Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Unidad#de#Medicina#Perinatal##
Hospital#Universitario#de#Cruces#
#
Variedad:
! Nalgas puras (65-70%)
! Nalgas completas (5%)
! Nalgas incompletas:( 25-30%)
! Factores ovulares:
placenta previa
oligoamnios-hidramnios
cordn corto
! Factores fetales:
gestacin mltiple
pretrmino
malformaciones fetales
! Otros:
antecedente de nalgas
componente hereditario
Diagnstico
! Exploracin:
M.Leopold
Foco auscultacin fetal
T.vaginal
! Ecografa:
Fundamentos
!
Recomendaciones
www.ajog.org
Received for publication June 30, 2005; revised September 30, 2005; accepted October 27, 2005
KEY WORDS
Breech presentation
Mode of delivery
Neonatal morbidity
Observational survey
Objective: A large trial published in 2000 concluded that planned vaginal delivery of term breech
births is associated with high neonatal risks. Because the obstetric practices in that study differed
from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of
delivery for term breech births in 2 such countries.
Study design: Observational prospective study with an intent-to-treat analysis to compare the
groups for which cesarean and vaginal deliveries were planned. Associations between the outcome
and planned mode of delivery were controlled for confounding by multivariate analysis. The main
outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal
morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses
in breech presentation at term in 138 French and 36 Belgian maternity units.
Results: Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526
(31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The
rate of the combined neonatal outcome measure was low in the overall population (1.59%;
95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It
did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted
Supported by 2 grants from the Ministry of Health (AOM01123 [PH-RC 2001] and AOM03040 [PH-RC 2003]). It was also partly funded by the
French College of Gynecologists and Obstetricians, the French Society of Perinatal Medicine, and the Belgian National Funds for Scientific
Research.
The funding sources had no role in the study design, data collection, data interpretation, or the writing of the report.
Reprints not available from the authors.
0002-9378/$ - see front matter ! 2006 Mosby, Inc. All rights reserved.
doi:10.1016/j.ajog.2005.10.817
Imprescindible
Valoracin
rigurosa
intraparto
Peso estimado
Variedad de nalgas
Pelvis adecuada
Actitud de cabeza
No otra contraindicacin
CTG continua tanto en dilatacin como en
expulsivo
Posibilidad de realizar una cesrea urgente
Presencia de dos toclogos
Analgesia adecuada
Asistencia peditrica
Progresin de la primera fase del parto#
Estimulacin oxitcica cuidadosa
Tiempos de fase pasiva y activa de
expulsivo.
Episiotoma, valoracin individual..
Tcnica correcta en la ayuda manual, con
conocimiento de las distintas maniobras a
aplicar si surgen complicaciones.
Indiferente#
Deexionada#
Imprescindible
! Preferible#la#MEF#
continua#durante#la#
dilatacin#e#
imprescindible#durante#
el#expulsivo.#
! Presencia#de#dos#
obstetras#
! Posibilidad#de#cesrea#
urgente.#
! Analgesia#adecuada#
! Asistencia#peditrica#
Periodo de dilatacin
Progresin#de#la#dilatacin#
Parto de nalgas
Periodo#expulsivo#
La duracin de la fase pasiva de la segunda etapa del
parto puede durar hasta 90 minutos, permitiendo que
la nalga descienda en la pelvis. Una vez que
comienza la fase activa y se inician los pujos, el parto
debe ser inminente despus de 60 minutos. Los pujos
maternos son esenciales para un parto seguro y
deben ser alentados.
Imprescindible
Valoracin
rigurosa
intraparto
Peso estimado
Variedad de nalgas
Actitud de cabeza fetal
Pelvis adecuada
No otra contraindicacin PV
CTG continua tanto en dilatacin como en
expulsivo
Posibilidad de realizar una cesrea urgente
Presencia de dos toclogos
Analgesia adecuada
Asistencia peditrica
Mecanismo para la
cabeza
Aqu#comienza#la#Ayuda#Manual!
Aqu#comienzan#las#Maniobras#para#la#
Cabeza#
#
Maniobras obsttricas
! Pequea extraccin podlica o ayuda manual:
#Frceps
de Piper
Maniobra de Pajot!
#Maniobra de Mauriceau
Gran extraccin
28#
Gran extraccin
Gran%extraccin%
Gran%
extraccin%
Recomendaciones en la
asistencia intraparto
! Mesa a altura adecuada.
! Posicin correcta de EEII de la mujer (evitar flexin exagerada).
! Parto espontneo mnimo hasta el ombligo y si es posible hasta el borde
inferior de la escpula.
! Para disminuir estmulo fetal, rodear el cuerpo con talla estril y hmeda.
! Prevencin del brazo nucal con adecuada traccin vertical hacia el suelo y
rotacional suave.
terminacin.
Puntos controvertidos en la
asistencia intraparto
! Episiotoma debe realizarse, aunque individualizando.
! El asa de cordn no es mandatoria.
! No tiene mucha importancia el hombro que se desprende
Frceps de Piper
Conclusiones
! No hay evidencia que en la presentacin podlica la salud de los RN a largo