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AND
MALPRESENTATIO
NS
OCCIPITOPOSTERI
OR, FACE, BROW,
SHOULDER
OCCIPITO-POSTERIOR
Vertex presentation
Occiput in post. Segment of pelvis overlying
the sacroiliac jt and sacrum
3 positions described:
1. Right occipitoposterior
2. Left occipitopoterior
3. Direct occipitoposterior
AETIOLOGY
DIAGNOSIS
ABDOMINAL EXAMINATION
Subumbilical flattening
Back is in one or the other flank so clinically
not felt
Limbs felt anteriorly
Shoulder in flanks
Unengaged or high head at term
Occiput and sinciput at same level
Fetal heart sounds in the flanks and are
frequently indistinct
VAGINAL EXAMINATION
Early In Labour-
Late In Labour
MECHANISM OF LABOUR
ENGANGING DIAMETER
Suboccipitofrontal-10.5cm
Occipitofrontal-11.5cm
COURSE OF LABOUR
Failure Of Rotation
Reasons-
MANAGEMENT
1.
2.
PERSISTENT
OCCIPITOPOSTERIOR
FACE PRESENTATION
POSITIONS
Left mentoanterior(LMA)
Right mentoanterior(RMA)
Right mentoposterior(RMP)
Left mentoposterior(LMP)
70% are mentoanterior and 30% posterior.
INCIDENCE AND
AETIOLOGY
Incidence- 1 in 500
Maternal Causes
- contracted pelvis
- obliquity of uterus
- multiparity or pendulous abdomen
Fetal Factors
DIAGNOSIS
ABDOMINAL EXAMINATION
In mentoanterior, back is felt with difficulty as it
is posterior and limbs anteriorly
Head remains high
Cephalic prominence is the occiput and on the
same side as the back
Groove b/w the head and back is prominent
Fetal heart sounds are transmitted through the
chest and heard well anteriorly in
mentoanterior
VAGINAL EXAMINATION
-conical bag of membranes
- chin, mouth, nose, malar eminences and
supraorbital ridges are felt
-in mentoanterior, chin is in one ant. Quadrant
and forehead in opp post. Quadrant
-done gently and without cream to avoid injury
to eyes
MECHANISM OF LABOUR
MENTOANTERIOR POSITION
1. Engagement
-engaging diameter- submentobregmatic-9.4cm
-biparietal diameter-7cm
This diameter pass only when face low down in
perineum
-when face distending the vulva, head engaged
4. FLEXION
-head born by flexion
-chin pivots under symphysis pubis and the
mouth, nose, orbit, forehead ,vertex and
occiput are born by flexion
MENTOPOSTERIOR
COMPLICATIONS
MATERNAL
Prolonged labour
Increased risk of operative delivery
Obstructed labour in persistent
mentoposterior
FETAL
MANAGEMENT
BROW PRESENTATION
Most unfavourable
Attitude is one of partial extension,
presenting part being the area between the
ant. Fontanelle above and glabella and
orbital ridges below and denominator is
forehead or frontum
Presenting diameter is verticomental13.5cm
Transitory presentation- flex or extend
INCIDENCE AND
AETIOLOGY
INCIDENCE-1 in 1000
CAUSE- similar to face presentation and
include any factors that interfers with
flexion of head
DIAGNOSIS
VAGINAL EXAMINATION
MECHANISM OF LABOUR
COMPLICATIONS
Both maternal and fetal risks are more
MATERNAL
Obstructed labour and rupture uterus
FETAL
Birth asphyxia
MANAGEMENT
ANTEPARTUM
Wait till labour
EARLY LABOUR
If membrane not ruptured wait for correction
After membrane rupture, brow presentation
diagnosed and in persistent brow presentation
CS done
Prologed labour with head high.. Brow
presentation must be suspected
LATE LABOUR
If features of obstructed labour or if fetus
dead- immediate CS done
If baby dead- also craniotomy
Dorsoanterior
Dorsoposterior
Dorsosuperior
Dorsoinferior
INCIDENCE AND
AETIOLOGY
Incidence- 1 in 500
MATERNAL FACTOR
Multiparity
Contracted pelvis
Uterine anomalies like septate,bicornuate
and arcuate uterus
Placenta praevia
Fibroid in the lower segment
FETAL FACTORS
Prematurity
Multiple pregnancy
Polyhydraminos
IUD
DIAGNOSIS
ABDOMINAL EXAMINATION
Transversely stretched
Fundal height less than period of gestation
No Fetal pole at fundus
Ballotable head in one flank & breech in the
other
In dorsoanterior, back is felt a uniform
reistance acros the front of abdomen
In dorsoposterior, limbs are felt anteriorly
Empty pelvic grip
VAGINAL EXAMINATION
MECHANISM OF LABOUR
NO mechanism of labour
Spontaneous version to breech or by
spontaneous rectification to vertex can occur
Rarely if fetus small or dead delivery occurs
by:
Spontaneous expulsion or birth corpora
conduplicata where fetus is expelled doubled
up
Spontaneous evolution where breech and
trunk are expelled followed by head
COMPLICATIONS
MATERNAL
Increased chance of caesarean section
Obstructed labour or ruptured uterus
FETAL
Birth asphyxia due to cord prolapse and
in obstructed labour
MANAGEMENT
CAESAREAN SECTION
Best option
When ECV fails and CI
Transverse inscision
NEGLECTED SHOULDER PRESENTATION
If baby dead-CS or craniotomy
Reference