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Lie, presentation, attitude, and position

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How to examine the gravid uterus.

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Lie, presentation, attitude, and position

  1. 1. LIE, PRESENTATION, ATTITUDE, AND POSITION LONGWAP A.S 600L JUTH
  2. 2. Fetal Lie. <ul><li>The lie is the relation of the long axis of the fetus to that of the mother, and is either longitudinal or transverse. </li></ul><ul><li>Occasionally, the fetal and the maternal axes may cross at a 45-degree angle, forming an oblique lie, which is unstable and </li></ul><ul><li>always becomes longitudinal or transverse during the course of labo </li></ul>
  3. 3. Fetal Presentation. <ul><li>The presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it. </li></ul><ul><li>It can be felt through the cervix on vaginal examination. Accordingly, in longitudinal lies, </li></ul><ul><li>the presenting part is either the fetal head or breech, creating cephalic and breech presentations, respectively. When the fetus lies with the long axis transversely, </li></ul><ul><li>the shoulder is the presenting part and is felt through the cervix on vaginal examination . </li></ul>
  4. 4. TYPES OF CEPHALIC PRESENTATION. <ul><li>Such presentations are classified according to the relationship between the head and body of the fetus </li></ul><ul><li>Ordinarily, the head is flexed sharply so that the chin is in contact with the thorax. </li></ul><ul><li>The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation </li></ul>
  5. 5. TYPES OF CEPHALIC PRESENTATION. <ul><li>Much less commonly, the fetal neck may be sharply extended so that the occiput and back come in contact and the face is foremost in the birth canal face presentation </li></ul><ul><li>The fetal head may assume a position between these extremes, partially flexed in some cases, with the anterior (large) fontanel, or bregma, presenting sinciput presentation </li></ul>
  6. 6. TYPES OF CEPHALIC PRESENTATION. <ul><li>or partially extended in other cases to have a brow presentation. These latter two presentations are usually transient. As labor </li></ul><ul><li>progresses, sinciput and brow presentations almost always are converted into vertex or face presentations by neck flexion or extension, respectively </li></ul><ul><li>Failure to do so can lead to dystocia </li></ul>
  7. 7. BREECH PRESENTATION. <ul><li>When the fetus presents as a breech, the three general configurations are frank, complete, and footling presentations </li></ul><ul><li>When the buttocks of the fetus enter the pelvis before the head, the presentation is breech </li></ul>
  8. 8. PREDISPOSING FACTORS <ul><li>Gestational age (B4 TERM) </li></ul><ul><li>Hydramnios, (>2,000ml ) </li></ul><ul><li>Uterine relaxation associated with great parity, </li></ul><ul><li>Multiple fetuses, </li></ul><ul><li>Oligohydramnios, (<300ml at term) </li></ul><ul><li>Hydrocephaly, </li></ul><ul><li>Anencephaly, </li></ul><ul><li>Previous breech delivery, </li></ul><ul><li>Uterine anomalies, and </li></ul><ul><li>Pelvic tumors </li></ul><ul><li>Implantation in the cornual-fundal region </li></ul><ul><li>Placenta previa </li></ul>
  9. 9. COMPLICATIONS OF BREECH <ul><li>1. Perinatal morbidity and mortality from difficult delivery. </li></ul><ul><li>2. Low birthweight from preterm delivery, growth restriction, or both. </li></ul><ul><li>3. Prolapsed cord. </li></ul><ul><li>4. Placenta previa. </li></ul><ul><li>5. Fetal, neonatal, and infant anomalies. </li></ul><ul><li>6. Uterine anomalies and tumors </li></ul>
  10. 10. TYPES OF BREECH With a frank breech presentation, the lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head
  11. 11. TYPES OF BREECH A complete breech presentation differs in that one or both knees are flexed
  12. 12. TYPES OF BREECH With incomplete breech presentation , one or both hips are not flexed and one or both feet or knees lie below the breech, such that a foot or knee is lowermost in the birth canal Footling breech is an incomplete breech with one or both feet below the breech
  13. 13. Fetal Attitude or Posture. <ul><li>In the later months of pregnancy the fetus assumes a characteristic posture described as attitude or habitus </li></ul><ul><li>As a rule, the fetus forms an ovoid mass that corresponds roughly to the shape of the uterine cavity. </li></ul><ul><li>The fetus becomes folded or bent upon itself in such a manner that the back becomes markedly convex; </li></ul><ul><li>the head is sharply flexed so that the chin is almost in contact with the chest </li></ul>
  14. 14. Fetal Position. <ul><li>Position refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal </li></ul><ul><li>Accordingly, with each presentation there may be two positions, right or left </li></ul><ul><li>Because the presenting part may be in either the left or right position, there are left and right occipital, left and right mental, and left and right sacral presentations </li></ul>
  15. 15. Varieties of Presentations and Positions. <ul><li>For still more accurate orientation, the relationship of a given portion of the presenting part to the anterior, transverse, or posterior portion of the maternal pelvis is considered. </li></ul><ul><li>Because the presenting part in right or left positions may be directed anteriorly (A), transversely (T), or posteriorly (P), there are six varieties of each of the three presentation </li></ul>
  16. 16. Occiput prest, the presentation, position, & variety may be abbreviated in clockwise fashion as:
  17. 17. Longitudinal lie. Cephalic presentation (A) vertex, (B) sinciput (C) brow (D) face presentations
  18. 18. Longitudinal lie. Vertex presentation B. Left occiput posterior (LOP). A. Left occiput anterior (LOA).
  19. 19. Longitudinal lie. Vertex presentation. A. Right occiput posterior (ROP). B. Right occiput transverse (ROT).
  20. 20. Longitudinal lie. Vertex presentation. Right occiput anterior (ROA)
  21. 21. Longitudinal lie. Breech presentation. Left sacrum posterior (LSP)
  22. 22. Transverse lie. Right acromiodorsoposterior (RADP) The shoulder of the fetus is to the mother's right, and the back is posterior.
  23. 23. RIGHT ACOMIODORSOPOSTERIO Transverse lie. The shoulder of the fetus is to the mother's right, and the back is posterior.
  24. 24. Face presentation. The occiput is the longer end of the head lever. The chin is directly posterior. Vaginal delivery is impossible unless the chin rotates anteriorly.
  25. 25. Brow posterior presentation.
  26. 26. CONCLUSION <ul><li>The understanding of the above description of the fetus in the mothers womb is very critical in understanding the mechanism of lalour. </li></ul><ul><li>THANKS </li></ul>
  27. 27. <ul><li>Thanks </li></ul><ul><li>Dr. longwap </li></ul><ul><li>JUTH </li></ul>

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