Malpresentations

Question 1

malpresentations- what?

Answer 1

all presentations of the baby that aren’t vertex

Question 2

vertex- what?

Answer 2

Vertex is bounded by the anterior and posterior fontanelles and the parietal eminences (baby comes out head first)

Question 3

malpresentations- predisposing factors?

Answer 3

-prematurity
-multiple pregnancy
-abnormalities of the uterus e.g. fibroids
-partial septate uterus
-abnormal uterus
-placenta praevia
-primiparity

Question 4

malpresentations- most common presentation?

Answer 4

Breech
-fetus bottom down in uterus

Question 5

what are the different types of breech?

Answer 5

complete breech, footling breech, frank breech

Question 6

describe complete breech?

Answer 6

legs folded with feet at the level of the baby’s bottom

Question 7

describe footling breech?

Answer 7

one or both feet point downwards so the legs would emerge first

Question 8

describe frank breech?

Answer 8

legs point up with feet by baby’s head so the bottom emerges first

Question 9

describe transverse position?

Answer 9

Fetus is positioned with the head on one side of the pelvis and the buttocks in the other

Question 10

Investigations for malpresentations?

Answer 10

All women in the UK with an uncomplicated breech pregnancy at term= ECV (external cephalic version)

-provided there are no contra-indications

Question 11

management of transverse lie malpresentation?

Answer 11

ceserean
-vaginal delivery is impossible unless it converts or is converted late in pregnancy

Question 12

management of breech malpresentation?

Answer 12

either vaginal or cesarean (need to use ECV to determine)

Question 13

breech <36 weeks management?

Answer 13

check again at 36 weeks
-most will resolve spontaneously

Question 14

breech >36 weeks managment?

Answer 14

ECV (external cephalic version)

-if this doesn’t work then plan C section