Malpositon Flashcards
Definition of Malposition
Abnormal positions of the vertex of fetal head relative to maternal pelvis
Examples of Malposition
Occiput transverse (ROT, LOT) Occiput Posterior ( ROP, LOP, OP)
Diagnosis of malposition
Abdo palp
Vaginal examination
USS
Maternal causes
Pendulous Abdomen Lax Abdo muscles Android pelvis Pevlic tumours Uterine Abnormalities Fibroids Placenta Previa
Fetal causes
Preterms IUD Macrosomia Multiple pregnancy Congenital Abnormalities Polyhydramnious
Complications of malposition
PROM PPROM Cord prolapse Prolonged labour Obstructed labour Increased incidence of assisted birth Increased trauma to genital tract Increased PPH & puerprial infection
What are the P’s of labour
Passage: Maternal pelvic capacity, pelvic floor muscles
Power: strength & timing of contractions
Passenger: baby, size, flexion, position
What are the mechanisms of labour briefly (normal) ?
Fetus descends, the leading part meets resistance of the the pelvic floor and rotated anteriorly under the symphisis pubis and the emerging fetus pivots around the pubic bone
Ways to tell if baby is in OP position
Bachache in labour
Asymmetric dilatation: persistant anterior lip
Vaginal examination anterior fontanelle in anterior quadrant
Long labour
Causes
shape of pelvis? size of bub
Complications of persistent OP
Increase risk of perineal lacerations 11.5 diameter
Increased risk of instrumental birth
Risk of deep transverse arrest
Increased risk of episiotomy
Ways to care for a woman in labour with a baby in OP position
Encourage all 4 positioning, leaning foward, massage, use of robozzo, water immersion
One-to-one midwifery support
Types of pelvis’s
Gynecoid - normal
Android - OP narrow
Anthropoid
Platypoid- not usually compatible with vaginal birth
