Malpresentation occurs when the fetus is in any position other than head first. Risk factors include maternal factors like parity and pelvic abnormalities, and fetal factors like prematurity and congenital anomalies. Breech presentation is the most common type of malpresentation, occurring in 3-4% of births. It increases risks of complications for both mother and baby. Vaginal breech delivery may be attempted if certain criteria are met, but often cesarean section is recommended. Shoulder dystocia and umbilical cord prolapse are obstetric emergencies that require maneuvers and potentially expedited delivery to prevent harm to mother and baby.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children.
Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children.
Presented by:
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
This presentation was prepared by me, Dr. P. Chizororo, to help fellow professionals understand one of the most common malpresentations, Breech presentation. Visit my YouTube channel, Nexus Medical Media for all pre-clinical subjects
types of breech
how you can manage a woman with breech baby?
what is External cephalic version and who can do it ?
what is the risks of vaginal breech birth ?
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
9. Introduction
Breech presentation occurs in 3-4% of all deliveries. The
occurrence of breech presentation decreases with advancing
gestational age. Breech presentation occurs in 25% of births
that occur before 28 weeks’ gestation, in 7% of births that
occur at 32 weeks, and 1-3% of births that occur at term.
.
Perinatal mortality is increased 2- to 4-fold with breech
presentation, regardless of the mode of delivery. Deaths most
often are associated with malformations, prematurity, and
intrauterine fetal demise.
10. PREDISPOSING FACTORS
prematurity, uterine abnormalities (eg, malformations,
fibroids), fetal abnormalities (eg, CNS malformations, neck
masses, aneuploidy), and multiple gestations.
AF abnormality.Abnormal placentation.
Contracted pelvis.MG.Pelvic tumor.
Perinatal mortality is increased 2- to 4-fold with breech
presentation, regardless of the mode of delivery.
Congenital malformation 6%
11. TYPES OF BREECHES
Frank breech (50-70%) - Hips flexed,
knees extended
Complete breech (5-10%) - Hips flexed,
knees flexed
Footling or incomplete (10-30%) - One
or both hips extended, foot presenting
22. Criteria for VD or CS
VD
Frank
GA>34w
FW=2000-3500gr
Adequate pelvis
Flexed head
Nonviable fetus
No indication
Good progress labor
CS
FW<1500or> 3500gr
Footling
Small pelvis
Deflexed head
Arrest of labor
GA24-34w
Elderly PG
Inf or poor history
Fetal distress
23. VAGINAL BREECH DELIVERY
Three types of vaginal breech deliveries:
1. Spontaneous breech delivery
2. Assisted breech delivery
3. Total breech extraction
24. Once the feet have delivered, there
may be temptation to pull on the feet.
However, this should never be done
with a singleton gestation because it
may precipitate an entrapped head in
an incompletely dilated cervix or it
may precipitate nuchal arms. As long
as the fetal heart rate is stable and no
physical evidence of a prolapsed cord
exists, expectant management may be
followed, awaiting full cervical
dilatation.
.
Footling breech presentation-
25. Assisted vaginal breech delivery
Thick meconium passage
is common as the breech
is squeezed through the
birth canal. This usually is
not associated with
meconium aspiration
because the meconium
passes out of the vagina
and does not mix with the
amniotic fluid.
26. Picture 3. Assisted vaginal
breech delivery: The
Ritgen maneuver is
applied to take pressure
off the perineum during
vaginal delivery.
Episiotomies often are cut
for assisted vaginal
breech deliveries, even in
multiparous women, to
prevent soft-tissue
dystocia.
27. Picture 4. Assisted vaginal breech delivery: No
downward or outward traction is applied to the fetus
until the umbilicus has been reached.
28. Picture 5. Assisted vaginal breech delivery: With a
towel wrapped around the fetal hips, gentle
downward and outward traction is applied in
conjunction with maternal expulsive efforts until the
scapula is reached. An assistant should be applying
gentle fundal pressure to keep the fetal head flexed.
29. Picture 6. Assisted vaginal breech delivery: After
the scapula is reached, the fetus should be rotated
90° in order to delivery the anterior arm.
30. Picture 7. Assisted vaginal breech delivery: The anterior
arm is followed to the elbow, and the arm is swept out of
the vagina.
31. Picture 8. Assisted vaginal breech delivery: The fetus is
rotated 180°, and the contralateral arm is delivered in a
similar manner as the first. The infant is then rotated 90°
to the back-up position in preparation for delivery of the
head.
32. Picture 9. Assisted vaginal breech delivery: The fetal head is
maintained in a flexed position by using the Mauriceau-Smellie-
Veit maneuver, which is performed by placing the index and
middle fingers over the maxillary prominence on either side of
the nose. The fetal body is supported in a neutral position with
care to not overextend the neck.
