Fetal lie, presentation, attitude and position

1. F E TA L L I E , P R E S E N TAT I O N ,
AT T I T U D E A N D P O S I T I O N
M U K E S H S A H
P G I
G O O D S A M M E D I C A L C E N T E R
REFERENCE: OBSTETRIC WILLIAM 24TH EDITION

2. I. FETAL LIE
1. LONGITUDINAL /TRANSVERSE LIE
>The relation of the long axis of the fetus to that of the mother
> present in over 99% of labors at term
PREDISPOSING FACTORS:
1.MULTIPARITY
2. PLACENTA PREVIA
3. HYDRAMNIOS
4. UTERINE ANOMALIES
2. OBLIQUE LIE
>fetal and maternal axis may cross at 45- degree angle
> UNSTABLE LIE, becomes longitudinal or transverse during the course of the labor

3. II.FETAL PRESENTATION AND PRESENTING PART
A.PRESENTING PART
>portion of the body of the fetus that is either foremost within the birth canal or in
closest proximity to it
>portion of the fetus felt through the cervix during vaginal examination
> determines presentation

4. II.FETAL PRESENTATION AND
PRESENTING PART
A.PRESENTING PART
1. LONGITUDINAL LIE- either fetal head or the breech( creating cephalic or
breech presentation)
2. TRANSVERSE LIE-shoulder

5. CEPHALIC PRESENTATION
CLASSIFICATION:
A. VERTEX/ OCCIPUT PRESENTATION
- MORE COMMON
-occipital fontanel is the presenting part
* vertex- lies in front of the occipital fontanel
*occiput- behind the fontanelle
B. SINCIPPUT PRESENTATION
- fetal head partially flexed with the anterior ( large ) fontanel, or bregma

6. CEPHALIC PRESENTATION
CLASSIFICATION:
C. BROW PRESENTATION
- fetal head partially extend with the brow presenting
D. .FACE PRESENTATION
- LESS COMMON
- fetal necksharply extended so that the occiput and back come in
contact and the face in foremost of the birth canal

7. CEPHALIC PRESENTATION
C. BROW
PRESENTATION
D. .FACE
PRESENTATION
A. VERTEX/ OCCIPUT
PRESENTATION
B. SINCIPPUT
PRESENTATION

8. BREECH PRESENTATION
- When the fetus present as breech ,the 3 general configuration are frank, complete and
footling presentation.
PREDISPOSING FACTORS COMPLICATIONS
1. Gestational age ( before term)
2. Hydramnios(>2,000ml)
3. Uterine contractions, associated with great
parity
4. Multiple fetuses
5. Hydrocephaly
6. Anencephaly
7. Previous breech delivery
8. Uterine anomalies
9. Pelvic tumors
10. Placenta previa
1. Perinatal morbidity and mortality
2. Low birth weight from pre term delivery,
growth restriction or both
3. Prolapsed cord
4. Placenta previa
5. Fetal, Neonatal, Infant anomalies
6. Uterine anomalies and tumors

9. BREECH PRESENTATION
TYPES:
1. FRANK BREECH
- thigh flexed and the leg extended over the anterior surface of the body
2. COMPLETE BREECH
- thigh flexed on the abdomen and the legs upon the thigh
3.INCOMPLETE / FOOTLING BREECH
- one or both feet or one of both knees may be lowermost

10. BREECH PRESENTATION
1.FRANK BREECH 2. COMPLETE BREECH 3.INCOMPLETE / FOOTLING BREECH

11. FETAL ATTITUDE OR POSTURE
ATTITUDE OR HABITUS
-fetus assumes a characteristic posture
-As a rule the fetus forms an ovoid mass that correspond roughly to the shape of
the uterine cavity.
-The fetus become folded or bent upon itself in such a manner that the cack
becomes markedly convex
-The head is sharply flexed so that the chin is almost in contact with the chest

12. FETAL POSITION
• FETAL POSITION
- relationship of the fetal presenting part to the right or left side of the maternal birth
canal
2 POSITION - 1. RIGHT
2. LEFT
- because the presenting part may be either left or right position, there are left and
right occipital , left and right mental, left and right sacral presentation.
DETERMINING POINTS IN VERTEX, FACE AND BREECH PRESENTATION
1. FETAL OCCIPUT
2. CHIN( MENTUM)
3.SACRUM

