Fetal malpositioning & malpresentation can pose a serious threat to maternal & fetal well being. The document discusses the risks, complication, and management of some of the common malpresentation & malpositioning.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
Fetal malpositioning & malpresentation can pose a serious threat to maternal & fetal well being. The document discusses the risks, complication, and management of some of the common malpresentation & malpositioning.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
This is the relationship of the longitudinal axis of the fetus to longitudina...ssuser0d3989
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.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
Cephalopelvic disproportion, contracted pelvis, Etiology, risk factors, management, assessment methods of cpd,clinical features,Munro Kerr muller method,imaging pelvimetry,trial of labour in CPD,conduct of Trial of labour,complications of CPD
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
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- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. •Vertex presentation
•Occiput in post. Segment of pelvis overlying the
sacroiliac jt and sacrum
• 3 positions described:
1. Right occipitoposterior
2. Left occipitopoterior
3. Direct occipitoposterior
3. AETIOLOGY
SHAPE OF PELVIC INLET- anthropoid or
android pelvis
FETAL FACTORS- marked deflexion-
1) high pelvic inclination
2) placenta on ant. Wall of uterus
3) back on the right side
UTERINE FACTORS- abnormal uterine
contractions
4. DIAGNOSIS
ABDOMINAL EXAMINATION
Subumbilical flattening
Back is in one or the other flank so clinically
not felt
Limbs felt anteriorly
Shoulder in flanks
Unengaged or high head at term
Occiput and sinciput at same level
Fetal heart sounds in the flanks and are
frequently indistinct
5. VAGINAL EXAMINATION
Early In Labour-
Early rupture of membranes
Sagittal suture in right oblique diameter
Post. Fontanelle in right posterior quadrant
and ant. Fontanellae in left anterior quadrant
Both fontanelle easily palpated
6. Late In Labour
Large caput present obscuring the sutures
Pinna points occiput
Perineum gapes much before head distends it
and premature straining can occur
Difficulty in applying forceps in unrecognized
occipitoposterior
7. MECHANISM OF LABOUR
ENGANGING DIAMETER
Suboccipitofrontal-10.5cm
Occipitofrontal-11.5cm
8. COURSE OF LABOUR
Anterior rotation- 90% cases, occiput
rotates anteriorly through 3/8 of circle
and baby born occipitoanterior.
Engagement may be delayed and labour
may be longer because of deflexion.
9. Posterior Rotation And Face To Pubis
Delivery
Head is deflexed.
Engaging diameter is occipitofrontal.
Sinciput rotates anteriorly then occiput rotates
posterioirly
Extreme flexion followed by extreme
extension
Perineal tears common
Liberal episiotomy needed
Occipitosacral position and face to pelvis are
more common anthropoid pelvis
10. Failure Of Rotation
Persistent occipitoposterior is the absence of
rotation and head remains as ROP or LOP
Deep transverse arrest is defined as head
being arrested with sagittal suture in
transverse diameter at the level of ischial
spine, after full dilation of cervix and inspite of
good uterine contractions
11. Reasons-
Deflexion of the head
Inefficient uterine contraction
Weak pelvic floor preventing anterior rotation
Pendulous abdomen and poor muscle tone
Cephalopelvic disproportion and android
pelvis
12. MANAGEMENT
Most of the malpositions will rotate
anteriorly and the baby will be born
spontaneously as occiput anterior
Posterior rotation- labour longer
- Judicious use of fluids, liberal
episiotomy and analgesia needed
-partogram essential
- -oxytocin augmentation
13. DEEP TRANSVERSE ARREST
1. Caesarean section-android pelvis,
cephalopelvic disproportions, traumatic
vaginal delivery causing intracranial
haemorrhage
2. Vacuum extraction- ideal- cup at posterior
fontanelle- promotes flexion, thus decreases
presenting diameter- promotes autorotation
suited for the pelvis- less traumatic, no need
for analgesia
14. 3. Manual rotation- under GA
-right hand grasps the sinciput, displacing it and
there by increasing flexion
- Small bitemporal diameter allows more space
for the thumb and finger to have firm grasp
across the temple with middle finger on the
frontal suture
- In LOP, left hand used- sinciput rotated and
forceps or vacuum used
15. 4. Forceps Rotation-
- Keilland forceps used
- Under GA
- In anteroposterior direction and rotation
carried out
- Adv- forceps need not be reapplied
16. PERSISTENT
OCCIPITOPOSTERIOR
Oxytocin augmentation tried
Most cases delivery as occipitoposterior
with face to pelvis, assisted with forceps
or vacuum
Rotation to occipitoanterior can be
attempted
Caesarean section otherwise
17. If any of the attempt to deliver the baby
vaginally fails.. Immediate CS should be
done
Otherwise, fetus may die and craniotomy by
experienced hands or CS must be done
18. FACE PRESENTATION
Cephalic presentation where the attitude is
one of complete extension, presenting part is
face and denominator is the chin or mentum
Engaging diameter is submentobregmatic-
9.4cm
Primary face presentation are present before
onset of labour and are rare
Secondary caused by extension during labour
and is most common
19. POSITIONS
Left mentoanterior(LMA)
Right mentoanterior(RMA)
Right mentoposterior(RMP)
Left mentoposterior(LMP)
70% are mentoanterior and 30% posterior.
