I have a question regarding our new 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?
Great question. We are very glad that you brought this forward. 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.