L5: Malpresentation & Malposition (Face) Flashcards by Ahmed Farag

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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Q

Incidence of Face Presentation

A

1/300-1/400 of deliveries.

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Q

Positions of Face Presentation

A

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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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Q

Most Common Position in Face Presentation

A

LMA

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Q

Types of Face Presentation

A

1ry & 2ry

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Q

Def of 1ry Face Presentation

A

Occurs during pregnancy before onset of labor

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Q

Etiology of 1ry Face Presentation

A

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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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Q

Etiology of 2ry Face Presentation

A

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Q

Mechanism of Labor in MA Position

A

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Q

Mechanism of Labor in MA Position

Descent

A

Slow

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Q

Mechanism of Labor in MA Position

Engagment

A

Engaging longitudinal diameter is SMB (9.5 cm)

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Q

Mechanism of Labor in MA Position

Increased EXTENSION

A

Chin becomes the lower most part of head.

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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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Q

Mechanism of Labor in MA Position

Restitution

A

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

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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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Q

Mechanism of Labor in MA Position

Delivery of shoulders & Trunk & Legs

A

As normal Labor

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Q

Mechanism of Labor in MP Position

A

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Q

Mechanism of Labor in MP Position

Descent

A

Slower

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Q

Mechanism of Labor in MP Position

Engagement

A

Engaging longitudinal diameter is SMB (9.5 cm).

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Q

Mechanism of Labor in MP Position

Increased Extension

A

Chin becomes the lower most part of head.

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Q

Mechanism of Labor in MP Position

Internal Rotation

A

Normal Mechanims
Abnormal Mechanisms

Q

Internal Rotation in MP Position

Normal Mechanism

A

Internal Rotation in **MP Position** - Abnormal Mechanisms

- Short Anterior Rotation - No Rotation - Posterior Rotation

Internal Rotation in **MP Position** - Short Anterior Rotation

Internal Rotation in **MP Position** - No Rotation

Internal Rotation in **MP Position** - Posterior Rotation

Internal Rotation in **MP Position** - Posterior Rotation, why can't it be delivered vaginaly like DOP?

Dx of **Face Presentation**

- During Pregnancy - During labor

Dx of **Face Presentation** - During Pregnancy

Dx of **Face Presentation** During Pregnancy - Hx

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

Dx of **Face Presentation** During Pregnancy - Abdominal Ex

Dx of **Face Presentation** During Pregnancy - US

To confirm diagnosis & exclude congenital anomalies.

Dx of **Face Presentation** During Labor

Dx of **Face Presentation** During Labor - Hx

As During pregnancy

Dx of **Face Presentation** During Labor - Abdominal Ex

As During pregnancy

Dx of **Face Presentation** During Labor - Vaginal Examination

Dx of **Face Presentation** During Labor - US

To confirm diagnosis & exclude congenital anomalies.

Managment of **Face Presentation**

- During Pregnancy - During Labor

Managment of **Face Presentation** - During Pregnancy

Managment of **Face Presentation** During Pregnancy

Managment of **Face Presentation** During Labor

- 1st Stage - 2nd Stage - 3rd Stage

Managment of **Face Presentation** During Labor - 1st Stage

As OP position (see before).

Managment of **Face Presentation** During Labor - 2nd Stage

- MA - MP

Managment of **Face Presentation** During Labor - 2nd Stage in MA

Managment of **Face Presentation** During Labor - 2nd Stage in MP

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

Managment of **Face Presentation** During Labor - 2nd Stage in MP (Long anterior Rotation)

The rest of management is as MA.

Managment of **Face Presentation** During Labor - 2nd Stage in MP (Long anterior Rotation didn't occur)

Managment of **Face Presentation** During Labor - 3rd Stage

As OP position (see before).

Complications of **Face Presentation**

MA positions are favorable than MP positions because .....

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

Def of **DTA**

Types of **DTA**

- DTA in OP - DTA in Face

Compare beween DTA in OP & Face

Compare beween DTA in OP & Face in terms of: - Incidence - Mechanism of occurence - Dx - Managment - Complications