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Y4R2 - Obstetrics I 🤰 > L5: Malpresentation & Malposition (Face) > Flashcards

L5: Malpresentation & Malposition (Face) Flashcards

1
Q

Def of Face Presentation

A
  • Cephalic malpresentation in which presenting part is face, denominator is mentum (chin) & head is extended.
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2
Q

Incidence of Face Presentation

A

1/300-1/400 of deliveries.

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3
Q

Positions of Face Presentation

A
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4
Q

Positions of Face Presentation

  • Which is more common, Anterior or Posterior? why?
A
  • MA positions (70%) are more common than MP positions (30%)
  • Because face presentation is the result of extension of deflexed head in OP position (ROP extends to LMA while LOP extends to RMA).
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5
Q

Most Common Position in Face Presentation

A

LMA

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6
Q

Types of Face Presentation

A

1ry & 2ry

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7
Q

Def of 1ry Face Presentation

A

Occurs during pregnancy before onset of labor

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8
Q

Etiology of 1ry Face Presentation

A
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9
Q

Def of 2ry Face Presentation

A
  • Develops during labor (common) & occurs in cases of OP positions associated e any condition which retards descent of occiput & encourages descent of sinciput
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10
Q

Etiology of 2ry Face Presentation

A
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11
Q

Mechanism of Labor in MA Position

A
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12
Q

Mechanism of Labor in MA Position

  • Descent
A

Slow

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13
Q

Mechanism of Labor in MA Position

  • Engagment
A

Engaging longitudinal diameter is SMB (9.5 cm)

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14
Q

Mechanism of Labor in MA Position

  • Increased EXTENSION
A

Chin becomes the lower most part of head.

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15
Q

Mechanism of Labor in MA Position

  • Internal Rotation
  • Flexion
A
  • Chin reaches pelvic floor 1st → rotates anteriorly 1/8 circle → becomes direct mentoanterior (DMA).
  • Submental region impinges under symphysis pubis & head is delivered by flexion.
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16
Q

Mechanism of Labor in MA Position

  • Restitution
A

Chin rotates 1/8 circle in opposite direction of internal rotation.

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17
Q

Mechanism of Labor in MA Position

  • External Rotation
A

Chin rotates 1/8 circle in the same direction of restitution due to internal rotation of anterior shoulder from oblique diameter to A-P diameter.

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18
Q

Mechanism of Labor in MA Position

  • Delivery of shoulders & Trunk & Legs
A

As normal Labor

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19
Q

Mechanism of Labor in MP Position

A
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20
Q

Mechanism of Labor in MP Position

  • Descent
A

Slower

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21
Q

Mechanism of Labor in MP Position

  • Engagement
A

Engaging longitudinal diameter is SMB (9.5 cm).

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22
Q

Mechanism of Labor in MP Position

  • Increased Extension
A

Chin becomes the lower most part of head.

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23
Q

Mechanism of Labor in MP Position

  • Internal Rotation
A
  • Normal Mechanims
  • Abnormal Mechanisms
24
Q

Internal Rotation in MP Position

  • Normal Mechanism
A
25
Q

Internal Rotation in MP Position

  • Abnormal Mechanisms
A
  • Short Anterior Rotation
  • No Rotation
  • Posterior Rotation
26
Q

Internal Rotation in MP Position

  • Short Anterior Rotation
A
27
Q

Internal Rotation in MP Position

  • No Rotation
A
28
Q

Internal Rotation in MP Position

  • Posterior Rotation
A
29
Q

Internal Rotation in MP Position

  • Posterior Rotation, why can’t it be delivered vaginaly like DOP?
A
30
Q

Dx of Face Presentation

A
  • During Pregnancy
  • During labor
31
Q

Dx of Face Presentation

  • During Pregnancy
A
32
Q

Dx of Face Presentation During Pregnancy

  • Hx
A

In MA positions, fetal movements are painful & felt on both sides of abdomen.

33
Q

Dx of Face Presentation During Pregnancy

  • Abdominal Ex
A
34
Q

Dx of Face Presentation During Pregnancy

  • US
A

To confirm diagnosis & exclude congenital anomalies.

35
Q

Dx of Face Presentation During Labor

A
36
Q

Dx of Face Presentation During Labor

  • Hx
A

As During pregnancy

37
Q

Dx of Face Presentation During Labor

  • Abdominal Ex
A

As During pregnancy

38
Q

Dx of Face Presentation During Labor

  • Vaginal Examination
A
39
Q

Dx of Face Presentation During Labor

  • US
A

To confirm diagnosis & exclude congenital anomalies.

40
Q

Managment of Face Presentation

A
  • During Pregnancy
  • During Labor
41
Q

Managment of Face Presentation

  • During Pregnancy
A
42
Q

Managment of Face Presentation During Pregnancy

A
43
Q

Managment of Face Presentation During Labor

A
  • 1st Stage
  • 2nd Stage
  • 3rd Stage
44
Q

Managment of Face Presentation During Labor

  • 1st Stage
A

As OP position (see before).

45
Q

Managment of Face Presentation During Labor

  • 2nd Stage
A
  • MA
  • MP
46
Q

Managment of Face Presentation During Labor

  • 2nd Stage in MA
A
47
Q

Managment of Face Presentation During Labor

  • 2nd Stage in MP
A

Wait for 2 hours + observe mother & fetus + give oxytocin drip to correct inertia (if there are no contra indications), Then:

  • Normal Mechanism
  • Abnormal Mechanisms
48
Q

Managment of Face Presentation During Labor

  • 2nd Stage in MP (Long anterior Rotation)
A

The rest of management is as MA.

49
Q

Managment of Face Presentation During Labor

  • 2nd Stage in MP (Long anterior Rotation didn’t occur)
A
50
Q

Managment of Face Presentation During Labor

  • 3rd Stage
A

As OP position (see before).

51
Q

Complications of Face Presentation

A
52
Q

MA positions are favorable than MP positions because …..

A
53
Q

Labor is usually prolonged in face presentation due to …..

A
54
Q

Def of DTA

A
55
Q

Types of DTA

A
  • DTA in OP
  • DTA in Face
56
Q

Compare beween DTA in OP & Face

A
57
Q

Compare beween DTA in OP & Face in terms of:

  • Incidence
  • Mechanism of occurence
  • Dx
  • Managment
  • Complications
A

Y4R2 - Obstetrics I 🤰 (52 decks)

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