21. Fetal Factors
-anencephaly and iniencephaly
-cord around the neck
-tumours of neck like congenital goitre
-spasm of sternocleidomatoid muscle
-dolicocephalic head
22. DIAGNOSIS
ABDOMINAL EXAMINATION
In mentoanterior, back is felt with difficulty as it
is posterior and limbs anteriorly
Head remains high
Cephalic prominence is the occiput and on the
same side as the back
Groove b/w the head and back is prominent
Fetal heart sounds are transmitted through the
chest and heard well anteriorly in
mentoanterior
23. VAGINAL EXAMINATION
-conical bag of membranes
- chin, mouth, nose, malar eminences and
supraorbital ridges are felt
-in mentoanterior, chin is in one ant. Quadrant
and forehead in opp post. Quadrant
-done gently and without cream to avoid injury
to eyes
24. MECHANISM OF LABOUR
MENTOANTERIOR POSITION
1. Engagement
-engaging diameter- submentobregmatic-9.4cm
-biparietal diameter-7cm
This diameter pass only when face low down in
perineum
-when face distending the vulva, head engaged
25. 2. DESCENT WITH INCREASING
EXTENSION
-Resistance encountered by extension
-occiput pushed towards back of fetus, while
chin descends
3. INTERNAL ROTATION
-Rotates anteriorly through 45°towards
symphysis
Neck traverse the posterior surface of
symphysis pubis
26. 4. FLEXION
-head born by flexion
-chin pivots under symphysis pubis and the
mouth, nose, orbit, forehead ,vertex and
occiput are born by flexion
5. RESTITUTION AND EXTERNAL ROTATION
-of chin occurs towards the side to which it was
originally directed and the shoulder are born
as in vertex
27. MENTOPOSTERIOR
-2/3RD cases rotate anteriorly through 3/8th circle
and deliver as mentoanterior
-some in oblique diameter and some rotate
posteriorly into the hollow of sacrum
-neck too short to span in the 12cm of the ant.
