Abnormal lie and presentation refers to any fetal position other than longitudinal lie with cephalic presentation. This document defines normal and abnormal lie and presentations and discusses their implications. An abnormal lie or presentation may indicate an underlying issue like macrosomia, pelvic obstruction, or fetal anomaly. It impacts labor, requiring c-section for any non-longitudinal lie or breech presentation. Diagnosis involves history, ultrasound, and physical exam to determine the cause and manage the high-risk pregnancy appropriately.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
Breech Presentation: This is one of the most well-known anomalies in fetal positioning. In a breech presentation, the baby's buttocks or feet are positioned to emerge first during childbirth, rather than the head. Breech presentations occur in approximately 3-4% of full-term pregnancies. There are different types of breech presentations, including frank breech, complete breech, and footling breech.
Transverse Lie: In this position, the fetus is lying horizontally across the uterus, with its head on one side and its feet on the other. This positioning can obstruct the birth canal and make vaginal delivery difficult or impossible.
Face Presentation: This occurs when the fetus presents with its face rather than the top of its head toward the birth canal. Face presentations are relatively rare and may result in prolonged labor or the need for cesarean delivery.
Occiput Posterior Position: In this position, the fetus is facing the mother's abdomen rather than her spine, with the back of the baby's head (occiput) against her spine. This position can lead to back labor and increased discomfort during childbirth.
Compound Presentation: In a compound presentation, one of the baby's limbs (such as an arm or hand) presents alongside the head during delivery. This can complicate the delivery process and increase the risk of injury to both the baby and the mother.
Asynclitic Presentation: This occurs when the baby's head is tilted to one side, making it difficult to descend through the birth canal. Asynclitic presentations can prolong labor and increase the likelihood of instrumental delivery (e.g., forceps or vacuum extraction).
Anomalies in fetal position can be diagnosed through physical examination, fetal ultrasound, or other imaging techniques. Management of these anomalies may involve techniques to try to manually correct the position of the fetus, such as external cephalic version for breech presentations, or interventions during labor and delivery, such as cesarean section.
Overall, awareness of anomalies in fetal position is crucial for healthcare providers to anticipate potential complications during childbirth and to ensure the safest possible outcome for both the baby and the mother.
Breech Presentation: This is one of the most well-known anomalies in fetal positioning. In a breech presentation, the baby's buttocks or feet are positioned to emerge first during childbirth, rather than the head. Breech presentations occur in approximately 3-4% of full-term pregnancies. There are different types of breech presentations, including frank breech, complete breech, and footling breech.
Transverse Lie: In this position, the fetus is lying horizontally across the uterus, with its head on one side and its feet on the other. This positioning can obstruct the birth canal and make vaginal delivery difficult or impossible.
Breech Presentation: This is one of the most well-known anomalies in fetal positioning. In a breech presentation, the baby's buttoc
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
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Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
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Equity: High costs could limit access to this potentially life-saving technology.
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Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
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According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
3. Normal lie
• lie of the fetus - the relationship between the long axis of the fetus with
respect to the long axis of the mother
• Normal lie - longitudinal lie
• longitudinal lie can either be cephalic or breech presentation
• Any other lie apart from this is abnormal
4. Presentation
• This is the part of the fetus that is overlying the maternal pelvic inlet
It is the part that will engage the birth canal
• The most common presentation is cephalic
• However, presentations can be any part of the fetus
e.g. breech, cord, hand, face etc
• Only cephalic presentation is normal
6. Abnormal lies
• Any lie apart from longitudinal
• Oblique and transverse lies are usually similar and need not be strictly
differentiated
• In both these lies, there is usually no presenting part
7. Abnormal presentations
• Any fetal presentation that is not cephalic
• Face, brow, cord, hand, breech
• Face and brow presentations
• Usually per abdomen, felt as cephalic
• diagnosed via vaginal exam (V/E)
8. • Can be felt per abdomen
• Soft fetal pole lower part of
uterus
Breech presentations
• Can be frank, complete or footling breech
• Footling breech presents as foot presentation
10. Implications
May signify underlying problem with pregnancy
Causes of abnormal lie
or presentation has to
be investigated
Is the fetus too big?
Is the inlet obstructed?
Is there an abnormality?
Too much or too little?
11. Differential diagnoses
May signify underlying
problem with
pregnancy
Causes of abnormal lie
or presentation has to
be investigated
Is the fetus too big?
Is the inlet obstructed?
Is there an abnormality?
Too much or too little?
Macrosomia
Polyhydramnios
Preterm
Fetal
Maternal
Placenta
Cervical
tumour
Problem
Diabetes
mellitus
Diabetes
mellitus
Fetal anomaly
Uterine
anomaly
Praevia
Fibroid
Diagnosis
15. Preparation for labour
• The lie at term prepares the presenting part for engagement during labour
• A combination of longitudinal lie and cephalic presentation is ideal
Greatest chance of successful vaginal delivery
• Any other lie apart from longitudinal cannot lead to vaginal delivery
• However, cephalic presentation is not the only presentation that can lead to
vaginal delivery
• Face and breech presentation can also have successful vaginal delivery
The chances are much less than cephalic
16. Lie and presentation in labour
• During labour, any lie that is not longitudinal has to be dealt with by Caesarean
section (LSCS)
• If diagnosed antenatally, prior to labour, the patient may have to be prepared for
elective LSCS
• Same applies for breech presentation
• Only breech presentation with low station and advanced cervical dilation may
be allowed to attempt vaginal delivery
• Breech in early labour has to be delivered by LSCS
17. Face and cord presentation
• Both of these can only be diagnosed through vaginal examination
• Cord presentation is an obstetric emergency
• Face presentation
• ⅓ may achieve normal delivery
• ⅔ will cause obstructed labour
22. Abnormal lies and fetal
presentations are high risk
situations that need a proper
diagnosis of the underlying
cause to avoid delivery
complications and morbidity
and mortality