Breech presentation with hydrocephalus is managed by :

Ans. is a, b and c i.e. Cesarean section, Trans-abdominal decompression, PV decompression and Craniotomy of after coming head Management options in case of breech presentation with hydrocephalus Cephalocentesis : In this, excessive fluid is removed thereby reducing the fetal head size, allowing vaginal delivery. It can be done : Per abdomen : A wide bore needle is inseed the maternal abdomen into the fetal head after emptying the bladder. The transabdominal approach is used successfully in both cephalic and breech presentation. ii. Per vaginal : With cephalic presentation, as soon as the cervix is dilated upto 3 - 4cm , ventricles are tapped trans vaginally with a wide bore needle. With breech presentation labour is allowed to progress upto delivery of trunk and shoulders. The needle is inseed transvaginally just below the anterior vaginal wall and into the aftercoming head through the widened suture line. Cesarean Section : recommends all hydrocephalic fetuses should be delivered abdominally, whereas the use of cephalocentesis should be limited to fetuses with severe associated abnormalities. Craniotomy is recommended if the obstetrician is well versed with the technique and is applicable for the forecoming (veex) and the after coming head (breech) in case of hydrocephalus if fetus is dead. Note: In a hydrocephalic fetus if BPD is < 10 cm or if head circumference is < 36 cms, vaginal delivery may be permitted.