Definition            DefintionFetal presenting part other than vertex includes breech, face, brow, transverse, and compo...
Related Factors  More than one pregnancy(e.g. Multipara,Grand multipara )More than one fetus (e.g. Twins)Too much or to...
Incidence of malpresentation           Defintion• Breech        3 in 100 (3%)• Face     1 in 500 (0.5%)• Brow     1 in 200...
Shoulder presentationIt is a Transverse liein which the long axis of the fetus is perpendicular( 900) to long axis of mot...
4 position in Shoulder presentation  Acrimon- anterior(60%)  Left Right   Acrimo- posterior(40%)   Right   Left Acr...
Lt Acrimoanterior   Rt AcrimoanteriorRt Acrimoposterior Lt Acrimoposterior
DiagnosisAbdominal examination, the head is usually felt in one  iliac fossa or in the flank. The breech in the other i...
On vaginal examinationEarly in labor the cervix is elevated lower uterine segment is imperfectly filledLate in labor ...
Neglected shoulder  Prolonged laborMembrane rupturedliquor drainedArm may be prolapsedFetus dead or dyingLower segme...
ManagementDuring pregnancy A-External cephalic version Can be tried up to full term, Even early in labour before ROM *...
During labor External cephalic version (ECV) is tried with  intact membranes : - If succeeded: Rupture of membranes and ...
ManagementIn modern practice, persistenttransverse lie in labor is delivered bycaesarean section whether the fetus isaliv...
Face Presentationhead is hyper extendedpresenting part is face- denominator is chin(mentum)between glabella & chinpres...
Types of Face Presentation2ry face (during labor) commenThe majority of cases of face are secondary to occipto-posterior...
AETIOLOGY
In Face presentation- 6 position
Lt mento-ant   Rt mento-ant   Rt mento-post
Diagnosis The chin serves as thereferenc point in describingthe position of the head. It is necessary to distinguishchin...
Diagnosis On abdominal examination,a groove may be felt betweenthe occiput and the back. On vaginal examination Neither...
Mechanism of labor in MA The head descends with the submento-bregmatic  diameter (9.5 cm). Descent, engagement, increase...
Mechanism of labor in MP Normal mechanism: In 2/3 of cases the chin rotates forwards 3/8 of a circle and delivered as M...
Management of Chin-anterior          Management of Chin-anterior              Cervix fully              dilated           ...
It is a cephalic presentation with the head midway between flexion and extension.Incidence: 1 /2000The frontal bone ist...
There are 4 main positions• - Left fronto-anterior.• - Right fronto-anterior.• - Right fronto-posterior.• - Left fronto-po...
Types &Etiology of browTransient brow(2RY)• During conversion of vertex to face.Persistent brow(1RY)• Extremely rareEti...
Mechanism of labourTransient brow(2RY)brow may be converted spontaneously into face (by extension) or vertex (by flexion)...
Persistent brow:There is no mechanism for delivery because thehead descends by the mento-vertical diameter (13.5 cm)  whi...
DiagnosisAbdominal examination:the occiput & sinciputare felt at the same level PV examinationfrontal bone, supra-orbital ...
Compound PresentationOccurs when an extremity  (usually an arm less  commonly lower limb)  prolepses alongside the  prese...
DiagnosisSuspect compound presentation  when1.Active labor is arrested2.The fetus fail to engage3.The prolapsed extremity...
ManagementDon’t manipulate the prolapsed extremity In many cases the extremity will spontaneously  be pulled back and aw...
Reduce the extremity if Prolapsed extremity prevent descent of  fetus gently reduce by pushing it upward  above the pelv...
THANK YOU
Shoulder,face ,braw,,compound presention for undergraduate
Shoulder,face ,braw,,compound presention for undergraduate
Shoulder,face ,braw,,compound presention for undergraduate
Shoulder,face ,braw,,compound presention for undergraduate
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Shoulder,face ,braw,,compound presention for undergraduate

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Unergraduate course lectuers in Obstetrics&Gynecology,Faculty of medicine,Zagazig University Prepared by Dr Manal Behery

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Transcript of "Shoulder,face ,braw,,compound presention for undergraduate"

