Thursday, August 24, 2017

The Tsovyanov maneuvers for frank and footling breech

I discovered two maneuvers for assisting frank and footling breeches while wading through PubMed literature on breech from the 1950s. I've never heard of anything like it before. It was introduced by N.A. Tsov'ianov in the Russian medical journal Sovetskaia Meditsina in 1951 in an article titled New method of conduction of labor in breech presentation.

Tsov'ianov (also spelled Tsovyanov) apparently introduced two maneuvers. Maneuver I was for frank breech presentations; maneuver II was for footlings.

I'm having a hard time finding details about these maneuvers, since all of the articles are in Russian and the references on PubMed do not include abstracts. However, I did find this website about breech pregnancy and birth written hosted by Ternopil State Medical University in the Ukraine and written by I. Kuziv. A friend of mine living in Russia, Katerina Perkhova, sent me the illustrations.

Here is Kuziv's summary of the "Tsovyanov I" maneuver for breech breech babies:
The manual aid by Tsovyanov I in frank breech presentations.

The aim of the manual aid: to prepare the maternal ways to the delivery of the head and shoulders and to keep the normal attitude of the fetus.

In the frank breech presentation the fetus extremities are flexed at the hips and extended at the knees and thus the feet lie in close proximity to the head. The circumference of the thorax with the crossing on it arms and legs is larger than circumference of the head and the after-coming head deliveries easily.

The technique. The aid begins after the delivery of the buttocks. The obstetrician’s hands are applied over the buttocks, the thumbs placed on the fetus sacrum and other fingers on the legs. The doctor gently supports the legs to avoid its flexion. If the normal attitude of the fetus is keeping the head deliveries easy.

It appears that the attendant holds the legs against the torso, keeping the feet near the head for as long as possible.

Here is Kuziv's summary of the "Tsovyanov II" maneuver for footling breech babies.
The manual aid by Tsovyanov II in footling presentations.

The aim of the manual aid: To perform [convert?] the footling presentation to the incomplete breech and to prepare the maternal ways to the delivery of the head and shoulders.

The doctor covers the area of the vulva with the sterile napkin and puts up resistance to the delivery of the feet. The feet are flexing and the footling presentation becomes incomplete breech presentation. Than the delivery manage as in incomplete breech presentation.

I think the author means that this second technique converts a footling presentation into a presentation where one or both hips are flexed. "Preparing the maternal ways" refers to creating a large enough diameter in the fetal presenting parts for the fetal head to pass through easily.

Thoughts? Comments? Are the Tsovyanov methods still taught in Russia, the Ukraine, or other countries in that region?


Post a Comment

Related Posts Plugin for WordPress, Blogger...