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Appreciating Complex Midwifery Care > Malpresentations and positions > Flashcards

Malpresentations and positions Flashcards

1
Q

What does Malposition means?

A

Where the occiput is in one or other posterior quadrant of the pelvis

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2
Q

What does Malpresentation means?

A

any presentation other than vertex

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3
Q

What does Lie mean?

A

the relationship of the long axis of the fetus to the long axis of the uterus

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4
Q

What does presentation mean?

A

Part of the fetus lying in the lower pole of the uterus

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5
Q

When discussing the position of the fetus what does it mean by the denominator?

A 
The denominator is the part of the presentation used to determine the position
Occiput in ...
Sacrum in...
Mentum 
   (chin)...
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6
Q

what does position mean?

A

The position is the relationship of the denominator to six areas of the woman’s pelvis
Left and right …
Left and right …
Left and right ..

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7
Q

What does attitude mean?

A

The relationship of the fetal head and limbs to its body. May be flexed, deflexed or partially extended

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8
Q

What is the diameter and presenting part of BI- PARIETAL?

A

9.5cm, Widest Transverse Diameter

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9
Q

What is the diameter and presenting part of BI-TEMPORAL?

A

8cm

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10
Q

What is the diameter and presenting part of SUBOCCIPITO-BREGMATIC ?

A

9.5cm

Vertex (well flexed)

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11
Q

What is the diameter and presenting part of SUBOCCIPITO-FRONTAL?

A 
10cm 
Vertex (less well flexed/ deflexed)
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12
Q

What is the diameter and presenting part of OCCIPITO-FRONTAL?

A

11.5cm

deflexed occipito posterior (face to pubes)

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13
Q

What is the diameter and presenting part of MENTOVERTICAL?

A

13cm

Brow ( head partially extended)

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14
Q

What is the diameter and presenting part of SUB-MENTO-BREGMATIC?

A

9.5cm

Face (head fully extended)

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15
Q

What is the diameter and presenting part of SUB-MENTO-VERTICAL?

A

11cm

Face (head not fully extended)

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16
Q

What is the Normal mechanism of labour?

A 
Descent
Flexion
Internal Rotation
Crowning of the Head
Extension
Restitution
Internal Rotation of the Shoulders
Lateral Flexion
17
Q

What can cause an OP position and give reference.

A

Maternal posture and lifestyle Android/anthropoid pelvis
Anterior placenta
Epidural analgesia plus oxytocin augmentation
Nulliparity
Increased maternal age Increased gestation
(Lewis,2010)

18
Q

How would you diagnose an OP position in an antenatal assessment?

A

Inspection of abdomen
•Palpation
•FH auscultation

In labour: 
Listen to woman 
FH auscultation
'VE 
Progress of labour  (Lewis,2010)

No evidence of getting into all fours; helping position of baby (RCM), only gives women comfort(Guitten, et.al.,2014)

19
Q

Name four complications of OK and it’s reference

A 
Episitomy
Third and fourth degree tear 
Increase blood loss 
Length of stay in hospital 
( Stephen Ratcliffe, 2008)
20
Q

What is the mechanism of occipito position- long rotation

A

Occipito frontal diameter engages (11cms) in R oblique diameter 12cms)

Increasing flexion and descent- Sub-occipito bregmatic diameter (9.5cms) in the pelvic cavity

Occiput meets the resistance of the pelvic floor and rotates 3/8th circle forwards

Head now in same position as occipitor anterior mechanism

The shoulders follow the head turning 2/8th from left to right oblique

Head is born by extension

Restitution

Internal rotation of shoulders

External rotation of head to mothers right

Lateral flexion

21
Q

Incidence of OP and reference

A

15-32% women experience OP

Simkin(2010)

22
Q

Care in labour for OP

A 
Communication with mum and support(NMC,2015)
One to one care 
General pain relief 
Comfortable position 
Assessment of progress 
Monitor Mother and fetal welling
23
Q

Normal mechanisms of Labour

A 
Descent
Flexion 
Internal rotation 
Crowning 
Extension
Restitution 
Internal rotation of shoulders 
Lateral flexion
24
Q

Incidence of Brow presentation

A

1 in 500- 1in 1400 deliveries

25
Q

Diagnosis for brow presentation

A

Large on engaged head
Not usually detected before onset of Labour
Present part is difficult to reach
No descent on presenting part

26
Q

Complications and management of Brow

A

Complications:
Cord Prolapse
Fetal Distress
Excessive moulding

Management 
Obstetricians involved 
High risk care 
DRs may want to see if head conversion to vertex 
LSCS

Appreciating Complex Midwifery Care (13 decks)

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