fetal malpostion and malpresentation(OP) _ دعلي فالح الاسدي

Question 1

what the difference between the malposition and malpresentation?

Answer 1

malposition : when the present part is the fetal head but not weel flex vertex with the occiput Ant

malpresention : when the present part is not the head

Question 2

whats the meaning of the occipital-post ?

Answer 2

normally the engagement happen the Lt oblique occipto-ANT

but this head malpostion led to be Rt (usually) oblique occipto POST (face to the pubic symphysis )

Question 3

what the cause of the occipto -post ?

Answer 3

+ fetus cause

• the fetus is small
• Placenta is Ant
• deflex head rotate the ANT

+pelvis problem

• pelvis is capacious (large )
• ant-post diameter of the pelvis is much larger than the transvese diameter

Question 4

how to dignosis the occipto -post?

Answer 4

1- during the pregnancy no importance
2- during lanbor
a-pt have early membrane rupture and poor engagement
b-during abdominal examination
- abdomen looks falt below the umbilicus
- limbs are easily felt
- but difficult to feel the heart sound and the back of the fetus

c vaginal exam

• hight presenting part (بعيده)
• the ant fontanelle is easy to feel near the pubic symphysis but the post is difficult
• then in the late labor there will be caput succedaneum

(fluid collection caused by the pressure of the presenting part that compresses the venous and lymphatic drainage )

3- using US may be useful

Question 5

whats the course of labor in occpto -post ?

Answer 5

-80% will have vaginal delivery
from this 80%
70% will have spontaneous rotation OA
10% direct OP and deliver face to the pubis

-20% of the fetus are persistant rt or lt oblique

Question 6

whats the ferure of the OP ?

Answer 6

Prolong 1st and 2nd stage

Question 7

whats the 1st stage management?

Answer 7

1- nothing done
2- give her epidural anesthesia
3- or if there is not enough cervical dilation so Augmentation if no benefit CS is indicted to avoid fetal distress

Question 8

whats the 2nd stage management?

Answer 8

-by vaginal examination we exam the fontanelle to see the flexion of the head
if the head is deflex or large caput (head) and marked moulding so no spontaneous rotation
we will interfere if there is
-fetal and maternal distress
- failure of decent

• so we assist delivery
  1-manually by the hand and by forceps but need general or epidural anesthesia

2-kjelllands forceps (rotation and traction)
3- vacuum extractor

Question 9

what is the deep transverse arrest of the fetal head?

Answer 9

when the fetal head descends down at the level of the ischial spine and the sagittal suture line on the transverse diameter of the pelvic

(head arrest at the ischial spine )

Question 10

when the deep transverse arrest of the fetal head diagnosis?

Answer 10

in the 2nd stage of labor

Question 11

what’s the mechanism of the deep transverse arrest of the fetal head?

Answer 11

either the problem in the head
- the occiput is post and oblique when it descends and rotates only partly foreword

-or the head has initial transverse position then descended in this position and arrest

or the pelvis is android so the head fails to descend even the rotation is normal

Question 12

how to diagnosis the deep transverse arrest of the fetal head?

Answer 12

in the vaginal examination in the 2nd stage then the head is arrested in the ischial spine when the sagittal suture in the transverse dimeter

Question 13

management of the deep transverse arrest of the fetal head ?

Answer 13

• is the augmentation of the uterine contraction by oxytocin
• rotation and traction to OP