15) Fetal malpresentation - shoulder , compound Flashcards
what is fetal malpresentation ?
malpresentation encompasses any presentation which is not vertex
what are all the fetal malpresentation ?
compound
shoulder
breech
what type of lie does baby have to be a shoulder presentation ?
transverse lie , vertebral column is perpendicular to the mother
thus the leading part is an arm or a shoulder
what is the etiology of shoulder presentation ?
Multiparity— lax and pendulous abdomen, imperfect uterine
tone and extreme uterine obliquity
prematurity
twins - second baby
hydramnios
bony abnormalities of pelvis
uterine tumors
polyhydraminos
when the amniotic fluid ruptures the shoulder or arm may become wedged as a shoulder presentation to
how do we diagnose a shoulder presentation ?
leopard manuevers
ultrasound
on vaginal examination the absence of head or feet
Elongated bag of the membranes can be felt if it does not rupture prematurely. The shoulder is identified by palpating the following parts—acromion process, the scapula, the clavicle and axilla
how are shoulder presentations sub classified ?
shoulder presentation are classified into four types based on location of scapula
left scapula anterior
right scapula anterior
left scapula posterior
right scapula posterior
what is the clinical management of shoulder presentation ?
ANTENATAL: External cephalic version should be done in all cases beyond 36 weeks
If version fails or is
Elective cesarean section is the preferred method of delivery.
however the uterus normally will not allow the version
and would need C section
what will it look like if it is vaginal birth for shoulder presentation
During labour the shoulder will be wedged into the pelvis and the head will in in one iliac fossa, with further uterine contraction the baby will suffocate.
uterus tries to expel the impacted fetus and as the retraction ring rises the musculature in the lower segment thins out leading eventually to uterine rupture and death of the mother
Bandl’s ring also known as the pathological retraction ring is the abnormal junction between the the two segments of the uterus
late sign for obstructed labour .
high risk for bandy ring formation
what is compound presentation ?
involves the extremity to be part of the vertex presentation presentation
less commonly the feet with vertex presentation , more commonly the hand or arm in vertex
hand or arm present along the breech.
when are compound presentation more observed in ?
premature rupture of membranes
preterm labour with pelvic masses displacing the fetal pole
more likely also with induced labour than spontaneous events
contracted pelvis
multiple pregnancy
what is the diagnosis of compound presentation?
vaginal examination ervical os is sufficiently dilated to feel the limb
how is compound presentation clinically managed ?
best accomplished with the babies normal reflexes - so applying a benign noxious stimulus such as a gentle pink to a fingertip of the advancing hand between contractions the hand may withdraw
less often gentle pressure upward may displace it successfully
if these manuevers are not successful labour can continue as normal if it is the vertex portion
if complete extremity prolapses and the fetus converts into a shoulder presentation delivery should be through c section
in which lie is there no mechanism of labour ?
transverse lie
