ABNORMAL PRESENTATIONS

Presentation refers to whichanatomical partof the

fetus is leading, that is, is closest to the pelvic inlet of the birth canal.

malpresentations

Face presentation Brow presentation Breech presentation Shoulder presentation

IN I!EN E

Breech "#$%% deli&eries' ephalic malpresentations "#$#( deli&eries'

)ace presentation occurs in # o) e&er* +,,-(,, li&e .irths

FA E PRESENTATION

POSITIONS Left mentoanterior (LMA) Right mentoanterior (RMA) Right mentoposterior (RMP) Left mentoposterior (LMP)

AETIOLO/0
Maternal Factors

ontracted pelvis !bli"uit# of uterus Multiparit# and pendulous abdomen

Fetal Factors

Anencephal# ord around the nec$ %umours of nec$ li$e congenital goitre &pasm of sternocleidomastoid muscle

!IA/NOSIS

di1ital e2amination mouth and nose3 the malar .ones3 and

particularl* the or.ital rid1es can .e palpated4

omplications
Maternal

Prolonged labour 'ncreased ris$ of operative deliver# !bstructed labour in persistent mentoposterior (etal

%he face after deliver# is oedematous and swollen. Lar#ngeal oedema )irth asph#*ia

BRO5 PRESENTATION
# in #,,, .irths premature rupture o) mem.ranes ma* precede .row presentation in as man* as 678 o) cases

!ia1nosis

a.dominal palpation .* Leopold maneu&ers4 prominent occipital prominence is

encountered alon1 the )etal .ac93 and the )etal chin is also palpa.le

:a1inal e2amination The mouth and chin are not palpa.le

La.or Mana1ement

close o.ser&ation ontinuous electronic )etal heart rate monitorin1 O2*tocin can .e used to au1ment la.or esarean deli&er* is per)ormed )or the usual o.stetrical indications3 includin1 arrest o) la.or and nonreassurin1 )etal heart rate pattern

Internal podalic &ersion and .reech e2traction are no lon1er recommended

BREE ; PRESENTATION
Positions

Le)t sacroanterior "LSA' Ri1ht sacroanterior "RSA' Ri1ht sacroposterior "RSP' Le)t sacroposterior "LSP

T*pes o) .reech

omplete .reech or )le2ed .reech Incomplete .reech Extended or frank breech Knee presentation Footling presentation

complicated .reech <ncomplicated .reech

omplete .reech

Extended or frank breech

Knee presentation

Footling presentation

Etiolo1*

Prematurit* Maternal )actors Multiparit# producing uterine rela*ation +terine obli"uit# Placenta praevia and cornuofundal attachment of placenta +terine fibroids in the lower segment +terine anomalies li$e bicornuate and septate uterus

Fetal )actors

Multiple pre1nanc* Anomalies li9e h*drocephalus Pol*h*dramnios Intrauterine death

!IA/NOSIS
A.dominal e2amination

;ead o) the )etus is )elt in the )undal 1rip4 Breech is )elt in the )irst pel&ic 1rip4 Fetal heart is heard a.o&e the um.ilicus4

:a1inal E2amination

onical .a1 o) mem.ranes4 Presentin1 part is hi1h up4 In )le2ed .eech3 the ischial tu.erosities3 anus3 sacrum3 .uttoc9s and )eet are palpated4

ME ;ANISM OF LABO<R

Mana1ement o) term .reech

Electi&e caesarean section E2ternal cephalic &ersion Assisted .reech deli&er* Emer1enc* caesarean section Breech e2traction

Assisted Breech !eli&er*

First Stage

vaginal e*amination maintain intact membranes till full cervical dilatation %, monitoring and epidural analgesia for labour are ideal.

Second stage

!eli&er* o) the .reech !eli&er* o) the Shoulders Lovset's manoeuvre

!eli&er* o) the A)ter omin1 ;ead Burns Marshall manoeuvre 4 Mauriceau Smellie Veil manoeuvre

Forceps for the after coming head

Lovset's manoeuvre

Mauriceau Smellie Veil manoeuvre

S;O<L!ER PRESENTATION
# in =,, positions

Ri1ht acromial Le)t acromial

!IA/NOSIS

Abdomen is transversel# stretched (undal height is less than the period of gestation

-o fetal pole at the fundus )allotable head in one flan$ and breech in the other

OMPO<N! PRESENTATION
In a compound presentation3 there is prolapse o) one or more lim.s alon1 with the head or .reech3 .oth enterin1 the pel&is at the same time

Etiolo1*

Prematurit* " commonest ' ontracted pel&is Pel&ic tumours Multiple pre1nanc* Macerated )etus