6-MALPRESENTATION SCS.pptx1111111111111111111222222

Nill

1. SCHOOL OF CLINICAL SCIENCES,MAKAMBO,MAKENI. Presentation topic : Mal Presentation Lecturer: Dr David B Conteh 4 th Cohort :Year 3 18/07/2024 ANSUMANA REDRAX K KAMARA 1

2. NAME OF GROUP SIX MEMBERS Ansumana K Kamara [REDRAX]………..22036 Aisha Medisher Kargbo …….22054 Mohamed Gbla ……….22023 Musa Fofanah …….22022 18/07/2024 ANSUMANA REDRAX K KAMARA 2

3. 18/07/2024 ANSUMANA REDRAX K KAMARA 3

4. 18/07/2024 ANSUMANA REDRAX K KAMARA 4

5. 18/07/2024 ANSUMANA REDRAX K KAMARA 5

6. 18/07/2024 ANSUMANA REDRAX K KAMARA 6

7. 18/07/2024 ANSUMANA REDRAX K KAMARA 7

8. CAUSES Multiple pregnancy [ eg multipara, grand multipara More than one fetus [ eg twins] Too much or too little amniotic fluid [ eg poly hydramnious , oligohydramnious ] Abnormal uterine shape [ eg arcuate , septate , supseptate ] Abnormal growth [ eg fibroid] Placenta previa Abnormality of pelvis Laxicity of uterine muscle The baby is term Had a previous breech baby Over 40 18/07/2024 ANSUMANA REDRAX K KAMARA 8

9. GENERAL COMPLICATIONS OF MALPRESENTATION Cord presentation or prolapse Prolonged vaginal labour Arrest of labor Slightly bruise face Shoulder dystocia Infection due to prolonged labour or surgical interventions PPH due to prolonged or obstructed labour Psychological impact: Increased stress & anxiety due to complicated labour Death 18/07/2024 ANSUMANA REDRAX K KAMARA 9

10. 18/07/2024 ANSUMANA REDRAX K KAMARA 10

11. 18/07/2024 ANSUMANA REDRAX K KAMARA 11

12. 18/07/2024 ANSUMANA REDRAX K KAMARA 12

13. 18/07/2024 ANSUMANA REDRAX K KAMARA 13

14. 18/07/2024 ANSUMANA REDRAX K KAMARA 14

15. DIAGNOSIS OF BREECH Abdominal examination - Inspection -On palpation ; LIE is longitudinal The fundus contain a firm, smooth and rounded mass which dependently move toward the back. On auscultation ; -The fetal heart beat is heard above the umbilicus if the breech is not engaged, and below the umbilicus if it is engaged. 18/07/2024 ANSUMANA REDRAX K KAMARA 15

16. CONT….. Vaginal examination; No sutures and fontanels are felt. When the membrane is ruptured, meconeum can be seen on the examining finger Abdominal ultrasound scan; To confirmed the presentation 18/07/2024 ANSUMANA REDRAX K KAMARA 16

17. MANAGEMENT OF BREECH PRESENTATION AT TERM Management options (1) external cephalic version (2) elective caesarean section (3) trial of vaginal delivery 18/07/2024 ANSUMANA REDRAX K KAMARA 17

18. 18/07/2024 ANSUMANA REDRAX K KAMARA 18

19. CAESAREAN SECTION 18/07/2024 ANSUMANA REDRAX K KAMARA 19

20. 18/07/2024 ANSUMANA REDRAX K KAMARA 20

21. COMPLICATIONS 18/07/2024 ANSUMANA REDRAX K KAMARA 21

22. CONT………… 18/07/2024 ANSUMANA REDRAX K KAMARA 22

23. TRANSVERSE LIE The baby lies horizontally across the uterus. The longest fetal axis is perpendicular to that of the mother. OBLIQUE LIE The baby is positioned at an angle between longitudinal and transverse lies. This make vaginal delivery difficult or impossible without medical intervention. The presenting part is usually one of the shoulders [acromion process],an iliac crest , a hand or an elbow. 18/07/2024 ANSUMANA REDRAX K KAMARA 23

24. 18/07/2024 ANSUMANA REDRAX K KAMARA 24

25. 18/07/2024 ANSUMANA REDRAX K KAMARA 25

26. 4 POSITIONS IN SHOULDER PRESENTATION 18/07/2024 ANSUMANA REDRAX K KAMARA 26

27. 18/07/2024 ANSUMANA REDRAX K KAMARA 27

28. DIAGNOSIS OF SHOULDER PRESENTATION OR 18/07/2024 ANSUMANA REDRAX K KAMARA 28

29. 18/07/2024 ANSUMANA REDRAX K KAMARA 29

30. 18/07/2024 ANSUMANA REDRAX K KAMARA 30

31. COMPOUND PRESENTATION  Extremity prolapses alongside the presenting part  Causes are conditions that prevent complete occlusion of the pelvic inlet by the fetal head ,  Like preterm labor .  The combination of an upper extremity and the vertex is the most common .  Diagnosis is made by vaginal examination  Labor is not necessarily contraindicated with a compound presentation; 18/07/2024 ANSUMANA REDRAX K KAMARA 31

