A 30-year-old G2P1001 patient comes to see you in the office at 37 weeks gestational age for her routine OB visit. Her first pregnancy resulted in a vaginal delivery of a 9-lb, 8-oz baby boy after 30 min of pushing. On doing Leopold maneuvers during this office visit, you determine that the fetus is breech. Vaginal exam demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is about 7 lb. You send the patient for a sonogram, which confirms a fetus with a frank breech presentation. There is a normal amount of amniotic fluid present, and the head is well flexed. As the patient's obstetrician, you offer all the following possible management plans except
The patient who has a fetus with a breech presentation has the option of scheduling an elective cesarean section at or after 39 weeks, or alternatively can elect to have a breech delivery if certain conditions are met. It is inappropriate to electively deliver any patient prior to 39 weeks without a documentation of fetal lung maturity because of the risk of neonatal respiratory distress syndrome. Therefore, if a patient declines to undergo a vaginal breech delivery, an elective cesarean should be scheduled at or after 39 weeks gestational age to avoid this complication of preterm delivery. If a patient would like to avoid a cesarean section but does not want to undergo a vaginal breech delivery, then an external cephalic version is an appropriate management plan. An external cephalic version (ECV) is a procedure where the fetus with a breech presentation is manipulated through the abdominal wall to change the presenting part to vertex. Studies indicate that if an ECV is not performed, 80% of breech presentations will persist at term vs. only 30% if a successful version is performed. ECV has an average success rate of about 60%; it is most successful in parous women with an unengaged breech and a normal amount of amniotic fluid (all conditions that exist in the patient described). A trial of labor for a pregnant woman with a fetus in the breech presentation is appropriate if the fetus is frank breech, has a flexed head, has a normal amount of amniotic fluid, and has an estimated weight between 2500 and 3800 g. In addition, the pelvis should be adequate as assessed with x-ray pelvimetry or a history of delivery of a previous baby of bigger size.
Allow the patient to undergo a vaginal breech delivery whenever she goes into labor
Send the patient to labor and delivery immediately for an emergent cesarean section
Schedule a cesarean section at or after 39 weeks gestational age
Schedule an external cephalic version in the next few days
Antepartum Haemorrhage