• Klasifikasi:
• Frank breech
• Complete breech
• Incomplete breech, footling
FR
• Idiopatik Diagnosis:
• Polyhydramnion 1. Anamnesis Persepsi gerak
• Gemeli janin
• Hydrocephalus 2. Pemfis leopold, auskultasi
FHR diatas umbilicus, VT
• Uterine abnormalities
3. USG
• Placenta previa
4. X-ray
• Pres bokong sebelumnya
Decision making
• Pertimbangan risk and benefit
1. Tawarkan:PSP jika > 36 wga; 2500-4000 gr
2. Partus percobaan: jika 31 -35 wga; ebw 1500-2500 gram
3. SC jika < 30 wga; ebw < 1500 gram
Koplikasi psp
- After coming head, pada < 30 wga; ebw < 1500 gram
- Hyperextensi sendi leher (stargazer) cedera cervical spinal cord
Tere are three general methods of breech delivery through
the vagina:
1. Spontaneous breech delivery. Te fetus is expelled entirely spontaneously
without any traction or manipulation other than support of the newborn.
2. Partial breech extraction. Te fetus is delivered spontaneously as far as
the umbilicus, but the remainder of the body is extracted or delivered with
operator traction and assisted maneuvers, with or without maternal
expulsive eforts.
3. Total breech extraction. The entire body of the fetus is extracted by the
obstetrician.
KONTRA INDIKASI PSP
• fetal or maternal contraindication to labour
• footling breech
• hyperextension of the fetal head
• absence of informed consent
• absence of experienced maternity health care giver
Cardinal movement breech delivery
1. Engagment bitorchanter axis dalam oblique thd pelvic diamteter
2. Descent anterior hip duluandiikuti posterior hip
3. internal rotation akibat tahanan dari pelvic floor, sampai bitorchanter sejajar dengan bidang
antero posterior dari pelvic outlet
4. Descent berlanjut sampai anterior hip tampak pada vulva
5. Dengan flexi tubuh janin posterior hip menkan perineum
6. Retraksi belanjut sampai bokong dan anterior hip lahir
7. Eksternal rotasi pada tubuh bayi membawa bahu untuk bertambah descent sampai bi
acromnion sejajar dengan antero posterior pelvic plane
8. Ekspulsi pada bahu, di lanjut kan kepala dalam keadaan flexi.
Cara persalinan dapat dilakukan :
• Persalinan spontan ( Bracht)