gyn

1. 1
Abnormal presentation.
Pr. Mbu / Dr.Nana
M2 2009-14/05/09.

2. 2
Abnormal presentation-1.
General objectives:
 Student should be able to define,
diagnose and advise women with
abnormal presentation.

3. 3
Abnormal presentation-2.
 Specific objctives:
 Define abnormal presentation.
 Name the different abnormal presentations.
 Discuss the risk factors and mode delivery of the
different types.
 Name the common complications associated with
abnormal presentation.

4. 4
Abnormal presentation-3.
 Lie: axis of foetus to axis of mother.
• Longitudinal ( cephalic, breech).
• Transverse (shoulder).
• Oblique. (cephalic / breech).
 Presentation: foetus two poles (cephalic / caudal). Pole
of foetus found at the inlet of pelvis or nearest.
• Normal presentation, cephalic
• Any other presentation is abnormal.

5. 5
Abnormal presentation-4.
Types of abnormal pesentations:
 Breech: caudal part at the brim or inlet.
Three types of breech presentations, complete.
Frank.
single or double footling.

6. 6
Abnormal presentation-5.
Incomplete breech-1

7. 7
Abnormal presentation-6.
Incomplete breech-2

8. 8
Abnormal presentation-7.
 Risk factors for breech presentation:
 Preterm pregnancy
 Multiple pregnancy
 Placenta praevia
 Grand-multi-parity
 P/H breech
 Borderline / contracted pelvises, uterine malformation.
 Foetal malformations, hydrocephalus, conjoint twins,
short cord, hydramnios, proms, oligohydramnios,
anencephalus, tumours e.g teratomas..

9. 9
Abnormal presentation-8.
• Cephalic, breech, others
29-32wks 78.1%
(cephalic)
14%(breech) 7.9%
(other
s)
33-36wks 88.7% 8.8% 2.5%
37-40wks 91.5% 6.7% 1.7%
Foetal presentation at various GA (US).
Occurs in 4-6% pregnancies.

10. 10
Abnormal presentation-9.
Diagnosis:
 Physical examination, Leopold´s manoeuver.
 Vaginal examination
 Ultrasonography
 X-ray

11. 11
Abnormal presentation-10.
 Delivery:
 C/S delivery is advisable and is indicated in the following
situations ( breech/large foetus, contracted to borderline
pelvis, hyperextended head, PET, ROM ≥12hrs, uterine
dysfunction, footling breech, prematurity <34 weeks,
severe IUGR, poor obstetrical Hx, desire for BTL.
 Spontaneous, prematurity
 Assisted breech delivery
 Breech extractions.

12. 12
Abnormal presentation-11.
Complications:
 Maternal, increased morbidity C/S
 Foetal, increased cord prolapse , increased
perinatal loss, prematurity, congenital
malformation, birth trauma (brain, spinal cord,
liver, adrenal glands, spleen, brachial plexus).

13. 13
Abnormal presentation-12.
 Face prsentation:
 Head is hyperextended, occiput in contact with foetal
back, chin (mentum) the presenting part.
 Incidence varies .0.1-0.3%.
 Diagnosis: rest on vaginal examinaton, nose, mouth,
malar bones, orbital ridges.
 X-ray may show a hyperextended head.

14. 14
Abnormal presentation-13.
 Etiology: factors that favour extension or hinder
flexion, contracted pelvis, large/macrosomic
foetuses, multiparous women with pendulous
abdomen, cord round neck, anencephalia.
 Delivery, by C/S chin posterior, vaginal chin
anterior and adequate pelvis.

15. 15
Abnormal presentation-14.
 Brow presentation:
 Portion of foetal head between orbital ridge and anterior
fontanelle presents at inlet.
 Foetal head midway between full flexion (occiput) and
full extension (face)
 Etiology: same as for face, usually unstable
 Treatment as for face presentation.

16. 16
Abnormal presentation-15.
 Shoulder presentation: transverse lie, sometimes in
oblique lie.
 Incidence 0.3-0.4%, increases with parity 10 folds after
parity 4.
 Etiology: grandmulti-parity, prematurity, placenta
praevia, contracted pelvis.
 Diagnosis: examination AC >UH
 Delivery by C/S.

17. 17
Abnormal presentation-16.
 Compound presentation:
 An extremity spontaneous enters pelvis with the
presenting part.
 vertex /hand 1:700 deliveries.
 Rarely lower limbs/ vertex, hand/breech.
 Cause usually unkown, but prematurity seen in two folds.

18. 18
Abnormal presentation-17.
 Conclusion:
 Abnormal presentation is a common cause of maternal
morbidity, foetal morbidity and mortality.
 Prompt diagnosis, proper decision taking and treatment
is capital to better outcome.
 Early referrals for better management is therefore
paramount for better outcome.