Malpresentation

Question 1

lie

Answer 1

fetal spine relative to maternal spine

• longitudinal
• transverse
• oblique

Question 2

presentation

Answer 2

fetal part that overlies pelvic inlet

• occiput (vertex)
• chin (mentum)
• brow
• compound = >1 part

Question 3

position

Answer 3

relationship of fetal presenting part to maternal pelvis

• occiput in cephalic
• sacrum in breech
• R/L
• anterior/posterior

Question 4

attitude

Answer 4

position of fetal head w/ regard to fetal spine

Question 5

station

Answer 5

descent of bony presenting part through birth canal (-5 to +5); 0 = plane of ischial spines

Question 6

denominator

Answer 6

part that is lowest

Question 7

complete breech

Answer 7

flexed at hips and knees

Question 8

incomplete breech

Answer 8

incomplete deflexion of one or both knees or hips

Question 9

frank breech

Answer 9

flexed at hips and extended at knees

Question 10

When should external cephalic version be attempted in transverse and oblique lies?

Answer 10

36-37wks

Question 11

funic presentation

Answer 11

umbilical cord presentation - rare at term

Question 12

malposition

Answer 12

any position that is not:

1) occiput anterior
2) left occiput anterior OR
3) right occiput anterior

Question 13

What are risks associated w/ malpresentation?

Answer 13

1) diminished vertical polarity of uterine cavity
2) increased/decreased fetal movement
3) obstructed pelvic inlet
4) fetal malformation
5) prematurity
6) abnormal placentation

Question 14

What are risk factors for malpresentation?

Answer 14

1) uterine anomaly
2) conditions that result in decreased fetal muscle tone, strength, or activity (e.g. oligo, aneuploidies, neuro dysfunctino)
3) cephalopelvic disproportion
4) sedentary lifestyle

Question 15

What are risks associated w/ footling breech?

Answer 15

1) cord prolapse

2) head entrapment

Question 16

What are risks associated w/ compound presentation?

Answer 16

1) cord prolapse = most common

2) birth trauma

Question 17

What are risks associated w/ face presentation?

Answer 17

1) prolonged labor –> intrapartum death
2) abnormal FHR
3) fetal laryngeal and tracheal edema

Question 18

What are risks associated w/ external cephalic version?

Answer 18

serious complications rare

1) abnormal FHR patterns
2) persistent pathologic FHR patterns
3) placental abruption
4) vaginal bleeding
5) emergency c/s

Question 19

When and why should external cephalic version be attempted?

Answer 19

@36-37wks

preterm ECV associated w/ perinatal mortality

Question 20

What are contraindications to external cephalic version?

Answer 20

1) oligo
2) fetal growth restriction
3) abnormal FHR tracing
4) uterine anomaly
5) ruptured membranes
6) HTN of pregnancy
7) antepartum bleeding

Question 21

What are risk factors for transverse lie and shoulder presentation?

Answer 21

1) multiparity
2) preterm fetus
3) uterine anomaly
4) poly
5) placenta previa

Question 22

What are risk factors for face presentation?

Answer 22

1) prematurity
2) fetal weight < 2500g
3) fetal macrosomia
4) anencephaly
5) high parity

Question 23

How should funic presentation be managed?

Answer 23

1) GET HELP!
2) put pt in Trendelenberg
3) get FHTs
4) emergency c/s

Question 24

Describe moxibustion

Answer 24

traditional Chinese method

• burn cigar-shaped roll of Artemisia vulgaris or “mugwort”
• hold over acupoint bladder 67 (lateral side of little toes)
• used to induce labor or vert fetus

Question 25

Which face presentation has better vaginal delivery outcomes?

Answer 25

mentum anterior - diameter can fit through canal; mentum posterior less likely to pass successfully

Question 26

What are contraindications to TOL in breech presentation?

Answer 26

1) cord presentation 2) fetal growth restriction OR macrosomia 3) any presentation other than complete or frank breech 4) clinically inadequate pelvis 5) fetal anomaly incompatible w/ vaginal delivery 6) estimated fetal weight <2500g or >4000g

Question 27

Describe labor management for breech presentation

Answer 27

1) perform clinical pelvic exam 2) ensure adequate labor progress; if not progressing --> C/S 3) continuous fetal monitoring mandatory 4) IOL NOT recommended; augmentation w/ oxytocin = okay 5) passive second stage w/out pushing may last up to 90min; active pushing should not last >60min 6) second stage should take place in/near OR 7) providers skilled in neonatal resuscitation close by