All of the following, for women with breech presentation at term seeking vaginal breech delivery is true EXCE… - AIIMS Rishikesh & Jodhpur NO - 2017

AIIMS Rishikesh & Jodhpur NO - 2017

Obstetrics & Gynaecology

Hard

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

The statement that diagnosing breech presentation for the first time in labor is a contraindication to vaginal breech delivery is incorrect.
While not ideal, a late diagnosis does not automatically preclude a trial of vaginal delivery.
If labor is progressing normally and other criteria for a safe vaginal breech birth are met (e.g., adequate pelvis, experienced provider), it may still be attempted.
The decision for cesarean delivery is not based solely on the timing of the diagnosis but on a comprehensive clinical assessment.

Option B: This is a true statement. Continuous electronic fetal heart rate monitoring is a standard of care for high-risk labors, such as breech presentation, to allow for early detection of fetal distress.
Option C: This is a true statement. Vaginal breech delivery involves specific maneuvers and has a higher risk of complications (e.g., head entrapment). It must be attended by a practitioner with demonstrated skill and experience in this type of delivery.
Option D: This is a true statement. Due to the risk of sudden and severe complications that may require immediate surgical intervention, a planned vaginal breech delivery should only occur in a hospital with the capability to perform an emergency cesarean section.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Breech Presentation at Term as background academic context rather than a clinical decision trigger.
Nurses play a critical role in the continuous monitoring of a woman in breech labor, recognizing signs of abnormal progress or fetal distress that require immediate physician notification.
A key nursing responsibility is to ensure all necessary personnel (skilled obstetrician, anesthesiologist, pediatrician) and equipment are immediately available for a planned vaginal breech delivery.
What if? If the fetus were in a footling or incomplete breech presentation, this would be a strong contraindication to a planned vaginal delivery at term due to the significantly increased risk of umbilical cord prolapse before the cervix is fully dilated.

How to Approach the Question

First, identify the negative keyword "EXCEPT" in the question stem. This means you are looking for the statement that is false.
Recall the standard safety protocols for a planned vaginal breech delivery, which is considered a high-risk procedure.
Evaluate each option based on the principles of safe obstetric care.
Option B (continuous monitoring), Option C (skilled provider), and Option D (emergency C-section facility) are all fundamental safety requirements for any high-risk delivery.
Consider Option A. While diagnosing breech late in labor is not ideal as it prevents thorough antenatal planning (like pelvimetry), it is not an absolute contraindication. Clinical decisions are based on the overall picture, including how labor is progressing.
Conclude that the statement claiming a late diagnosis is an absolute contraindication is the false statement and therefore the correct answer.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 24-43