Breech And ECV Extra Questions

1. A woman at 36 weeks of gestation presents with an uncomplicated breech presentation and consents to undergo an external cephalic version (ECV) after consultation. Unfortunately, due to logistics, this service will not be available when she is 37 weeks. What management is most appropriate?

A. Elective caesarean section at 37 weeks
B. Elective caesarean section at 38 weeks
C. ECV at 36 weeks
D. ECV at 38 weeks
E. Induction of labour 37 weeks to avoid potential cord prolapse

2. A woman undergoes a successful external cephalic version at 37 weeks gestation. What is the chance of spontaneous reversion to breech?

A. <5%
B. 6–8%
C. 10–12%
D. 14–16%
E. 18–20%

3. Which tocolytic agent has been proven to increase the success of an ECV?

A. Glyceryl trinitrate (GTN) patch
B. Glyceryl trinitrate (GTN) sublingually
C. Magnesium sulphate infusion
D. Nifedipine
E. Terbutaline

4. A Gravida 3, Para 2 (both full term normal deliveries) is diagnosed with breech presentation at 35+1 weeks of gestation and is keen to have an external cephalic version. At what gestation is external cephalic version recommended for this mother?

A. 35 weeks
B. 36 weeks
C. 37 weeks
D. 38 weeks
E. 39 weeks

5. Ms XY is 36/40 weeks pregnant. She is undergoing an ECV for breech presentation today. She is known to be RH-negative and non-sensitised. She had 2 anti-D injections ( RAADP) at 28 and 34 weeks in keeping with the hospital policy. Which of the following treatment options are best suited to her?

A. Anti-D is not needed as she had already received it at 34/40 weeks.
B. 250 IU of anti-D.
C. 500 IU of anti-D if the test for FMH is positive.
D. 500 IU of anti-D within 72 h.
E. Postnatal anti-D administration only.

6. A 30 years old pregnant woman at 39 weeks came in A&E with strong labour pains. On examination, Os is fully dilated, breech presentation, FHR normal. Patient counselled regarding pros and cons of breech delivery. She has consented for vaginal breech delivery. What is the initial management at this stage ?

A. Start continuous fetal CTG
B. Intermittent fetal heart auscultation
C. Emergency LSCS
D. ECV
E. Attempt breech extraction

7. As an ST 5 preparing foryour completion of acertiﬁed training, you are asked to look into the department Caesarean section rate, compare it with other low-Caesarean section rate countries and propose some changes in the practices at your department. You ﬁnd that the rate of vaginal delivery for breech presentation was very low at only 7%. To how much should vaginal delivery for breech presentations be increased in order to reduce the overall Caesarean section rate substantially?

A. 9%.
B. 15%.
C. 17%.
D. 19%.
E. 21%.

8. A 32-year-old woman is on her third pregnancy with two previous uncomplicated vaginal deliveries. She presented in labour. She has a twin pregnancy and both babies are in a cephalic presentation. The pregnancy has been uncomplicated to date and both twins are above the 50th centile for growth with no discordant growth. The CTG has been normal throughout labour. The ﬁrst twin is delivered uneventfully. The second twin is found to be transverse. What would be the best immediate action?

A. Breech extraction.
B. Caesarean section.
C. External cephalic version.
D. Rupture of membranes and commence syntocinon.
E. Wait for another 30 minutes

9. You are supervising an ST2 performing an elective Caesarean section for breech presentation. He makes a small laceration on the baby’s right buttock when incising the uterus. It is not actively bleeding and is approximately 1.5cm in length and superﬁcial. The ST2 is extremely upset about this complication. What is the single most appropriate next step?

A. Ask the ST2 to go and explain it to the parents in recovery as it was their complication.
B. Fill in an incident form and notify the delivery suite manager.
C. Go to the parents with the junior doctor, explain and apologize about the complication and document it in the notes.
D. Reassure your colleague that it is a non-signiﬁcant complication and it happens to everyone.
E. Tell the paediatrician and ask them to highlight it to the parents at the baby check.

10. A 33-year-old P1 presents in clinic with a history of previous caesarean section for breech presentation. Her booking BMI is 34 and she is currently at 40+10 gestation. She is very keen for vaginal birth. What are her chances of a successful vaginal birth?

A.10%
B. 25%
C. 55%
D. 75%
E. 90%

11. A third gravida with breech presentation presents in the triage ward with leaking per vaginum without any labour pains at 32 weeks. On examination, FHR is 140 bpm, cervix is 4 cm dilated with a loop of cord lying in the vagina with good cord pulsations. You decide to perform a category 1 caesarean section. What is the best intervention to prevent fetal asphyxia until she is transferred to theatre?

A. Start intranasal oxygen at 5-10 l/min
B. Start intranasal oxygen at 10-15 l/min
C. Put her in lithotomy position
D. Put her in left lateral position with a pillow under her buttocks
E. Manually replace the cord in the uterus

12. What is the approximate incidence of breech presentation at 28 weeks of gestation?

A. 4%
B. 8%
C. 10%
D. 15%
E. 20%

13. A 20-year-old primigravida presents to the delivery suite with rupture of membranes and labour pains for one hour. She is currently 32+4 weeks pregnant and a scan 5 days ago showed flexed breech with mild oligohydramnios. The estimated baby weight according to the last scan was 2050 grams. She has regular contractions and the cervix is 5 centimetres dilated, fully effaced with breech presentation at 0 station. She is transferred to theatre. On examination the breech has delivered with fetal head inside with a tight cervix. What is the best intervention for a safe delivery in this situation?

A. Injection of terbutaline
B. Emergency caesarean section and use lower segment incision
C. Emergency section and use vertical midline uterine incision
D. Lateral cervical incisions
E. Deliver head by Burns Marshall technique

14. A 20-year-old woman is 36 weeks pregnant in her first pregnancy and is being reviewed in the antenatal clinic. A recent obstetric growth scan conﬁrms breech presentation of a normally grown fetus with normal liquor volume. She has no other complicating medical or obstetric disorders. She is deciding between planned vaginal or elective caesarean (LSCS) modes of delivery. Which of the following is correct in relation to the counselling she will receive?

A. External cephalic version (ECV) may be offered and has around a 50 % success rate for conversion to cephalic presentation.
B. Footling breech presentation is considered favourable for vaginal breech delivery.
C. If opting for vaginal breech delivery, induction of labour at 38 weeks is recommended to avoid excessive fetal growth.
D. Intermittent fetal heart rate monitoring is recommended for spontaneous onset vaginal breech labour.
E. LSCS and vaginal breech birth have similar rates of perinatal mortality and early neonatal morbidity

15. Mrs XY is 36/40 weeks pregnant. She is undergoing an ECV for breech presentation today. She is known to be RH-negative and non-sensitised. She had 2 anti-D injections (RAADP) at 28 and 34 weeks in keeping with the hospital policy. Which of the following treatment options are best suited to her?

A. Anti-D is not needed as she had already received it at 34/40 weeks.
B. 250 IU of anti-D.
C. 500 IU of anti-D if the test for FMH is positive.
D. 500 IU of anti-D within 72 h.
E. Postnatal anti-D administration only.

16. Ms XY is 35/40 weeks pregnant in her ﬁrst pregnancy. Her USS today reveals a baby with extended breech presentation. What is the incidence of breech presentation at term?

A. <1 %
B. 1–2 %
C. 3–4 %
D. 4–8 %
E. 8–10 %