Malpresentation

1. PRESENTED BY –
MR.ROMI SONKAR
B.SC NURSING 4TH YEAR
MALPRESENTATION;

2. DEFINITION
WHERE THE FETUS LYING LONGITUDINALLY, BUT PRESENTS IN
ANY MANNER OTHER THAN VERTEX.
OR
MALPRESENATION ARE ALL PRESENTATIONS OF FETUS ,OTHER
THEN THE VERTEX .

3. MALPRESENTATIONS
 FACE PRESENTATION
 BROW PRESENTATION
 SHOULDER PRESENTATION
 BREECH PRESENTATION
 COMPOUND PRESENTATION

4. CAUSES OF MALPRESENATION
 DEFECT IN THE POWER
 PENDULOUS ABDOMEN
 DEXTRO ROTATION OF THE UTERUS
 DEFECT IN PASSAGE
 CONTRACTED PELVIS
 ANDROID PELVIS
 PELVIC TUMOURS
 UTERINE NAOMALIES
 PLACENTA PREVIA

5.  DEFECT IN THE PASSENGER
 PRETERM FETUS
 INTRA-UTERINE FETAL DEATH
 MACROSOMIA
 MULTIPLE PREGNANCY
 CONGENITAL ANAMOLIES
 POLYHYDRAMNIOS

6. FACE PRESENTATION
 HEAD IS HYPEREXTENDED
 PRESENTING PART IS FACE
 DENOMINATOR IS CHIN (mentum)
 PRESENTING DIAMETER IS SUBMENTOBREGMATIC (9.5cm)
 PROBABLY DUE TO LACK OF MOULDING OF FACIAL BONES

7. FACE PRESENTATION

8. MANAGEMENT
 Prolonged labour is common.
 • Descent and delivery of the head by flexion may occur in the chin-
anterior position.
 • In the chin-posterior position, however, the fully extended head is
blocked by the sacrum. This prevents descent and labour is arrested→
caesarean section

9. BROW PRESENTATION
 THE FETAL HEAD IS MIDWAY BETWEEN FULL FLEXION (vertex) AND
HYPEREXTENSION (face) along a longitudinal axis.

10. MANAGEMENT
 If the fetus is alive or dead, deliver by caesarean section.
 *Do NOT deliver brow presentation by vacuum extraction, outlet forceps or
symphysiotomy. Mentovertical D = 14cm Attitude = Partial Extension

11. BREECH PRESENTATION
 WHEN THE BUTTOCKS OR THE FEET ARE THE PRESENTING PARTS .
 THE COMMONST MALPRESENTATION HAS HIGHER PERINATAL MORTALITY AND
MORBIDITY.
TYPES:-
1.FRANK (extended) BREECH PRESENTATION.
2.COMPLETE (flexed) BREECH PRESENTATION.
3.FOOTLING BREECH PRESENTATION.

12. BREECH PRESENTATION

13. MANAGEMENT

14. SHOULDER PRESENTATION
 Occurs as a result of transverse lie or oblique lie
 Predisposing factors = breech presentation
 On abdominal examination, the head or the buttocks cannot be felt at the symphysis pubis and the head is
usually felt in the flank.
 On vaginal examination, a shoulder may be felt, but not always. An arm may prolapse and the elbow, arm or hand
may be felt in the vagina.

15. SHOULDER PRESENTATION

16. MANAGEMENT
 Monitor for signs of cord prolapse.
 If the cord prolapses and delivery is not imminent, deliver by caesarean section.
 • In modern practice, persistent transverse lie in labour is delivered by caesarean section
whether the fetus is alive or dead.

17. COMPOUND PRESENTATION
 Occurs when an arm prolapses alongside the presenting part.
 Both the prolapsed arm and the fetal head present in the pelvis simultaneously.

18. COMPOUND PRESENTATION

19. MANAGEMENT
 Replacement of the prolapsed arm.
 Assist the woman to assume the knee-chest position.
 Push the arm above the pelvic brim and hold it there until a contraction pushes the head into
the pelvis.
 Proceed with management for normal childbirth.
 If the procedure fails or if the cord prolapses, deliver by caesarean section.

20. SIGNS OF MALPRESENTATION
 PENDULOUS ABDOMEN.
 NONENGAGEMENT OF THE PRESENTING PART IN THE LAST 3-4 WEEKS IN
PRIMIGRAVIDA.
 PROM OR ITS RUPTURE EARLY IN LABOUR.
 DELAYED IN THE DESCENT OF THE PRESENTING PART DURING LABOUR.
 VAGINAL EXAMINATION , X-RAYS OR USG ARE MORE CONCLUSIVE.

21. BIBLIOGRAPHY
o BOOK REFERENCES
BHASKAR NIMA – A TEXTBOOK OF MIDWIFERY AND OBSTETRICAL
NURSING, EDITION 3RD PUBLISHED BY EMMESS MEDICAL PUBLISHER
PAGE NO. 446 – 449.
o NET REFERENCES
www.medical-dictionary.thefreedictionary.com
www.abclawcenters.com