36. ABNORMAL LIE, MALPRESENTATIONS, and MALPOSITIONS Flashcards
Abnormal Lie?
Transverse and Oblique
Malpresentation?
Breech, Brow, Face and Cord
Malposition
Occipito-Posterior
What causes abnormal lies, malpresentation and malposition?
Maternal Factors: Pelvic size, uterus abnormalities, placenta previa, multiparity, preterm labour
Foetal factors: Macrosomia (D), Multiple pregnancy, polyhydramnios (D), congenital abnormalities, IUFD.
Clinical Consequences of the abnormal lie, malpresentation and malpositions.
High Presenting part, early rupture of membranes, Slow dilation of the cervix, CPD, uterine rupture, pathological (Bandl’s) retraction ring
What is CPD?
Cephalopelvic disproportion (CPD) is a condition where the baby’s head or body is too large to fit through the mother’s pelvis.
Causes: Macrosomia, abnormal presentation, Hydrocephalus, pelvic size, obesity, multiple gestation.
Clinical Consequences of the abnormal lie, malpresentation and malpositions on the Mother.
Maternal exhaustion: HIE
Trauma
C-section
Post-partum haemorrhage
Infection
Paralytic ileus (intestines are temporarily paralyzed)
Psychological: bonding and future pregnancies.
Clinical Consequences of the abnormal lie, malpresentation and malpositions on the Foetus.
Excessive caput succedaneum and molding of the foetal head, fetal asphyxia, fetal trauma, cord prolapse.
Risk of transverse lie
Risk of cord prolapse: intrapartum haemorrhage and HIE.
What is external cephalic version (ECV)?
Procedure used in obstetrics of turn a transverse or breech presentation to cephalic. Done late in pregnancy between 36-38 weeks pregnancy.
How to diagnosed Brow presentation on vaginal examination?
Can palpate the anterior fontanelle, supraorbital ridges and the bridge of the nose.
What is the vertical diameter of a brow presentation?
13.5 cm
Face presentations that can be delivered vaginally
Submentobregmatic diameter = 9.5 = Suboccipito-bregmatic diameter.
