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ABNORMALPRESENTATIONS

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Presentation

refers to which anatomical part of the

fetus is leading, that is, is closest to the

pelvic inlet of the birth canal.

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malpresentations

Face presentation

Brow presentation

Breech presentation

Shoulder presentation

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INI!ENE

Breech "#$%% deli&eries'

ephalic malpresentations "#$#(

deli&eries'

)ace presentation occurs in # o) e&er*

+,,-(,, li&e .irths

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FAE PRESENTATION

POSITIONS

Left mentoanterior (LMA)

Right mentoanterior (RMA)

Right mentoposterior (RMP)

Left mentoposterior (LMP)

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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

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!IA/NOSIS

di1ital e2amination

mouth and nose3 the malar .ones3 and

particularl* the or.ital rid1es can .e

palpated4

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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

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BRO5 PRESENTATION

# in #,,, .irths

premature rupture o) mem.ranes ma*

precede .row presentation in as man* as

678 o) cases

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!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

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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

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BREE; PRESENTATION

Positions

Le)t sacroanterior "LSA'

Ri1ht sacroanterior "RSA'

Ri1ht sacroposterior "RSP'

Le)t sacroposterior "LSP

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T*pes o) .reech

omplete .reech or )le2ed .reech

Incomplete .reech

Extended or frank breech

Knee presentation

Footling presentation

complicated .reech

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omplete .reech

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Extended or frank breech

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Knee presentation

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Footling presentation

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Etiolo1* Prematurit*

Maternal )actors

Multiparit# producing uterine rela*ation

+terine obli"uit#

Placenta praevia and cornuofundal attachmentof placenta

+terine fibroids in the lower segment

+terine anomalies li$e bicornuate and septateuterus

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Fetal )actors

Multiple pre1nanc*

Anomalies li9e h*drocephalus

Pol*h*dramnios

Intrauterine death

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!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

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: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

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ME;ANISM OF LABO

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Mana1ement o) term .reech

Electi&e caesarean section

E2ternal cephalic &ersion

Assisted .reech deli&er*

Emer1enc* caesarean section

Breech e2traction

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Assisted Breech !eli&er*

First Stage

vaginal e*amination

maintain intact membranes till full cervical

dilatation

% monitoring and epidural analgesia forlabour are ideal.

Second stage

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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

4Mauriceau Smellie Veil manoeuvre

Forceps for the after coming head

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Lovset's manoeuvre

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Mauriceau Smellie Veilmanoeuvre

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S;O

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!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 inthe other

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OMPO

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Etiolo1*

Prematurit* " commonest '

ontracted pel&is

Pel&ic tumours

Multiple pre1nanc*

Macerated )etus

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