Malpresentation Flashcards

1
Q

What is the difference between malpresentation and malposition?

A
  • Malpresentation - longitudinal lie but vertex is not presenting part
  • Malposition - vertex presentation but not occipito-anterior position
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2
Q

What is a breech presentation? How often does it occur?

A
  • Where the foetal buttocks or lower extremities present
  • 3% at term (15% at 30 weeks)
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3
Q

What are predisposing factors to a breech-presenting baby?

A
  • Foetal: prem, multiplets, congenital malformations
  • Liquor: oligo/polyhydramnios
  • Uterine: cavity distortions (fibroids, cancer)
  • Placenta: praevia
  • Pelvis: contractures or birth canal obstructions
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4
Q

What is the difference between a frank/complete/footling breech baby?

A
  • Frank 65% - extended legs
  • Complete 25% - fully flexed
  • Footlng 10% - one or both thighs extended
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5
Q

What are the problems associated with breech birth?

A
  • 4x increase in perinatal mortality
    • Asphyxia and birth trauma
  • Associations: premature labour, PPROM, foetal abnormalities, placenta praevia and abruption
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6
Q

Why is there an increased risk to a baby of asphyxia/birth trauma with a breech presentation?

A
  • Cord prolapse
  • Entrapment of the foetal head (cervix, disproportion)
  • Traumatic injury (CNS, nerve/muscle injury)
  • Arm hyperextension
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7
Q

What are the management options for a mother with a breech-presenting baby?

A
  • External cephalic version
  • Elective caesarean section
  • Trial of vaginal delivery
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8
Q

How is external cephalic version performed?

A
  • 60-70% success
    • Done at >=36 weeks in case of (very rare) complications and need for delivery
    • Initial CTG, tocolytic (terbutaline) to relax uterus, attempt to perform forward somersault, CTG afterwards and anti-D if Rh-
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9
Q

What are the contraindications to performing external cephalic version?

A
  • T3 bleeding, uterine abnormalities, ruptured membranes, oligohydramnios, need for C-section or vaginal delivery required
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10
Q

What are the indications for an elective caesarean section delivery?

A
  • Low or high foetal weight
  • Preterm
  • Hyperextended foetal head
  • Placenta praevia
  • Concerns about foetal wellbeing
  • Footling or complete breech
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11
Q

In the setting of breech presentation, when might a trial of vaginal delivery be allowed?

A
  • Frank or complete breech
  • Foetal weight 2.5-3.5 kg
  • Gestation > 36 weeks
  • Flexed foetal head
  • Adequate pelvis
  • No indications for C-section
  • Experienced team
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12
Q

What is the most common kind of face malpresentation? When might you decide to move to a caesarean section?

A
  • Mentoanterior
  • If mentotransverse/mentroposterior do not rotate to mentoanterior. Most MA deliver vaginally well
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13
Q

What are the characteristics on vaginal examination of a baby presenting face-first?

A
  • Mouth located (no sphicnter tone!)
  • Mouth forms triangle with malar prominences
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14
Q

What are the characteristics on vaginal examination of a baby presenting brow-first?

A
  • Anterior fontanelle
  • Orbital ridges
  • Eyes

Move to CS if this presentation persists (risk of hyperextension)

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15
Q

How is a diagnosis of foetal shoulder malpresentation made?

A
  • Palpation of the head not in the pelvis
  • Palpation on vaginal exam of other foetal parts presenting
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