33. Picture 10. Piper forceps application: Pipers are
specialized forceps used only for the aftercoming head of
a breech presentation. They are used to keep the head
flexed during extraction of the fetal head. An assistant is
needed to hold the infant while the operator gets on one
knee to apply the forceps from below.
34. Picture 11. Assisted vaginal breech delivery: Low 1-minute Apgar scores are not
uncommon after a vaginal breech delivery. A pediatrician should be present for the
delivery in the event that neonatal resuscitation is needed.
48. Definition:
Shoulder dystocia (Sh. D) is the inability to
deliver the fetal shoulders after delivery of
the head, without the aid of specific
maneuvers (ie. other than gentle downward
traction on the head) .
50. PATHOPHYSIOLOGY
Shoulder dystocia results from
a size discrepancy between the
fetal shoulders and the pelvic inlet
when:
1. The bisacromial diameter is large
relative to the biparietal diameter
2. Pelvic brim is flat rather
than gynecoid
.
56. Brachial plexus injuries,
Fractures of the humerus, and
Fractures of the clavicle
are the most commonly reported
injuries associated with shoulder
dystocia
Fetal Complications of Sh D
57. Traction combined with fundal
pressure has been associated with a
high rate of brachial plexus injuries
and fractures
Fetal Complications of Sh D
58. Fewer than 10% of deliveries complicated by
shoulder dystocia will result in brachial plexus
injury.
Fetal Complications of Sh D
59. Release techniques
Head –shoulder interval > 7min.
Brain injury
With hypoxic fetus it is much shorter
Fetal Complications
(sensitivity & specificity :70 %)
62. RISK FACTORS FOR SHOULDER
DYSTOCIA
Antenatal:
Excessive maternal weight gain
Macrosomia
G. diabetes
Short stature
Post term
63. RISK FACTORS FOR SHOULDER
DYSTOCIA
Intrapartum:
1. Protracted or arrested active phase
2. Protracted or failure of descent of
head
3. Need for midpelvic assisted delivery
66. ACOG Issues Guidelines
Recommendation 1991
1-Call for help: assistants, anesthesiologist
2-Initial gentle attempt of traction.
3-Generous episiotomy.
4-Suprapubic pressure.
67. ACOG Issues Guidelines
Recommendation 1991
.
5-The Mc Roberts
manoeuvre
(Exaggerated hyper
flexion of the thighs
upon the abdomen.)
& Suprapubic
pressure in the
direction of the Foetal
face
68. No increase in pelvic dimensions.
Decrease in the angle of pelvic inclination P=0.001
Straightening of the sacrum P= 0.04%
Tends to free the impacted anterior shoulder
Gherman et al Obstet Gynecol 95:43 ,2000
McRoberts manoeuvre: X ray pelvimetry study
69. ACOG Issues Guidelines
Recommendation 1991
.
If Mc Roberts failed:
6-Woods manoeuvre:
•The hand is placed
behind the posterior
shoulder of the fetus.
•The shoulder is
rotated progressively 180 d in a corkscrew manner so
that the impacted anterior shoulder is released.
75. Umbilical Cord Prolapse
Etiology
– 1-275 deliveries
Classification
– Complete: cord is seen or palpated ahead of presenting part
(OB Emergency)
– Fundic: cord felt through intact membranes ahead of
presenting part
– Occult: hidden or not visible at any time during course of
labor
Definition: umbilical cord that lies below/beside
presenting part
76. Umbilical Cord Prolapse
Precipitating factors:
Long umbilical cord
Abnormal location on
placenta
Small or preterm infant
Polyhydramnios
Multiple gestation
Precipitating factors:
Amniotomy before fetal
head is engaged
IUPC placement
External cephalic
version
77. Clinical Manifestations:
Cord observed or palpated
Bradycardia following ROM
Repetitive, variable decelerations that do not
respond to medical intervention (e.g. amnioinfusion)
Prolonged decelerations (>15 bpm lasting 2 mins or
longer yet <10 mins)
78. Nursing interventions:
Assess fetal viability
Call for assistance
Relieve pressure from cord (usually presenting part)
Continuous manual relief of pressure from presenting part
Avoid excessive manipulation of cord
Re-position client: Trendelenburg, modified Sim’s, or knee-chest
Prepare for emergency delivery
Administer oxygen by mask 10-12 L/min
Fill maternal bladder with 500-700 cc NS
Continuous fetal monitoring
Possible neonatal resuscitation (notify neonatal team per
hospital protocol)
79. Aim of Medical management:
Immediate delivery of viable infant
Hallmark treatment: C-section