Malpresentatin
Presentatin = relatinsship if leading part if fietus witsh maternal pelvic inlet
Malpresentatin = Fetal presentatin at term wshicsh prevents NVB i.e. anytshing but vertex (face,
brow, shoulder, breech).
Risk factirs =
Maternal
- Pelvic animaly – fbriids , ivarian mass, pelvic fracture
- Uterine malfirmatin (e.g. bicirnuate)
- Priir breecsh delivery
- Multparity
Fietal
- Twins
- Prematurity
- SGA ir Macrismia
- Fietal cingenital animalies (anencepshaly, shydricepshalus)
Uteriplacental
- Placenta previa
- Pilyshydramniis/Oligishydramniis
Presentatin Descriptin Management
Vertex Occiput if tshe shead is tshe leading part. Determine pisitin witsh a VE
3 pissible positions fir vertex
(subiccipitibregmatc presentatin:
diameter = 9.5cm) – Ocipito-anterior/OA – Facing
NARROWEST backwards (tiwards ciccyx) alliwing
iptmal shead lexiin. May be sligsht le
ir rigsht (ROA ir LOA). Tshese pisitins
are IDEAL FOR VAGINAL DELIVERY.
Ocipito-posterior/OP – Facing firward
(tiwards pubis).
OA
Ocipito-transverse/OT – Facing eitsher
NVB – tshis is tshe ideal pisitin and
le ir rigsht (LOT ir ROT).
presentatin
Malpisitin (OP ir OT)
Risk factirs fir malpisitin (OP and OT):
Wait - Spintaneius ritatin (45%)
Preterm labiur
Manual rotation (insert shand vaginally)
Pelvic sshape
Instrumental rotation (Kielland
Epidural (piir tine if pelvic muscles)
firceps)
C-section
Face Head is presentng but cimpletely Mentiantetir
extended. NVB atempted
(9.5cm) Mentoanterior – Extended shead witsh Firceps witsh EXTRA CARE as facial
cshin facing pubis. Diameter as small as trauma is likely
OA cepshalic si NVB ti be atempted. C-sectin if unsuccessful
Mentoposterior - Extended shead witsh
cshin facing ciccyx. Mentipisteriir/Mentitransverse
Mentotransverse – Extended shead C-sectin
witsh cshin facing le ir rigsht.
Brow Head is presentng but sligshtly extended. C-sectin
(Mentivertcal = 14cm) –
WIDEST
Parietal/Military Head neitsher lexed nir extended. C-sectin
(11.3cm)
Shoulder/transverse Sshiulder frst. Nit deliverable ECV befire labiur.
C-sectin if labiur shas begun.
Frank (extended) breech (65%) – Mist ECV (external cephalic version) - Perfirmed
cimmin. Baby’s legs are up next ti its a er 36 weeks.
abdimen, witsh its knees straigsht and its Atempted cinversiin if breecsh inti
feet next ti its ears. vertex OA by manual manipulatin
Incomplete (footling) breech (25%) – One tshriugsh maternal abdimen
Presentatin = relatinsship if leading part if fietus witsh maternal pelvic inlet
Malpresentatin = Fetal presentatin at term wshicsh prevents NVB i.e. anytshing but vertex (face,
brow, shoulder, breech).
Risk factirs =
Maternal
- Pelvic animaly – fbriids , ivarian mass, pelvic fracture
- Uterine malfirmatin (e.g. bicirnuate)
- Priir breecsh delivery
- Multparity
Fietal
- Twins
- Prematurity
- SGA ir Macrismia
- Fietal cingenital animalies (anencepshaly, shydricepshalus)
Uteriplacental
- Placenta previa
- Pilyshydramniis/Oligishydramniis
Presentatin Descriptin Management
Vertex Occiput if tshe shead is tshe leading part. Determine pisitin witsh a VE
3 pissible positions fir vertex
(subiccipitibregmatc presentatin:
diameter = 9.5cm) – Ocipito-anterior/OA – Facing
NARROWEST backwards (tiwards ciccyx) alliwing
iptmal shead lexiin. May be sligsht le
ir rigsht (ROA ir LOA). Tshese pisitins
are IDEAL FOR VAGINAL DELIVERY.
Ocipito-posterior/OP – Facing firward
(tiwards pubis).
OA
Ocipito-transverse/OT – Facing eitsher
NVB – tshis is tshe ideal pisitin and
le ir rigsht (LOT ir ROT).
presentatin
Malpisitin (OP ir OT)
Risk factirs fir malpisitin (OP and OT):
Wait - Spintaneius ritatin (45%)
Preterm labiur
Manual rotation (insert shand vaginally)
Pelvic sshape
Instrumental rotation (Kielland
Epidural (piir tine if pelvic muscles)
firceps)
C-section
Face Head is presentng but cimpletely Mentiantetir
extended. NVB atempted
(9.5cm) Mentoanterior – Extended shead witsh Firceps witsh EXTRA CARE as facial
cshin facing pubis. Diameter as small as trauma is likely
OA cepshalic si NVB ti be atempted. C-sectin if unsuccessful
Mentoposterior - Extended shead witsh
cshin facing ciccyx. Mentipisteriir/Mentitransverse
Mentotransverse – Extended shead C-sectin
witsh cshin facing le ir rigsht.
Brow Head is presentng but sligshtly extended. C-sectin
(Mentivertcal = 14cm) –
WIDEST
Parietal/Military Head neitsher lexed nir extended. C-sectin
(11.3cm)
Shoulder/transverse Sshiulder frst. Nit deliverable ECV befire labiur.
C-sectin if labiur shas begun.
Frank (extended) breech (65%) – Mist ECV (external cephalic version) - Perfirmed
cimmin. Baby’s legs are up next ti its a er 36 weeks.
abdimen, witsh its knees straigsht and its Atempted cinversiin if breecsh inti
feet next ti its ears. vertex OA by manual manipulatin
Incomplete (footling) breech (25%) – One tshriugsh maternal abdimen
