Transverse Lie & Face Presentation Flashcards
Any woman presenting at term with a transverse or oblique lie is at potential risk of
cord prolapse following spontaneous rupture of the membranes
prolapse of the hand, shoulder or foot once in labour
The diagnosis of transverse or oblique lie might be suspected by (5)
1- Inspection: the abdomen often appears asymmetrical
2- SFH may be less than expected
3- palpation the fetal head or buttocks may be in the iliac fossa (ballottable head is found in-none iliac fossa & the breech in the other)
4- Abdomen Is unusually wide where as the fundus is only slightly above the umbilicus & No fetal pole is detected in the fundus
5- The back position is identified, with back ant. , a hard resistance plane
extends across the front of the abdomen
6- On vaginal exam., scapula & clavicle can be felt
Can baby with transverse lie delivered vaginally?
The only exception to this is for exceptionally preterm or small babies, where vaginal delivery may occur irrespective of lie or presentation
In a multiparous woman, an unstable lie will often (correct itself — stay) in early labour
Correct itself (as long as the membranes are intact)
Causes of transverse lie?
High parity
preterm
uterine abnormalities
Oligohydramnios or poly
contracted pelvis
What’s the definition of compound presentation & Causes & Mx?
Compound presentation:
An extremity prolapses alongside the presenting part such as a hand or
arm with the head.
Causes:
are conditions that prevent complete occlusion of the pelvic
inlet by the fetal head including preterm labor.
Mx:
The condition should be observed closely to ascertain whether the arm
retracts with descent of the presenting part.
If it fails to retract & prevents descent of the head,it should be pushed
gently upward & the head downward by fundal pressure.
Mx of transverse lie?
You can try ECV
If labour is advanced or ECV contraindicated or failed then you should do C-S
In face presentation what’s the attitude of the head & diameter & name of diameter
Full extension of the head
Submento - vertical = 9.5cm
In brow presentation what’s the attitude of the head & diameter & name of diameter
Greater deflexion of the head
Mento - vertical = 13,5-14cm
What are the positions expected in face presentation
Which ones should be delivered by C-S
Four positions are possible:
- right mentoanterior
- right mentoposterior
- left mentoanterior
- left mentoposterior
Mentoposterior by C-S
Mentoanterior may need foreceps
How you diagnose face presentation
- abdominal examination limb felt anteriorly
- pelvic grip head is not engaged
- vaginal examination the whole face of the fetus will be felt
- ultrasound must performed to exclude any fetal congenital abnormalities and assessment of fetal size
What are the causes of face & brow presentation
- Maternal:
multiparity with pendulous abdomen
contracted pelvis
DM due to polyhydramnious and macrosomia - Fetal causes:
anencephaly
goiter
twist of the umbilical cord around the fetal neck
increased tone of neck extensors
How you diagnose brow presentation
- Finding on abdominal examination similar to that of face presentation
- Vaginal examination there will be presence of supraorbital ridges and anterior fontanelle
- Ultrasound examination should be done to exclude any fetal congenital abnormalities
What are the causes & Dx of OP presentation
Aetiology :
- Presence of anthropoid or android pelvis
- Marked deflexion of the fetal head
- Brachycephaly of fetal head
- Abnormal uterine cotractions
Diagnosis :
- Abdominal examination, flattening of the abdomen below the umbilicus
- Fetal limbs are easily palpated anteriorly at the midline
- Pelvic grip , the head is not engaged
- Vaginal examination, posterior fontanelle and lambdoid suture felt near the sacroiliac joint
- Cervix may not be well applied by the pesenting part
- Ultrasound to confirm diagnosis and assessing fetal weight wellbeing and amniotic fluid volume
Complications of op
Prolonged labor
early rupture of membrane
extreme moulding of fetal skull
PPH
perineal injuries
