Malpresentation Flashcards
lie
fetal spine relative to maternal spine
- longitudinal
- transverse
- oblique
presentation
fetal part that overlies pelvic inlet
- occiput (vertex)
- chin (mentum)
- brow
- compound = >1 part
position
relationship of fetal presenting part to maternal pelvis
- occiput in cephalic
- sacrum in breech
- R/L
- anterior/posterior
attitude
position of fetal head w/ regard to fetal spine
station
descent of bony presenting part through birth canal (-5 to +5); 0 = plane of ischial spines
denominator
part that is lowest
complete breech
flexed at hips and knees
incomplete breech
incomplete deflexion of one or both knees or hips
frank breech
flexed at hips and extended at knees
When should external cephalic version be attempted in transverse and oblique lies?
36-37wks
funic presentation
umbilical cord presentation - rare at term
malposition
any position that is not:
1) occiput anterior
2) left occiput anterior OR
3) right occiput anterior
What are risks associated w/ malpresentation?
1) diminished vertical polarity of uterine cavity
2) increased/decreased fetal movement
3) obstructed pelvic inlet
4) fetal malformation
5) prematurity
6) abnormal placentation
What are risk factors for malpresentation?
1) uterine anomaly
2) conditions that result in decreased fetal muscle tone, strength, or activity (e.g. oligo, aneuploidies, neuro dysfunctino)
3) cephalopelvic disproportion
4) sedentary lifestyle
What are risks associated w/ footling breech?
1) cord prolapse
2) head entrapment
What are risks associated w/ compound presentation?
1) cord prolapse = most common
2) birth trauma
What are risks associated w/ face presentation?
1) prolonged labor –> intrapartum death
2) abnormal FHR
3) fetal laryngeal and tracheal edema
What are risks associated w/ external cephalic version?
serious complications rare
1) abnormal FHR patterns
2) persistent pathologic FHR patterns
3) placental abruption
4) vaginal bleeding
5) emergency c/s
When and why should external cephalic version be attempted?
@36-37wks
preterm ECV associated w/ perinatal mortality
What are contraindications to external cephalic version?
1) oligo
2) fetal growth restriction
3) abnormal FHR tracing
4) uterine anomaly
5) ruptured membranes
6) HTN of pregnancy
7) antepartum bleeding
What are risk factors for transverse lie and shoulder presentation?
1) multiparity
2) preterm fetus
3) uterine anomaly
4) poly
5) placenta previa
What are risk factors for face presentation?
1) prematurity
2) fetal weight < 2500g
3) fetal macrosomia
4) anencephaly
5) high parity
How should funic presentation be managed?
1) GET HELP!
2) put pt in Trendelenberg
3) get FHTs
4) emergency c/s
Describe moxibustion
traditional Chinese method
- burn cigar-shaped roll of Artemisia vulgaris or “mugwort”
- hold over acupoint bladder 67 (lateral side of little toes)
- used to induce labor or vert fetus
Which face presentation has better vaginal delivery outcomes?
mentum anterior - diameter can fit through canal; mentum posterior less likely to pass successfully
What are contraindications to TOL in breech presentation?
1) cord presentation
2) fetal growth restriction OR macrosomia
3) any presentation other than complete or frank breech
4) clinically inadequate pelvis
5) fetal anomaly incompatible w/ vaginal delivery
6) estimated fetal weight <2500g or >4000g
Describe labor management for breech presentation
1) perform clinical pelvic exam
2) ensure adequate labor progress; if not progressing –> C/S
3) continuous fetal monitoring mandatory
4) IOL NOT recommended; augmentation w/ oxytocin = okay
5) passive second stage w/out pushing may last up to 90min; active pushing should not last >60min
6) second stage should take place in/near OR
7) providers skilled in neonatal resuscitation close by