32. 18/07/2024 ANSUMANA REDRAX K KAMARA 32

33. RISKS  Fetal risk: birth trauma, cord prolapse (11 – 20%), neurologic and musculoskeletal damage .  Maternal risks include soft tissue damage and obstetric laceration.  However, the prolapsed extremity should not be manipulated .  75% of vertex/upper extremity combinations deliver spontaneously.  Occult or undetected cord prolapse is possible  The primary indications for surgical intervention are cord prolapse, non reassuring FHR, and arrest of labor . 18/07/2024 ANSUMANA REDRAX K KAMARA 33

34. BROW PRESENTATION Brow presentation is rare type of malpresentation during childbirth where the baby's head is partially extended leading the forehead or brow to be the first part to engage with the maternal pelvis This presentation occur in less than 1% of all deliveries and it can also lead to complication if not manage appropriately 18/07/2024 ANSUMANA REDRAX K KAMARA 34

35. CAUSES OF BROW PRESENTATION FETAL CAUSES Fetal size Fetal abnormalities Multiply gestation Prematurity Polyhydramnios Nuchal cord 18/07/2024 MATERNAL CAUSES Multiparity Pelvic size and shape Uterine abnormalities Maternal age ANSUMANA REDRAX K KAMARA 35

36. DIAGNOSIS OF BROW PRESENTATION By physical examination By vaginal examination By ultrasound COMPLICATIONS OF BROW PRESENTATION Prolonged labor Fetal distress Birth injuries Maternal complication 18/07/2024 ANSUMANA REDRAX K KAMARA 36

37. MANEGEMENT OF BROW PRESENTATION 1.EXPECTANT MANAGEMENT Close monitoring of labor progress and fetal condition Many brow presentation convert to either a vertex or face presentation spontaneously during labor if this occur vagina delivery may become possible 2.TRIAL LABOR If labor is progressing well and there are no signs of fetal distress a cautious trial of labor maybe attempted Continuous fetal monitoring is essential to detect any signs of distress 3.CESAREAN SECTION 18/07/2024 ANSUMANA REDRAX K KAMARA 37

38. 18/07/2024 ANSUMANA REDRAX K KAMARA 38

39. 18/07/2024 ANSUMANA REDRAX K KAMARA 39

40. TYPES OF FACE PRESENTATION 1 Mentum Anterior 2 Mentum posterior MENTUM ANTERIOR The fetal chin [ mentum ] is facing towards the mothers pubic symphysis front MENTUM POSTERIOR The fetal chin is facing towards the mothers sacrum 18/07/2024 ANSUMANA REDRAX K KAMARA 40

41. 18/07/2024 ANSUMANA REDRAX K KAMARA 41

42. 18/07/2024 ANSUMANA REDRAX K KAMARA 42

43. 18/07/2024 ANSUMANA REDRAX K KAMARA 43

44. 18/07/2024 ANSUMANA REDRAX K KAMARA 44

45. 18/07/2024 ANSUMANA REDRAX K KAMARA 45

46. 18/07/2024 ANSUMANA REDRAX K KAMARA 46

47. 18/07/2024 ANSUMANA REDRAX K KAMARA 47

48. 18/07/2024 ANSUMANA REDRAX K KAMARA 48

49. TYPES OF MALPOSITIONS 18/07/2024 ANSUMANA REDRAX K KAMARA 49

50. 18/07/2024 ANSUMANA REDRAX K KAMARA 50

51. 18/07/2024 ANSUMANA REDRAX K KAMARA 51

52. 18/07/2024 ANSUMANA REDRAX K KAMARA 52

53. 18/07/2024 ANSUMANA REDRAX K KAMARA 53

54. 18/07/2024 ANSUMANA REDRAX K KAMARA 54

55. 18/07/2024 ANSUMANA REDRAX K KAMARA 55

56. MANAGEMENTS 18/07/2024 ANSUMANA REDRAX K KAMARA 56

57. 18/07/2024 ANSUMANA REDRAX K KAMARA 57

58. 18/07/2024 ANSUMANA REDRAX K KAMARA 58

59. 18/07/2024 ANSUMANA REDRAX K KAMARA 59

60. 18/07/2024 ANSUMANA REDRAX K KAMARA 60

61. 18/07/2024 ANSUMANA REDRAX K KAMARA 61

62. 18/07/2024 ANSUMANA REDRAX K KAMARA 62