Malpresentations

Question 1

Malpresentations
- Definitions
- Features

Answer 1

any presentation other than the vertex. These include breech, face, brow, forehead, shoulder or cord presentations.

Features

• 95% of pregnancies are in vertex presentation

• Malpresentation needs an early diagnosis in labor

Question 2

Face presentation

Characteristics

Answer 2

1. Characteristics:

a. Fetal head is hyperextended
b. Eye, nose, mouth can be felt in vaginal examination
c. 1/500 deliveries

d. Associated with maternal multiparity and fetal cerebral anencephaly

e. Chin is denominator (prominent of the presenting part) defined as mento- (prefix) and position is described as anterior, transverse or posterior

Question 3

Face presentation

Diagnosis

Answer 3

a. Vaginal examination – during labor

b. Ultrasound – to confirm or exclude

Question 4

Face presentation

Management

Answer 4

a. Mento-anterior – chin faces pubic symphysis, vaginal delivery (with or without assisted deliver) or C-section (in slow labor).

b. Mento-posterior – chin faces coccyx, C-section.

Question 5

Brow presentation

Answer 5

1. Characteristics:

a. Fetal head is between vertex and face presentation – head is partly extended and partly flexed

b. Most unfavorable rare condition
c. 1/1500 deliveries

2. Diagnosis
   a. Vaginal examination – during labor of fontanelle, supraorbital ridges and to of nose
3. Management

a. Usually corrects itself because it is less stable than face presentation

b. C-section – in case brow presentation persists.