparas with a history of difficult labor or neonatal birth injury, precious infants, fetal distress, umbilical cord prolapse with good fetal heart rate, and cervix not fully dilated, cesarean section should be performed to end labor.

　　2. Management of Vaginal Delivery

　　(1) The First Stage of Labor：Pregnant women should not stand or walk, but should lie on their sides to avoid rupture of the amniotic membrane. Once the membrane ruptures, the fetal heart should be immediately monitored to check for umbilical cord prolapse. If there is umbilical cord prolapse and the fetal heart is good, the cervix is not fully dilated, an emergency cesarean section should be performed to save the fetus; if there is no umbilical cord prolapse, the fetal heart should continue to be closely monitored and the progress of labor observed. When the cervix is dilated to 4-5cm, the fetus's feet can be extruded outside the vagina, and the method of blocking the vulva can be used to fully dilate the cervix and vagina. During the blocking of the vulva, the fetal heart should be monitored and attention should be paid to whether the cervix is fully dilated. Blocking the vulva after the cervix is fully dilated can easily cause fetal distress and uterine rupture. When the cervix is fully dilated, preparations for delivery and rescue of newborns with asphyxia should be made.

　　(2) The Second Stage of Labor：Before delivery, urination should be induced to empty the bladder, and a posterior-sidewards incision should be performed on the perineum for primiparas.

　　(3) The Third Stage of Labor：Actively rescue newborns with asphyxia. After the placenta is delivered, uterotonics should be used to prevent postpartum hemorrhage. Routine examination should be performed to check for lacerations in the soft birth canal. If there are lacerations, they should be sutured promptly and antibiotics should be administered to prevent infection.