Malpresentation and Position Flashcards
What is different about the engagement for primips and multips?
Primip = head can engage and then disengage several times Multip = once head is engaged, usually stays there
What are some of the causes of OP position?
- Maternal lifestyle (e.g. slouching on sofa)
- Android/anthropoid pelvis
- Anterior placenta
- Epidural and synto
- Primip
How can OP position be diagnosed antenatally?
- Dip near umbilicus
- Palpation
- FH auscultation
How can OP position be diagnosed in labour?
- Back pain/ urge to push early
- Inspection and palpation
- VE
- Progress of labour (e.g. early SROM, incoordinate contractions)
Why do OP babies often have an IOL?
Go to postdates as head can’t descend so labour isn’t initiated
Describe long rotation
- Flexion on descent
- Occiput rotates forwards at pelvic floor
- Head now in same position as OA
- Shoulders follow and head born by extension
Describe short rotation
- 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
What is deep transverse arrest?
- Head descends with some flexion
- Flexion no maintained and head caught in bi-spinous diameter
- Head cannot deliver
What are some of the risks associated with OP delivery?
- DTA
- Maternal exhaustion
- Increased risk of epidural/ instrumental/ CS
- Cord prolapse
- Excessive moulding/ haemorrhage
- Hypoxia
What are some of the causes of face presentation?
- Polyhydramnios
- Enlargement of foetal neck
- Multiple coils of cord around neck
- Anencephaly
- Multiple pregnancy
- Prematurity
How can face presentation be diagnosed?
- Deep groove between head and back palpable
- VE (PP high, eyes/ nose/ mouth felt
What position must babies rotate to in order to have a successful vaginal delivery from face presentation?
Mento-anterior
What are some of the complications associated with face presentation?
- Cord prolapse
- Obstructed labour
- Foetal distress
- Severe perineal trauma
- Facial bruising and oedema
How can brow presentation be diagnosed?
- Large, non-engaged head on palpation
- PP high
- Anterior fontanelle felt on one side and orbital ridges on other
- No descent
What are some of the risks associated with brow presentation?
- Cord prolapse
- Foetal distress
- Excessive moulding
- Obstructed labour
What type of presentation is immediately considered an obstetric emergency?
Shoulder presentation or Deep Transverse Arrest
What are the 4 types of breech presentation?
- Complete (flexed) - both legs bent
- Frank (extended) - both legs straight up
- Incomplete - one leg bent, one leg up
- Kneeling
- Footling
When should an ECV be performed?
Primip = 36/40 Multip = 37/40
What are some contraindications for an ECV?
- Placenta praevia
- Multiple pregnancy
- Rhesus isoimmunisation
- SROM
- IUD
- Preeclampsia
What is internal podalic version?
Inserting the hand into the vagina and pulling the foot down on a breech baby - most commonly used to deliver 2nd twin
How should a breech baby be delivered?
- Hands-off where possible
- Hands on bony prominences only to reduce injuries
- Episiotomy only if required
How are the legs delivered in breech presentation?
Leave the baby to deliver naturally. If baby gets stuck at hips, apply pressure to popliteal fossae to deliver the legs
How are the shoulders delivered in breech presentation?
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
How is the head delivered in breech presentation?
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
When should a presentation scan be booked antenatally?
- Breech on palpation
- Unstable lie
- Unsure of presentation at 36/40 or later
What is the postnatal management for a baby that was breech any time after 36/40?
Hip scan