13. VARIETIES OF PRESENTATION AND
POSITION
-relation of a given portion of the presenting part to the anterior , transverse ,
or posterior portion of the mother pelvis is considered
- 2 positions, 3 varieties for each position ( either left or right)
- 6 varieties for each presentation ( three right and three left)

14. OCCIPUT PRESENTATION , POSITION AND VARIETY MAY
BE ABBREVIATED IN CLOCKWISE FASHION AS;
A- ANTERIOR
T-TRANSVERSE
P-POSTERIOR

15. FETAL ATTITUDE OR POSTURE
LEFT MENTO ANTERIOR RIGHT MENTO ANTERIOR RIGHT MENTO POSTERIOR

16. FETAL ATTITUDE OR POSTURE
LONGITUDINAL LIE VERTEX PRESENTATION
LEFT OCCIPUT ANTERIOR LEFT OCCIPUT POSTERIOR

17. FETAL ATTITUDE OR POSTURE
RIGHT OCCIPUT ANTERIOR
LONGITUDINAL LIE IN BREECH PRESENTATION
LEFT SACRUM POSTERIOR POSITON (LSP)

18. FETAL ATTITUDE OR POSTURE
Transverse lie. Right acromiodorsoposterior position (RADP). The shoulder of
the fetus is to the mothers right and back posterior

19. PRESENTATION AND POSITIONS FREQUENCY
PRESENTATION: at near term
1.VERTEX- 96 %
-2/3 LEFT OCCIPUT and 1/3 RIGHT OCCIPUT
2.BREECH – 3.5%
-much greater in earlier pregnancy
* Ultrasonography- 14% ( 29-32 weeks)
-converted spontaneously to vertex as term aproach
3.FACE – 0.3%
4.SHOULDER 0.4 %

20. REASON FOR PREDOMINANCE OF CEPHALIC PRESENTATION
• WHY FETUS AT TERM USUALLY PRESENTS BY VERTEX?
-most logical explanation is that the uterus is piriforn shaped.
* at 32 week-amniotic cavity is large compared to fetal mass and there is no
of the fetus by the uterine walls
- the ratio of the amniotic fluid volume and fetal mass altered bec amniotic fluid
decreases by increasing fetal size.

21. DIAGNOSIS OF PRESENTATION AND POSITION OF THE FETUS
• METHODS TO DETERMIBED FETAL PRESENTATION AND POSITION
1. ABDOMINAL PALPATION- LEOPOLDS MANEUVER
2. VAGINAL EXAMINATION
3. COMBINED EXAMINATION
4. AUSCULTATION
5. ULTRASOUND
6. CT-SCAN DOUBTFUL CASES
7.MRI

22. METHODS TO DETERMINED FETAL PRESENTATION AND POSITION
1. ABDOMINALPALPATION- LEOPOLDS MANEUVER
A.FIRST MANEUVER- the examiner palpate the fundus with the tip of the fingers of both
hand in order to define which fetal pole presents the fundus
BREECH- large, nodular body, head feels hard and round and more freely movable
and ballotable.
B. SECOND MANEUVER- the palm of the examiner hand are placed on either side of the
abdomen , and gentle but deep pressure is exerted.On one side , a hard resistand structure
felt , the back and on the other , numerous small, irregular and mobile parts are felt, the
extremities.

23. METHODS TO DETERMINED FETAL PRESENTATION AND POSITION
C. THIRD MANEUVER
- employing the thumb and the fingers 0f one hand, the examiner grasp the
lower portion of the maternal abdomen, just above the symphysis pubis . If the
presenting part is not engaged, a movable body will be felt, usually the fetal head.
D. FOURTH MANEUVER- the examiner faces the mother’s feet and with the tips of the
frst three fingers of each hand, exert deep pressure in the direction of the axis of the
pelvic inlet. If the head presents, one hand is arrested sooner than the other by a
rounded body.

24. Thank You!