Help For Breech Delivery

HELP FOR BREECH DELIVERY STEPS / ACTIVITIES Preparation Introduce yourself and greet the patient. Prepare approval for medical treatment for the patient's family. Prepare the patient for the procedure:The mother is in the lithotomy position on the bed delivery, emptying the bladder, rectum and cleaning the perineal area with antiseptic Prepare the necessary tools and medicines: Parturition set: Sterile handscreen Like an instrument Amnitom (1/2 kocher) Episiotomy scissors Umbilical cord clamp Cut the umbilical cord Central cord tying Crooked De Lee slime sucker Placental site Sterile gauze, 3 ml DTT syringe cotton and needle no. 23G Cuching medicine Heacting set: Like an instrument Nailpouder 10 cc syringe Handscoen Tweezers Nail heacting (for skin, for muscles) Cut gut thread Doek is sterile Stethoscope Spighnomanometer Thermometer Baby resuscitation equipment Cunam piper/ long cunam Apron, mask, protective glasses, boots (PPE) cloth cover (blanket, cover) Mom's clothes Baby clothes Towels, washcloths Plastic basin Iron basin Book/pen for documentation DTT/sterile gloves 0.5% chlorine solution Uterotonics (Ergometrine maleate, Oxytocin) Local anesthetics (Lidocaine 2%) Aquabidest Povidone-iodine Catheter Standard infusion Infusion set (abocath 16 or 18) RL Infusion Fluid Wear complete birthing equipment Wash hands up to the elbows with soap under running water and dry hands with a DTT towel Wear DTT/sterile gloves Implementation BREECH AID MEASURES Installing the duct Carrying out repeated internal examinations for final assessment. Leading patients to take correct measurements The helper stands in front of the vulva Give birth to a baby: Bracht Method (Using Mother's Pushing Energy) Wait for the buttocks to be born while helping to open the vulva When the buttocks open the vulva, give an injection of oxytocin 2-5 units/IM Perform an episiotomy when the buttocks open the vulva Holding the buttocks in a Bracht manner, that is, the two helping thumbs are parallel to the long axis of the thigh, while the other fingers hold the pelvis At his moment, the mother is led to push. When the umbilical cord is visible, loosen it When the scapula is born, performing hyperlordosis towards the mother, the assistant initiates Kristeller. Assess whether both shoulders can be delivered spontaneously. If both shoulders are born spontaneously, Bracht is continued With successive hyperlordosis movements, the navel, stomach, shoulders, arms, chin, mouth, and finally the entire head are born Place the baby on the mother's stomach. Cut the baby's umbilical cord Carrying out resuscitation of newborns and management of newborns Classic/ Deventer method (giving birth to the back shoulder then the front shoulder) Both legs of the fetus are held with the helper's right hand at the ankles and elevated upwards as far as possible so that the fetus's stomach approaches the mother's stomach. The helper's left hand is inserted into the birth canal and with the middle and index fingers traces the fetus's shoulder to the cubital fossa then the forearm is delivered with a movement as if the forearm is rubbing the fetus's face. To deliver the front arm, the grip on the fetus' ankle is replaced with the helper's left/non-dominant hand and pulled steeply downwards so that the fetus's back approaches the mother's back. In the same way the forelimbs are born If the front arm is difficult to birth, the front arm must be rotated to become the rear arm. The shoulder girdle and arms of the newborn are gripped with both helping hands in such a way that the two thumbs of the helping hand are located on the back and parallel to the axis of the fetus's body while the other fingers grip the chest. The rotation is directed towards the fetus's abdomen and chest, so that the forelimbs are located behind. Then the rear arm is born in the same way. Muller's method (giving birth to the front shoulder first, then the back shoulder) The fetal buttocks are held femuro-pelvically, that is, the two supporting thumbs are placed parallel to the middle sacral spine and the index fingers on the iliac crest and the other fingers grip the front of the thigh. The fetal body is pulled down as far as possible until the front shoulder appears below the symphysis, and the front arm is delivered by hooking the lower elbow. After the front shoulder and front arm are born, the fetal body, which is still held femuro-pelvically, is pulled upwards until the back shoulder is born. If the back shoulder is not born by itself, then the back arm is born by hooking the forearm with the two helping fingers. Loveset's way After the baby's buttocks and feet are born, the baby's body is held femuropelvically with both hands. Rotate baby 1800so that the back shoulder becomes the front shoulder. Roll back 1800in the opposite direction to the left/right several times until the back shoulder appears below the symphysis and the arm can be born. If the arm cannot be born by itself, the fetal arm can be born by hooking the forearm with a helping finger. If there is head congestion Mauriceau Way The child's body is placed on the helper's forearms, as if it were a fetus horseback riding. The index and middle fingers are inserted into the mouth and the fourth finger grips the canine fossa. The index finger and third finger of the other hand grip the fetus' neck from the back. Assign an assistant to press the uterine fundus using Kristeler. Simultaneously with his and the assistant pressing the uterine fundus, the helper pulls downwards in the direction of the axis of the birth canal guided by the finger inserted to press the chin/mouth. If the sub occiput appears below the symphysis, the fetal head is elevated upwards with the sub occiput as a hypomoclion so that the chin, mouth and entire head are born. Note: Removing the baby's head with Piper forceps is carried out if removing the baby's head fails. The method is to wrap the baby's hands and body in sterile cloth, lift them upwards, or ask an assistant to hold the baby's feet. Piper forceps are placed transversely to the pelvis and the head is then pulled. Helping the birth of the baby Cutting and tying the umbilical cord Carrying out initial treatment for the newborn Injecting oxytocin 10 IU Deliver the placenta spontaneously or manually if indicated. Stitch the birth canal wound if any Teach the mother to perform uterine fundus massage herself. Tidy up the patient Clean up equipment Washing hands Documenting the actions that have been taken.