Breech Traction

Generally, the maternal cervix has been opened or nearly open, umbilical cord prolapse or fetal distress, the fetus is still alive, for the rescue of the fetus can not immediately cesarean section to end the delivery; twin pregnancy, the first fetus after delivery, the second If the fetus has umbilical cord prolapse or fetal distress, the child must be terminated in time. Breech traction means that the entire part of the fetus is delivered by the surgeon. Treatment of diseases: breech dystocia, soft birth canal abnormal dystocia Indication The cervix has been opened or nearly open, umbilical cord prolapse or fetal distress, the fetus is still alive, for the rescue of the fetus can not immediately cesarean section to end the delivery; twin pregnancy, the first fetus after delivery, the second fetus appears Umbilical cord prolapse or fetal distress must end the childbirth in time. Preoperative preparation 1. Maternal bladder lithotomy, genital disinfection, catheterization. 2. Bilateral pudendal nerve block anesthesia. 3. The primiparous breech or tight perineal women must have a larger perineal incision. 4. Prepare for rescue of neonatal resuscitation. 5. When you are ready, go out and produce the forceps. Surgical procedure 1. If the fetus has a single foot or both feet have been exposed to the vulva or vagina, the surgeon holds the traction by hand. 2. If the fetal feet are still in the uterine cavity, they should reach into the uterine cavity and hold the single foot or both feet. 3. If the fetus is exposed to the single hip, you can use both hands to hook the groin of the fetus, and then pull the force to pull down the hips. Then, according to the support method, the fetal foot and the trunk are delivered, and the shoulder and the fetal head are delivered according to the method of blocking the buttocks. (Fig. 19, Fig. 20). If the hook fails, the pinard can be used to pull the foot. That is, the hand that protrudes into the uterine cavity reaches the armpit along one side of the femoral arm. The lower arm is flexed by pressing the armpit with the hand, and the foot is pulled downward, and the buttocks and the other lower limb are pulled out. Be careful to start pulling the foot in front of the foot to keep the position in front of the head. If the flexion of the lower limb in front is difficult, the rear foot can be pulled first, but then the other foot is taken, then the feet are pulled down and rotated into the anterior position during the traction process. complication (1) maternal complications 1. Injury of the birth canal: It is related to the following factors: 1 The uterus is not open for vaginal midwifery, traction or posterior delivery. 2 The hip time is not enough or too long. 3 The operation is not standardized, and the technique is rude. After the delivery of the fetal placenta, routine examination of the cervix, suspected uterine rupture should be performed in the uterine cavity. If there is aura or complete rupture, the laparotomy should be performed immediately, and the surgical method should be determined according to the degree of rupture and the location. 2. Postpartum hemorrhage: It is related to the fact that the gluteal first dew can not evenly force the lower part of the uterus, but can not induce a good uterine contraction. In addition, there are many opportunities for surgical operation, and the chance of postpartum uterine contraction and impaired bleeding in the soft birth canal is also increased. Use the birth chart to guide the progress of labor, find and actively deal with difficult births in time, eliminate the delayed production, and effectively prevent postpartum hemorrhage. 3. Calving infection: Give antibiotics to prevent infection after childbirth. (two) fetal complications 1. Injury: The incidence rate is about 0.96% to 10%, which is related to the choice of delivery method and the experience of the delivery. (1) intracranial hemorrhage: mostly caused by mechanical damage and asphyxia. When the head is turned out, the fetal head cannot be deformed to adapt to the birth canal, and mechanical damage can occur when the fetal head is pulled. In particular, the head extension is more susceptible to injury. (2) Spinal injury: It is easy to occur when the hip is pulled. The damage often occurs between the seventh cervical vertebra and the second thoracic vertebra. If the spinal cord injury is accompanied, it can cause neonatal death, and the survivor will also leave permanent damage. (3) Hip plexus injury: The incidence rate is 17 times that of the head position, which is related to the excessive side traction when the fetal head is delivered. In severe cases, it can cause paralysis of the forearm. (4) radial nerve injury: related to excessive traction of the neck. It is characterized by difficulty in breathing. The levator muscle is elevated in the fluoroscopy, and the diaphragm is moving in the opposite direction with the inhalation. (5) Fracture: is the most common complication. The rise of the fetal arm is most likely to cause a fracture of the clavicle or tibia. Childbirth that violates the delivery mechanism can lead to fracture of the lower extremity. 2. Fetal and neonatal asphyxia: data reported significantly higher than the head position.