Aspect of sacrum
-shoulders get impacted along with head making
delivery impossible
-engaging diameter is sternobregmatic-17cm
-no mechanism of labour
28. CAUSES OF PROLONGED LABOUR
Face is less effective dilator of cervix
No moulding of face
More chance of rupture of membranes
Long internal rotation in mentoposterior
Internal rotation occurs only late in 2nd stage
30. FETAL
Face after delivery is oedematous
Laryngeal oedema can also occur- baby
watched for 24 hrs
Congenital malformations like anencephaly
Birth asphyxia due to cord prolapse and
prolonged labour
31. MANAGEMENT
Mentoanterior, forward rotation in
mentoposterior- labour allowed
CPD, anencephaly, other anomalies,
persistent mentoposterior, obstructed
labour- CS DONE
Dead baby- CS or craniotomy
32. BROW PRESENTATION
Most unfavourable
Attitude is one of partial extension,
presenting part being the area between the
ant. Fontanelle above and glabella and
orbital ridges below and denominator is
forehead or frontum
Presenting diameter is verticomental-
13.5cm
Transitory presentation- flex or extend
34. DIAGNOSIS
Rarely made before labour
ABDOMINAL EXAMINATION
High mobile head, which feels large from
side to side
Cephalic prominence is the occiput and is on
same side as back and groove between
cephalic prominence and back is less
prominent than in face presentation
35. VAGINAL EXAMINATION
Membranes felt in early labour
Anterior frontanelle is felt at one end and root
of nose and orbital ridges at other end of
oblique or transverse diameter
Nose and mouth are palpable but not the chin
36. MECHANISM OF LABOUR
Presenting diameter - verticomental
No mech of labour for persistent brow
presentation
Spontaneous labour only if baby very
small or pelvis large
In persistent brow, verticomental dia is
shortened & the occipitofrontal dia
elongated with marked moulding and
large caput on forehead
38. MANAGEMENT
ANTEPARTUM
Wait till labour
EARLY LABOUR
If membrane not ruptured wait for correction
After membrane rupture, brow presentation
diagnosed and in persistent brow presentation
–CS done
Prologed labour with head high.. Brow
presentation must be suspected
39. LATE LABOUR
If features of obstructed labour or if fetus
dead- immediate CS done
If baby dead- also craniotomy
40. SHOULDER PRESENTATION
AND TRANSVERE LIE
Long axes of fetal and maternal ovoid
are approximately at right angles to
each other and shoulder is presenting in
the pelvic inlet.
Denominator- acromion
POSITIONS
Right acromial
Left acromial
41. DEPENDING UPON DIRECTION OF THE
BACK
Dorsoanterior
Dorsoposterior
Dorsosuperior
Dorsoinferior
42. INCIDENCE AND
AETIOLOGY
Incidence- 1 in 500
MATERNAL FACTOR
Multiparity
Contracted pelvis
Uterine anomalies like septate,bicornuate
and arcuate uterus
Placenta praevia
Fibroid in the lower segment
44. DIAGNOSIS
ABDOMINAL EXAMINATION
Transversely stretched
Fundal height less than period of gestation
No Fetal pole at fundus
Ballotable head in one flank & breech in the
other
In dorsoanterior, back is felt a uniform
reistance acros the front of abdomen
In dorsoposterior, limbs are felt anteriorly
Empty pelvic grip
45. VAGINAL EXAMINATION
Conical bag of membranes with a high
presenting part
Hand/shoulder/elbow may be felt as a
uniform resistance across the front of
abdomen
Shoulder can be identified by ribs running
parallel to each other
Late in labour, shoulder may be wedged in
the pelvis and hand freequently prolapse into
the vagina
46. Thumb of the prolapsed hand, when
supinated points to head
To side, to which the prolapsed hand
belongs, can be determined by shaking hand
with the fetus. If the right hand is required,
prolapsed hand is the right and viceversa
ULTRASONOGRAPHY
Confirms diagnosis and position
Rules out anomalies
Rules out placenta praevia
47. MECHANISM OF LABOUR
NO mechanism of labour
Spontaneous version to breech or by
spontaneous rectification to vertex can occur
Rarely if fetus small or dead delivery occurs
by:
- Spontaneous expulsion or birth corpora
conduplicata where fetus is expelled doubled
up
- Spontaneous evolution where breech and
trunk are expelled followed by head
48. NEGLECTED SHOULDER PRESENTATION
Due to ill fitting presenting part, membranes
may rupture early and freequently ensues cord
prolapse, once labour commence
A labour pain becomes stronger, the shoulder
forced into the pelvic inlet
Nullipara- uterine inertia
Multipara-bandl ring or pathological retraction
ring-obstructed labour- neglected shoulder
presentation
Mother-exhausted,febrile and urine show ketone
bodies-uterine rupture- death of both mother
and baby
49. COMPLICATIONS
MATERNAL
Increased chance of caesarean section
Obstructed labour or ruptured uterus
FETAL
Birth asphyxia due to cord prolapse and
in obstructed labour
50. MANAGEMENT
EXTERNAL CEPHALIC VERION
At term or early in labour if membranes
intact and not contraindicated
More successful in multipara
If successful followed by stabilizing
induction
More success than for breech
51. CAESAREAN SECTION
Best option
When ECV fails and CI
Transverse inscision
NEGLECTED SHOULDER PRESENTATION
If baby dead-CS or craniotomy