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Appreciating Complex Midwifery Care > Malposition and Presentation > Flashcards

Malposition and Presentation Flashcards

1
Q

What are the 6 main types of presentation?

A
  1. Vertex
  2. Brow
  3. Face
  4. Breech
  5. Shoulder (dorsoanterior)
  6. Shoulder (dorsoposterior_
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2
Q

What is malposition?

A

Where the occiput is in one of the other posterior quadrant of the pelvis; the foetus adopts a deflexed attitude as in an OP position

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3
Q

What is malpresentation?

A

Any presentation other than vertex (foetus adopts an extended attitude)

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4
Q

How is the engagement of the PP different in primips and multips?

A 
Primips = head usually engages at 32/40 but often comes back out for baby to move position
Multips = head engages and rarely comes back out
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5
Q

What is lie?

A

The relationship of the long axis of the foetus to the long axis of the uterus

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6
Q

What are the 3 types of lie?

A
  1. Longitudinal
  2. Oblique
  3. Transverse
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7
Q

What is presentation?

A

The part of the foetus lying in the lower pole of the uterus

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8
Q

What is position?

A

The denominator and the position in relation to the woman’s pelvis

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9
Q

What are the 7 types of position?

A
  1. Direct OA
  2. ROA
  3. LOA
  4. Direct OP
  5. ROP
  6. LOP
  7. LOT/ROT
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10
Q

What are the 3 types of denominator?

A
  1. Occiput
  2. Sacrum
  3. Mentum
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11
Q

What is attitude?

A

The relationship of the foetal head and limbs to the body

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12
Q

What are the 3 types of attitude?

A
  1. Fully flexed (head forward)
  2. Poorly flexed (straight line)
  3. Extended (head back)
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13
Q

What are the 4 sutures on the foetal skull?

A
  1. Frontal
  2. Coronal
  3. Sagittal
  4. Lamboidal
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14
Q

What are the 4 bones of the foetal skull?

A
  1. Frontal
  2. Coronal
  3. Parietal
  4. Occipital
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15
Q

What are the 8 diameters of the foetal skull?

A
  1. Bi-parietal (9.5cm)
  2. Bi-temporal (8cm)
  3. Suboccipitobregmatic (9.5cm)
  4. Suboccipitofrontal (10cm)
  5. Occipitofrontal (11.5cm)
  6. Mento-vertical (13cm)
  7. Submentobregmatic (9.5cm)
  8. Submentovertical (11cm)
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16
Q

What diameters cause a vertex PP?

A

Suboccipitobregmatic (well flexed) and Suboccipitofrontal (poorly flexed/deflexed)

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17
Q

What diameter causes a brow PP?

A

Mentovertical

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18
Q

What diameters cause a face PP?

A

Submentobregmatic (fully extended) and Submentovertical (not fully extended)

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19
Q

What are the 3 diameters of the pelvic brim?

A 
AP = 11cm
Oblique = 12cm
Transverse = 13cm
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20
Q

What are the 3 diameters of the pelvic cavity?

A 
AP =  12cm
Oblique = 12cm
Transverse = 12cm
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21
Q

What are the 3 diameters of the pelvic outlet?

A 
AP = 13cm
Oblique = 12cm
Transverse = 11cm
22
Q

Give some of the causes of OP position

A
  • Maternal position and lifestyle
  • Android/anthropoid pelvis (Myles)
  • Anterior placenta
  • Epidural and synto
  • Nulliparity
  • Increased mat age/ gestation
23
Q

How can OP position be diagnosed antenatally?

A
  • Inspection of abdomen (dip near umbilicus)
  • Palpation
  • FH auscultation
24
Q

What does the OP position increase the risk of?

A

IOL for postdates; don’t go into established labour as head cant descend

25
Q

How can OP position be diagnosed in labour?

A
  • Listen to the woman
  • Inspection and palpation
  • FHR round side/deep
  • VE (feel ears, see which way they move)
  • Progress of labour (e.g. early SROM, incoordinate contractions)
26
Q

What might the woman say that suggests the baby is in an OP position?

A
  • Reduced FM
  • Severe back pain
  • Urge to push in early labour
27
Q

What are the first 5 steps of long rotation?

A
  1. Occipitofrontal diameter engages in R oblique diameter
  2. Increasing flexion and descent = sub-occipito bregmatic diameter in pelvic cavity
  3. Occiput meets resistance of pelvic floor and rotates forwards
  4. Head now in same position as occipitoanterior mechanism
  5. Shoulders follow head from left to right oblique
28
Q

What are the last 5 steps of long rotation?

