L5: Malpresentation & Malposition (Complex) Flashcards
Def of Complex (Compound) Presentation
- Prolapse of ≥ 1 fetal limb beside head or breech (footling & shoulder presentations aren’t included in this group
Incidence of Complex (Compound) Presentation
1 is complex per each 1000
Types of Complex (Compound) Presentation
Etiology of Complex (Compound) Presentation
- General causes of malpresentations.
Dx of Complex (Compound) Presentation
Dx of Complex (Compound) Presentation
- Suspicion
1) Delayed progress in active phase of labor.
2) Failure of engagement.
3) Fetal head remains high & deviated from midline during labor (especially after ROM).
Dx of Complex (Compound) Presentation
- Definitive Dx
- Condition is only diagnosed on PV examination (limb is present beside head or breech).
Dx of Complex (Compound) Presentation
- PV
Condition is only diagnosed on PV examination (limb is present beside head or breech).
Management of Complex (Compound) Presentation
- Depends on
Management of Complex (Compound) Presentation
- If Labor is ptogressing
- Don’t interfere (the best treatment for complex presentation in absence of complications is masterful inactivity).
Management of Complex (Compound) Presentation
- If labor is arrested
Management of Complex (Compound) Presentation
- If labor is arrested (Reposition)
Reposition of prolapsed limb:
- in normal pelvis, it is done under anesthesia & head is pushed into pelvis.
Management of Complex (Compound) Presentation
- if labor is arrested (Forceps)
but take care not to include limb in forceps.
1. if the head is engaged
2. if cervix is fully dilated.
Management of Complex (Compound) Presentation
- if labor is arrested (CS)
- if head isn’t engaged.
- if reposition isn’t feasible or is unsuccessful.
- if there is other obstetric indication for CS.
Management of Complex (Compound) Presentation
- if labor is arrested (IPV)
Has no role as it carries high risk of rupture uterus & fetal death.
