A primigravida woman presents with a breech presentation. The nurse should be aware of which possible complic… - NORCERT 8 Mains-2025

NORCERT 8 Mains-2025

Obstetrics & Gynaecology

Medium

Appeared in: NORCERT 8 Mains-2025

Explanation

Breech presentation significantly increases the risk of umbilical cord prolapse, an obstetric emergency.
This occurs because the presenting part (buttocks or feet) does not fit as snugly into the maternal pelvis as the fetal head does, leaving space for the cord to descend.
The risk is highest after the rupture of membranes, as the gush of amniotic fluid can carry the cord down ahead of the fetus.
Compression of the prolapsed cord between the fetal presenting part and the maternal pelvis can cut off the fetus's oxygen supply, leading to hypoxia, brain damage, or death.

Option A: Preterm labor is an associated condition or a cause of breech presentation, not a complication that results from it. Breech is more common in preterm infants as they may not have had time to turn to a head-down position.
Option B: Quickening is the mother's first perception of fetal movement, a normal physiological event of pregnancy that typically occurs between 16 and 20 weeks. It is not a complication.
Option D: Oligohydramnios (low amniotic fluid) is a potential cause of breech presentation because it restricts fetal movement, preventing the fetus from turning to a head-down position. It is not a complication caused by the breech presentation itself.

Visual 1: Diagram: Comparison of cephalic vs. breech presentation, showing how the fetal head effectively seals the pelvic inlet while the breech presentation leaves gaps, increasing the risk for cord prolapse.
Visual 2: Illustration: Depiction of umbilical cord prolapse in a footling breech presentation, clearly showing the cord preceding the fetal feet through the cervix.

Clinical Relevance

Nursing practice connection: Use the key finding related to Complications of Breech Presentation to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant for signs of cord prolapse in any laboring patient with a known breech presentation, especially after rupture of membranes. This includes continuous fetal heart rate monitoring to detect sudden, severe variable decelerations or bradycardia.
Immediate recognition and intervention are critical. The nurse's first action upon discovering a prolapsed cord is to relieve pressure on the cord by manually elevating the presenting part and repositioning the mother (e.g., knee-chest or Trendelenburg) while simultaneously calling for help and preparing for an emergency cesarean section.
What if? If the patient with a breech presentation has intact membranes, the risk of cord prolapse is significantly lower. However, the potential for this emergency still exists, and the care team must be prepared for an immediate C-section if membranes rupture and prolapse occurs.

How to Approach the Question

First, identify the core clinical scenario: a primigravida with a breech presentation.
Next, understand the question's focus: it specifically asks for a complication of this presentation, meaning a problem that can happen because of the breech position.
Analyze the options by considering the cause-and-effect relationship. Ask, 'Does the breech presentation directly cause this condition, or is it merely associated with it?'
Evaluate 'Preterm labor' and 'Oligohydramnios'. Recognize that these are often causes or associated factors for a breech presentation, not complications resulting from it.
Evaluate 'Quickening'. Identify this as a normal physiological event in pregnancy, unrelated to complications.
Evaluate 'Cord prolapse'. Understand the mechanical reason why a breech presentation creates a poor seal at the cervix, allowing space for the cord to slip down. This establishes a direct cause-and-effect relationship.

Concept Tested & Keywords

Concept Tested: Complications of Breech Presentation
Stem keywords: primigravida, breech presentation, complication
Lead-in keywords: which possible
Clinical cues: Breech presentation is a key cue, signaling a higher risk for specific complications compared to a cephalic presentation.

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