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Abn Presntn
Abn Presntn
fetus is leading, that is, is closest to the pelvic inlet of the birth canal.
malpresentations
IN I!EN E
FA E PRESENTATION
POSITIONS Left mentoanterior (LMA) Right mentoanterior (RMA) Right mentoposterior (RMP) Left mentoposterior (LMP)
AETIOLO/0
Maternal Factors
Fetal Factors
Anencephal# ord around the nec$ %umours of nec$ li$e congenital goitre &pasm of sternocleidomastoid muscle
!IA/NOSIS
omplications
Maternal
Prolonged labour 'ncreased ris$ of operative deliver# !bstructed labour in persistent mentoposterior (etal
%he face after deliver# is oedematous and swollen. Lar#ngeal oedema )irth asph#*ia
BRO5 PRESENTATION
# in #,,, .irths premature rupture o) mem.ranes ma* precede .row presentation in as man* as 678 o) cases
!ia1nosis
encountered alon1 the )etal .ac93 and the )etal chin is also palpa.le
La.or Mana1ement
close o.ser&ation ontinuous electronic )etal heart rate monitorin1 O2*tocin can .e used to au1ment la.or esarean deli&er* is per)ormed )or the usual o.stetrical indications3 includin1 arrest o) la.or and nonreassurin1 )etal heart rate pattern
BREE ; PRESENTATION
Positions
Le)t sacroanterior "LSA' Ri1ht sacroanterior "RSA' Ri1ht sacroposterior "RSP' Le)t sacroposterior "LSP
T*pes o) .reech
omplete .reech or )le2ed .reech Incomplete .reech Extended or frank breech Knee presentation Footling presentation
omplete .reech
Knee presentation
Footling presentation
Etiolo1*
Prematurit* Maternal )actors Multiparit# producing uterine rela*ation +terine obli"uit# Placenta praevia and cornuofundal attachment of placenta +terine fibroids in the lower segment +terine anomalies li$e bicornuate and septate uterus
Fetal )actors
!IA/NOSIS
A.dominal e2amination
;ead o) the )etus is )elt in the )undal 1rip4 Breech is )elt in the )irst pel&ic 1rip4 Fetal heart is heard a.o&e the um.ilicus4
:a1inal E2amination
onical .a1 o) mem.ranes4 Presentin1 part is hi1h up4 In )le2ed .eech3 the ischial tu.erosities3 anus3 sacrum3 .uttoc9s and )eet are palpated4
ME ;ANISM OF LABO<R
Electi&e caesarean section E2ternal cephalic &ersion Assisted .reech deli&er* Emer1enc* caesarean section Breech e2traction
vaginal e*amination maintain intact membranes till full cervical dilatation %, monitoring and epidural analgesia for labour are ideal.
Second stage
!eli&er* o) the A)ter omin1 ;ead Burns Marshall manoeuvre 4 Mauriceau Smellie Veil manoeuvre
Lovset's manoeuvre
S;O<L!ER PRESENTATION
# in =,, positions
!IA/NOSIS
Abdomen is transversel# stretched (undal height is less than the period of gestation
-o fetal pole at the fundus )allotable head in one flan$ and breech in the other
OMPO<N! PRESENTATION
In a compound presentation3 there is prolapse o) one or more lim.s alon1 with the head or .reech3 .oth enterin1 the pel&is at the same time
Etiolo1*
Prematurit* " commonest ' ontracted pel&is Pel&ic tumours Multiple pre1nanc* Macerated )etus