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YEAR 3 REVISION > Malpresentation and Position > Flashcards

Malpresentation and Position Flashcards

1
Q

What is different about the engagement for primips and multips?

A 
Primip = head can engage and then disengage several times
Multip = once head is engaged, usually stays there
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2
Q

What are some of the causes of OP position?

A
  • Maternal lifestyle (e.g. slouching on sofa)
  • Android/anthropoid pelvis
  • Anterior placenta
  • Epidural and synto
  • Primip
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3
Q

How can OP position be diagnosed antenatally?

A
  • Dip near umbilicus
  • Palpation
  • FH auscultation
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4
Q

How can OP position be diagnosed in labour?

A
  • Back pain/ urge to push early
  • Inspection and palpation
  • VE
  • Progress of labour (e.g. early SROM, incoordinate contractions)
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5
Q

Why do OP babies often have an IOL?

A

Go to postdates as head can’t descend so labour isn’t initiated

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6
Q

Describe long rotation

A
  • Flexion on descent
  • Occiput rotates forwards at pelvic floor
  • Head now in same position as OA
  • Shoulders follow and head born by extension
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7
Q

Describe short rotation

A
  • Descent with little/no flexion
  • Sinciput rotates forwards at pelvic floor (now in direct OP)
  • Occiput passes into hollow of sacrum
  • Shoulders enter pelvis in L oblique
  • Occiput born by extension
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8
Q

What is deep transverse arrest?

A
  • Head descends with some flexion
  • Flexion no maintained and head caught in bi-spinous diameter
  • Head cannot deliver
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9
Q

What are some of the risks associated with OP delivery?

A
  • DTA
  • Maternal exhaustion
  • Increased risk of epidural/ instrumental/ CS
  • Cord prolapse
  • Excessive moulding/ haemorrhage
  • Hypoxia
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10
Q

What are some of the causes of face presentation?

A
  • Polyhydramnios
  • Enlargement of foetal neck
  • Multiple coils of cord around neck
  • Anencephaly
  • Multiple pregnancy
  • Prematurity
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11
Q

How can face presentation be diagnosed?

A
  • Deep groove between head and back palpable

- VE (PP high, eyes/ nose/ mouth felt

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12
Q

What position must babies rotate to in order to have a successful vaginal delivery from face presentation?

A

Mento-anterior

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13
Q

What are some of the complications associated with face presentation?

A
  • Cord prolapse
  • Obstructed labour
  • Foetal distress
  • Severe perineal trauma
  • Facial bruising and oedema
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14
Q

How can brow presentation be diagnosed?

A
  • Large, non-engaged head on palpation
  • PP high
  • Anterior fontanelle felt on one side and orbital ridges on other
  • No descent
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15
Q

What are some of the risks associated with brow presentation?

A
  • Cord prolapse
  • Foetal distress
  • Excessive moulding
  • Obstructed labour
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16
Q

What type of presentation is immediately considered an obstetric emergency?

A

Shoulder presentation or Deep Transverse Arrest

17
Q

What are the 4 types of breech presentation?

A
  1. Complete (flexed) - both legs bent
  2. Frank (extended) - both legs straight up
  3. Incomplete - one leg bent, one leg up
  4. Kneeling
  5. Footling
18
Q

When should an ECV be performed?

A 
Primip = 36/40
Multip = 37/40
19
Q

What are some contraindications for an ECV?

A
  • Placenta praevia
  • Multiple pregnancy
  • Rhesus isoimmunisation
  • SROM
  • IUD
  • Preeclampsia
20
Q

What is internal podalic version?

A

Inserting the hand into the vagina and pulling the foot down on a breech baby - most commonly used to deliver 2nd twin

21
Q

How should a breech baby be delivered?

A
  • Hands-off where possible
  • Hands on bony prominences only to reduce injuries
  • Episiotomy only if required
22
Q

How are the legs delivered in breech presentation?

A

Leave the baby to deliver naturally. If baby gets stuck at hips, apply pressure to popliteal fossae to deliver the legs

23
Q

How are the shoulders delivered in breech presentation?

A

Lovsett’s maneouvre:

  • Hold bony prominences of hips and rotate 90 degrees
  • Use a hand to release the arm
  • Repeat this in the other direction
24
Q

How is the head delivered in breech presentation?

A

Mariceau Smellie-Viet maneouvre:

  • Use forearm to support baby’s body
  • Place a finger on each cheekbone
  • Use the other hand to apply pressure to the occiput and then encourage flexion to deliver the baby up and onto the mother
25
Q

When should a presentation scan be booked antenatally?

A
  • Breech on palpation
  • Unstable lie
  • Unsure of presentation at 36/40 or later
26
Q

What is the postnatal management for a baby that was breech any time after 36/40?

A

Hip scan

YEAR 3 REVISION (49 decks)

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