Abnormal foetal lie, malpresentation and malabsorption Flashcards
Define lie
The relationship between the long axis of the foetus and the mother
List the different types of lie
Longitudinal
Transverse
Oblique
Define presentation
The foetal part that first enters the maternal pelvis
Which presentation is most common/safest?
Cephalic vertex presentation
List the presentations
Cephalic vertex Breech Shoulder Face Brow
Define position
The position of the foetal head as it exits the birth canal
Describe the usual position of the foetus
The foetal head engages in the occipto-anterior position
What other positions occur?
Occipito-posterior and occipito-transverse
List some risk factors for abnormal foetal lie , malpresentation and malposition
Prematurity Multiple pregnancy Uterine abnormalities Foetal abnormalities Placenta praevia Primiparity
How is abnormal foetal lie, position and presentation identified?
Abdominal examination
Lie - face the patients head, place your hands on either side of uterus and gently apply pressure, one side will feel fuller and firmer (back and foetal limbs may feel knobbly on the opposite side)
Presentation - face the patients head, palpate the lower uterus with the fingers of both hands, the head feels hard and round (cephalic) and the bottom feels soft and triangular (breech)
Vaginal examination
Position - during labour assess position of the head, landmarks of foetal head includes anterior and posterior fontanelles
What might make foetal lie and presentation difficult to identify?
Maternal high BMI
Full bladder
Small foetus
Polyhydramnios
What investigations can be done to detect malpresentation and abnormal foetal lie
Ultrasound scan
How is abnormal foetal lie managed?
External cephalic version (36-38 weeks)
What are the complications of ECV?
Foetal distress
Premature rupture of membranes
Antepartum haemorrhage
Placental abruption
Who is ECV contraindicated in?
Recent APH
Ruptured membranes
Uterine abnormalities
Previous C-section
How is breech malpresentation managed?
ECV before labour
Vaginal breech delivery
C-section
How is brow malpresentation managed?
C-section
How is face malpresentation managed?
If the chin is anterior a normal labour is possible, however it is likely to be prolonged and there is an increased risk of a C-section being required
If chin is posterior C-section is necessary
How is shoulder malpresentation managed?
C-section
What percentage of malposition spontaneously resolve?
Occipito-anterior as labour progresses
How is malposition managed if the foetal head does not rotate?
Rotation and operative vaginal delivery can be attempted
C-section can be performed