  1. 1. Definition DefintionFetal presenting part other than vertex includes breech, face, brow, transverse, and compound presention.
  2. 2. Related Factors More than one pregnancy(e.g. Multipara,Grand multipara )More than one fetus (e.g. Twins)Too much or too little amniotic fluid (e.g. Poly hydramnious, oligohydramnios)Abnormal uterine shape (e.g. Arcuate ,septate, supseptate) or abnormal growth (e.g Fibroid)Placenta previaThe baby is preterm
  3. 3. Incidence of malpresentation Defintion• Breech 3 in 100 (3%)• Face 1 in 500 (0.5%)• Brow 1 in 2000 (0.02%)• Shoulder 1 in 300 (0.3%)• Compound 1 in 5000 ( 0.05%)
  4. 4. Shoulder presentationIt is a Transverse liein which the long axis of the fetus is perpendicular( 900) to long axis of mother.Shoulder of baby comes in– the lower segment of uterus(0.5%)
  5. 5. 4 position in Shoulder presentation Acrimon- anterior(60%) Left Right Acrimo- posterior(40%) Right Left Acrimo anterior position is more common as the concavity of front of fetus fix in convexity of maternal spine Placenta is posterior in 60% of cases
  6. 6. Lt Acrimoanterior Rt AcrimoanteriorRt Acrimoposterior Lt Acrimoposterior
  7. 7. DiagnosisAbdominal examination, the head is usually felt in one iliac fossa or in the flank. The breech in the other iliac fossa but at a higher level Fundal level just above umbilicus FH sound heard below the umbilicus
  8. 8. On vaginal examinationEarly in labor the cervix is elevated lower uterine segment is imperfectly filledLate in labor The cervix is sufficiently dilated: We can feel: scapula, acromion, clavicle, axilla and ribsConfirm position: If the arm is prolapsed and supinated the dorsum points to the back and the thumb points to the head.
  9. 9. Neglected shoulder Prolonged laborMembrane rupturedliquor drainedArm may be prolapsedFetus dead or dyingLower segment overstretchedSigns and symptoms of obstructed labor
  10. 10. ManagementDuring pregnancy A-External cephalic version Can be tried up to full term, Even early in labour before ROM * Laxity of the abdominal & uterine walls makes the procedure easier than in breech * The fetus will be rotated only 90 degrees. B. If fails, do external podalic version. head.
  11. 11. During labor External cephalic version (ECV) is tried with intact membranes : - If succeeded: Rupture of membranes and application of abdominal binder. - If failed: C.S. is the safest for the mother & fetus. If the membranes are ruptured before full cervical dilatations do C.S.
  12. 12. ManagementIn modern practice, persistenttransverse lie in labor is delivered bycaesarean section whether the fetus isalive or dead
  13. 13. Face Presentationhead is hyper extendedpresenting part is face- denominator is chin(mentum)between glabella & chinpresenting diameter issubmentobregmatic (9.5cm)
  14. 14. Types of Face Presentation2ry face (during labor) commenThe majority of cases of face are secondary to occipto-posterior which transformed to mento anteriorCauses are maternal1ry face (during pregnancy )rareCauses are fetal
  15. 15. AETIOLOGY
  16. 16. In Face presentation- 6 position
  17. 17. Lt mento-ant Rt mento-ant Rt mento-post
  18. 18. Diagnosis The chin serves as thereferenc point in describingthe position of the head. It is necessary to distinguishchin-anterior positions inwhich the chin is anterior inrelation to the maternal pelvis from chin-posterior positions.
  19. 19. Diagnosis On abdominal examination,a groove may be felt betweenthe occiput and the back. On vaginal examination Neither the occiput nor the sinciput are palpable supra-orbital ridges, chin,alveolar margin ± ala nasiConfirm presention
  20. 20. Mechanism of labor in MA The head descends with the submento-bregmatic diameter (9.5 cm). Descent, engagement, increased extension of the head the chin meets the pelvic floor first and rotates forwards 1/8 of a circle. With further descent the submental-region hinges below the symphysis pubis the head is delivered by flexion , followed by restitution and external rotation of the chin as in vertex presentation.
  21. 21. Mechanism of labor in MP Normal mechanism: In 2/3 of cases the chin rotates forwards 3/8 of a circle and delivered as MA Abnormal mechanism (In 1/3 of cases): The chin may rotate forwards 1/8 circle (deep transverse arrest of the face). no rotation(persistent oblique MP). The chin rotate backwards 1/8 circle (direct MP)
  22. 22. Management of Chin-anterior Management of Chin-anterior Cervix fully dilated Cervix not fully dilated Allow normal child Allow normal child birth Augmentation of Augmentation of birthSlowSlow labour labourprogressprogress Descent Descentwith nowith no unsatisfactory unsatisfactorysigns ofsigns ofobstruction Augmentationobstruction Augmentation Forceps delivery of labour of labour
  23. 23. It is a cephalic presentation with the head midway between flexion and extension.Incidence: 1 /2000The frontal bone isthe denominator.
  24. 24. There are 4 main positions• - Left fronto-anterior.• - Right fronto-anterior.• - Right fronto-posterior.• - Left fronto-posterior.
  25. 25. Types &Etiology of browTransient brow(2RY)• During conversion of vertex to face.Persistent brow(1RY)• Extremely rareEtiology: same as face
  26. 26. Mechanism of labourTransient brow(2RY)brow may be converted spontaneously into face (by extension) or vertex (by flexion) and this followed by spontaneous delivery
  27. 27. Persistent brow:There is no mechanism for delivery because thehead descends by the mento-vertical diameter (13.5 cm) which is longer than anyof the diameters of the pelvic inlet. So, the head become arrested at the pelvic inlet ,and labour is obstructed.
  28. 28. DiagnosisAbdominal examination:the occiput & sinciputare felt at the same level PV examinationfrontal bone, supra-orbital ridges and the root of thenose are felt.
  29. 29. Compound PresentationOccurs when an extremity (usually an arm less commonly lower limb) prolepses alongside the presenting part.• Both the prolapsed arm and the fetal head present in the pelvis simultaneously.
  30. 30. DiagnosisSuspect compound presentation when1.Active labor is arrested2.The fetus fail to engage3.The prolapsed extremity is palpated directly
  31. 31. ManagementDon’t manipulate the prolapsed extremity In many cases the extremity will spontaneously be pulled back and away from the presenting part. Spontaneous delivery in 75% of vertex /upper extremity presentation Do continuous FHR monitoring because of associated occult cord prolapse
  32. 32. Reduce the extremity if Prolapsed extremity prevent descent of fetus gently reduce by pushing it upward above the pelvic brim and hold it until a contraction pushes the head into the pelvis.Do CS if Non reassuring FHR trace Cord prolapsed Failure of labor to progress
  33. 33. THANK YOU
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