Managing Complications in Pregnancy and Childbirth: - IAWG

S-82 Malpositions and malpresentations- flexed head.• Examine the woman regularly and record progress on a partograph(page C-65).• If the membranes rupture, examine the woman immediately toexclude cord prolapse.Note: Do not rupture the membranes.• If the cord prolapses and delivery is not imminent, deliver bycaesarean section (page P-43).• If there are fetal heart rate abnormalities (less than 100 or morethan 180 beats per minute) or prolonged labour, deliver bycaesarean section (page P-43).Note: Meconium is common with breech labour and is not a sign offetal distress if the fetal heart rate is normal.The woman should not push until the cervix is fully dilated. Fulldilatation should be confirmed by vaginal examination.CAESAREAN SECTION FOR BREECH PRESENTATION• A caesarean section (page P-43) is safer than vaginal breechdelivery and recommended in cases of:- double footling breech;- small or malformed pelvis;- very large fetus;- previous caesarean section for cephalopelvic disproportion;- hyperextended or deflexed head.Note: Elective caesarean section does not improve the outcome inpreterm breech delivery.COMPLICATIONSFetal complications of breech presentation include:• cord prolapse;• birth trauma as a result of extended arm or head, incompletedilatation of the cervix or cephalopelvic disproportion;