A
  1. Head is born by extension
  2. Restitution
  3. Internal rotation of shoulders
  4. External rotation of head to mother’s right
  5. Lateral flexion
29
Q

What are the first 5 steps of short rotation?

A
  1. Occipitofrontal diameter engages in right oblique diameter
  2. Descent occurs with little/no flexion
  3. Sinciput meets the resistance of the pelvic floor and rotates forward
  4. Occiput passes into the hollow of the sacrum
  5. Shoulder enters the pelvis in left oblique
30
Q

What are the last 5 steps of short rotation?

A
  1. The root of the nose pivots under the pubic arch
  2. Occiput sweeps the pelvic floor by flexion and face is born by extension
  3. Restitution
  4. External rotation of the head
  5. Lateral flexion
31
Q

Describe the process of Deep Transverse Arrest

A
  1. Head descends with some flexion
  2. Head starts long rotation but flexion not maintained and head caught in bi-spinous diameter of the outlet in deflexed position
  3. Head cannot deliver

= Obstetric emergency

32
Q

What are the usual outcomes of OP position?

A
  • Deflexed head (long rotation to OA)
  • Deflexed head (long rotation but deep transverse arrest)
  • Deflexed head (short rotation to direct OP)
  • High deflexed head - partial extension = brow
  • Full extension = face
33
Q

Why is maternal/perinatal morbidity increased in OP position?

A
  • Obstructed labour
  • Maternal exhaustion
  • Epidural and instrumental
  • Trauma
  • Cord prolapse
  • Moulding (prolonged labour)
  • Hypoxia
  • PPH
34
Q

What are the causes of face presentation?

A
  • Pelvis shape
  • Grand multiparity
  • Polyhydramnios
  • Multiple coils of cord around neck
  • Anencephalic foetus
  • Prematurity
35
Q

How can face presentation be diagnosed antenatally?

A
  • Non-engaged head
  • Deep groove between head and back palpable
  • Difficult to identify
36
Q

How can face presentation be diagnosed during labour?

A
  • VE (eyes, nose, mouth)

- PP high, soft and irregular

37
Q

Why are facial features harder to palpate as labour progresses?

A

Facial oedema

38
Q

What is usually the presenting diameter in face presentation?

A

9.5cm

39
Q

What are the first 5 steps of the mento-anterior mechanism?

A
  1. Descent with extension of the head
  2. Mentum = leading part
  3. Internal rotation of the head; chin reaches pelvic floor and rotates forward
  4. Chin escaped under symphysis pubis
  5. Flexion of head; sinciput, vertex and occiput sweep perineum
40
Q

What are the last 4 steps of the mento-anterior mechanism?

A
  1. Restitution; mentum turns to original side of back
  2. Internal rotation of shoulders (anterior shoulder rotates)
  3. External rotation of head
  4. Lateral flexion
41
Q

What are the complications associated with face presentation?

A
  • Cord prolapse
  • Obstructed labour
  • Foetal distress
  • Severe perineal trauma
  • Facial oedema/ intracranial bleeding
42
Q

What care should be given in labour with face presentation?

A
  • Involve obstetric team
  • Careful VE’s
  • No FSE
  • Adequate analgesia
  • Episiotomy
  • Prepare parents for baby’s appearance
43
Q

What are the primary ways of diagnosing brow presentation?

A
  • Large non-engaged head on palpation

- Not usually detected before onset of labour

44
Q

What are the secondary ways of diagnosing brow presentation?

A
  • PP high and difficult to reach
  • VE; anterior fontanelle felt on 1 side of pelvis and orbital ridges/root of nose felt on other side
  • No descent of PP
45
Q

What are the 3 possible outcomes of brow presentation?

A
  • Convert to vertex
  • Convert to face
  • Remain as brow
46
Q

What are the complications associated with brow presentation?

A
  • Cord prolapse
  • Foetal distress
  • Excessive moulding
  • Obstructed labour
47
Q

What is usually the cause of shoulder presentation?

A

Unstable lie (transverse/oblique)

48
Q

What are the common causes of unstable lie?

A
  • Laxity of uterine muscles
  • Multiple pregnancy
  • Polyhydramnios
  • Placenta praevia
  • Fibroid
49
Q

How can unstable lie be correct?

A

External version to longitudinal lie

50
Q

What is the outcome of shoulder presentation?

A

This is an obstetric emergency and the baby will be delivered by CS

51
Q

How can mothers optimise foetal position?

A

Spend time on hands and knees/ upright rather than slouched/lying down

52
Q

What is the heaviest part of a foetus?

A

Its back

Appreciating Complex Midwifery Care (14 decks)

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