Malpresentation & Malposition

University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

123

Pages:

1
Author:

Pierre BERNARD

Malpresentation & Malposition Lie Presentation Position – long axis (longitudinal 99%, transverse, oblique) – part at pelvic brim (cephalic, breech, face, brow) – head angle (should be occipito-transverse, can be OA/OP) Face Presentation 1/500 births, some link to anencephaly usually only recognised during labour & face becomes swollen Position described by chin (mento-) Enters mentotransverse & 90o rotate to mentoanterior (head born with flexion) If mentoposterior head is wider à cephalopelvic disproportion (often requires section) Brow Presentation 1/1500 births supraorbital ridges & bridge of nose palpable on VE May flex to convert to face, or extend to become vertex If brow persists will require C-section Breech Presentation 40% at 20 weeks, 25% at 32 weeks, 3% at term If breech at 38 weeks <4% conversion to cephalic Assoc with multiple pregnancy, bicornuate uterus, fibroids, placenta praevia, polyhydramnios & oligohydramnios 65% of breech are frank (extended), remainder flexed or footling (footling à increased risk cord prolapse) External Cephalic Version Should be offered for all non complicated breechs at 38 weeks. Most success when not engaged Pointless if placenta praevia as C-sect will still be needed Absolute contraindications – multiple pregnancy, abruption Relative contraindications – PET, fetal growth restriction Procedure Check CTG & US. ? fast & prep for theatre. Ritodrine iv infusion will soften uterus Manually rotate baby in direction it is facing (ie forward) Check CTG every 2 mins If unsuccessful return to breech (don’t leave transverse) Give anti-D if Rh-ve Success Rate – 30% primip, 50% multip Vaginal delivery for breech If no complications, < 3.8kg and NOT footling Require specialist experience – often need epidural, episotomy & careful monitoring Risk of developmental dysplasia of hip & klumpke’s paralysis Transverse / Oblique lie Assoc with multips, preterm labour, multiple pregnancy, polyhydramnios, placenta praevia, uterine abnormality, lower uterine fibroids Increased risk of cord prolapse if spontaneous ROM ECV can usually be performed C sect may be required if established in transverse Unstable lie Can manage conservatively with repeated ECV Or turn to cephalic & induce labour = “stabilising induction” Or C-section