FACE PRESENTATION
• DIGNOSTIC LANDMARKS-EYES,NOSE MOUTH
AND CHIN
• POSITION-MENTO
ANTERIOR/POSTERIOR,MENTO TRANSVERSE
• MANAGEMENT GUIDELINES-FETUS IS DEAD
OR ALIVES WITH ANOMALIES INCOMPATABLE
WITH LIFE,ALLOW VAGINAL DELIVERY
• MENTO ANTERIOR ,R/O FPD
FACE PRESENTATION AND BROW
IF LABOUR IS PROGRESSING WELL
MENTO POSTERIOR- C/S
BROW -NORMALLY INCOMPATABLE WITH
VAGINAL DELIVERY
DIAGNOSTIC LANDMARKS-ROOT OF THE
NOSE,SUPRAORBITAL RIDGES,ANTERIOR
FONTANEL
MANAGEMENT - CESARIAN SECTION
SHOULDER PRESENTATION
• DIAGNOSTIC LANDMARKS
• UTERUS IS ENLARGED TRANSVERSLY AND
SHORTENED VERTICALLY
• EMPTINESS AT THE LOWER POLE
• ON PV PALPABLE CLAVICLE ,RIBS ARM
PROLAPSE
MANAGEMENT
• WITH FETUS ALIVE –C/SECTION
• WITH FETUS DEAD-DESTRUCTIVE
OPERATION,OR C/S
• COMPOUND PRESENTAION
• PROLAPSE OF ONE OR MORE LIMBS IN
CEPHALIC PRESENTATION
• PROLAPSE OF HAND OR ARM IN BREECH
PRESEENTATION
COMPOUND PRESENTATION
• PUSH THE HAND ABOVE THE FETAL HEAD
• ARM MAY BE DIFFICULT TO REPLACE AND
CESARIAN SECTION MAY BE NECESSARY
• MALPOSITION
• INCORRECT POSITIONING OF THE VERTEX
• OCCIPITO POSTERIOR POSITION
• PERSISTENT O.P.P
0CCIPITO POSTERIOR POSITION
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•
•
•
•
DIAGNOSIS
PALPATION
AUSCULTATION
VAGINAL EXAMINATION
LONG ROTATION-135° --OCCIPITO ANTERIORSVD EXPECTED
• SHORT ROTATION- 45°--FACE TO PUBIS—AVD
OR C/SECTION
MALPRESENTATION
ANY PRESENTATION OTHER THAN
THE NORMAL VERTEX OF THE FETAL
HEAD
MALPRESENTAION
•
•
•
•
•
FACE
BROW
SHOULDER
BREECH
COMPOUND
CAUSES OF MALPRENTATION
•
•
•
•
•
HIGH PARITY
PREMATURITY
FETAL ANOMALIES
POLYHYDRAMNIOS
MILD CPD
BREECH PRESENTATION
WHEN THE BUTTOCKS AND/OR THE FEET ARE
THE PRESENTING PARTS
THE COMMONEST MALPRESENTATION
HAS HIGHER PERINATAL MORTALITY AND
MORBIDTY
CAUSES OF BREECH PRESENTATIONPREMATURITY,MULTIPLE PREGNANCY,FETAL
MALFORMATION,HYDRAMNIOUS
CLASSIFICATION AND RISKS
•
•
•
•
COMPLETE
FRANK
FOOTLING
INTRAPARTUM RISK TO THE FETUS-CORD
ACCIDENTS,FRACTURE AND DISLOCATION OF
LIMBS,DAMAGE TO INTRA-ABDOMINAL
ORGANS,INTRACRANIAL
HAEMORRHAGE,DAMAGE TO THE CERVICAL
SPINE AND BRACHIAL PLEXUS
MANAGEMENT
• UNCOMPLICATED BREECH
• ELECTIVE C/S?
• PLANNED VAGINAL DELIVERY?
FRANK BREECH
• C0MPLETE BREECH
• FOOTLING
VAGINAL DELIVERY
• KEEP MEMBRANES INTACT AS LONG AS
POSSIBLE
• BREECH IS SMALLER THAN THE AFTER
COMING HEAD
• BEFORE BEARING DOWN THE CERVIX MUST
BE FULLY DILATED
• LET THE BREECH DESCEND TO THE PERINEUM
ANATOMICAL LANDMARKS
• ANTERIOR BUTTOCKS BEGIN TO DISTEND
PERINEUM- ACTION?
THEN POSTERIOR BUTTOCKS- ACTION?
• HIPS –LEGS FLEXED- ACTION?
• HIPS- LEGS EXTENDED-ACTION?
• UMBILICUS- ACTION?
• SCAPULA- ACTION?
• NAPE OF THE NECK-ACTION?
SPECIAL MANOEUVRES
•
•
•
•
•
•
PINARDS
MAURICEAU-SMELLIE-VEIT
LØVESET
PRAGUE
REVERSE PRAGUE
FORCEPS
Complications of breech delivery
• EXTENDED ARMS
• NUCHAL ARM
• OCCIPUT POSTERIOR OF THE AFTERCOMING
HEAD
• HEAD ENTRAPMENT BY INCOMPLETELY
DILATED CERVIX
BREACH EXTRACTION
• IS THERE A PLACE FOR BREECH EXTRACTION?