Malpresentations and positions Flashcards
What does Malposition means?
Where the occiput is in one or other posterior quadrant of the pelvis
What does Malpresentation means?
any presentation other than vertex
What does Lie mean?
the relationship of the long axis of the fetus to the long axis of the uterus
What does presentation mean?
Part of the fetus lying in the lower pole of the uterus
When discussing the position of the fetus what does it mean by the denominator?
The denominator is the part of the presentation used to determine the position Occiput in ... Sacrum in... Mentum (chin)...
what does position mean?
The position is the relationship of the denominator to six areas of the woman’s pelvis
Left and right …
Left and right …
Left and right ..
What does attitude mean?
The relationship of the fetal head and limbs to its body. May be flexed, deflexed or partially extended
What is the diameter and presenting part of BI- PARIETAL?
9.5cm, Widest Transverse Diameter
What is the diameter and presenting part of BI-TEMPORAL?
8cm
What is the diameter and presenting part of SUBOCCIPITO-BREGMATIC ?
9.5cm
Vertex (well flexed)
What is the diameter and presenting part of SUBOCCIPITO-FRONTAL?
10cm Vertex (less well flexed/ deflexed)
What is the diameter and presenting part of OCCIPITO-FRONTAL?
11.5cm
deflexed occipito posterior (face to pubes)
What is the diameter and presenting part of MENTOVERTICAL?
13cm
Brow ( head partially extended)
What is the diameter and presenting part of SUB-MENTO-BREGMATIC?
9.5cm
Face (head fully extended)
What is the diameter and presenting part of SUB-MENTO-VERTICAL?
11cm
Face (head not fully extended)
What is the Normal mechanism of labour?
Descent Flexion Internal Rotation Crowning of the Head Extension Restitution Internal Rotation of the Shoulders Lateral Flexion
What can cause an OP position and give reference.
Maternal posture and lifestyle Android/anthropoid pelvis
Anterior placenta
Epidural analgesia plus oxytocin augmentation
Nulliparity
Increased maternal age Increased gestation
(Lewis,2010)
How would you diagnose an OP position in an antenatal assessment?
Inspection of abdomen
•Palpation
•FH auscultation
In labour: Listen to woman FH auscultation 'VE Progress of labour (Lewis,2010)
No evidence of getting into all fours; helping position of baby (RCM), only gives women comfort(Guitten, et.al.,2014)
Name four complications of OK and it’s reference
Episitomy Third and fourth degree tear Increase blood loss Length of stay in hospital ( Stephen Ratcliffe, 2008)
What is the mechanism of occipito position- long rotation
Occipito frontal diameter engages (11cms) in R oblique diameter 12cms)
Increasing flexion and descent- Sub-occipito bregmatic diameter (9.5cms) in the pelvic cavity
Occiput meets the resistance of the pelvic floor and rotates 3/8th circle forwards
Head now in same position as occipitor anterior mechanism
The shoulders follow the head turning 2/8th from left to right oblique
Head is born by extension
Restitution
Internal rotation of shoulders
External rotation of head to mothers right
Lateral flexion
Incidence of OP and reference
15-32% women experience OP
Simkin(2010)
Care in labour for OP
Communication with mum and support(NMC,2015) One to one care General pain relief Comfortable position Assessment of progress Monitor Mother and fetal welling
Normal mechanisms of Labour
Descent Flexion Internal rotation Crowning Extension Restitution Internal rotation of shoulders Lateral flexion
Incidence of Brow presentation
1 in 500- 1in 1400 deliveries
Diagnosis for brow presentation
Large on engaged head
Not usually detected before onset of Labour
Present part is difficult to reach
No descent on presenting part
Complications and management of Brow
Complications:
Cord Prolapse
Fetal Distress
Excessive moulding
Management Obstetricians involved High risk care DRs may want to see if head conversion to vertex LSCS
