asked 2 years ago
I have a question regarding the Emergency Childbirth Medical Directive. My understanding from the protocol is that we can stay on scene to deliver a breech presentation, but for a limb presentation we must transport immediately. I know that we can deliver a complete breech and a frank breech, but what about a footling breech? Is that considered to be a limb presentation that requires immediate transport?
1 Answers
answered 2 years ago
Great question. A limb presentation includes when either an arm OR a leg (such as in a footling breech) is presenting first. Although a footling breech falls technically under the umbrella term of “Breech”, which involves a stay-on-scene initial approach, a “footling” would be considered a limb presentation, which is as you mention an indication for immediate transport under the Load and Go Standard within the BLS-PCS.
The reason for this being a 3x increased risk of cord prolapse (5 vs 15%, Breech vs Footling respectively). Cord prolapse causes ischemia to the fetus and therefore is associated with high rates of fetal morbidity and mortality. Management of cord prolapse is emergent C-section. Therefore, this condition is correlated with increased rates of cord prolapse and is therefore an indication for Load and Go.
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