Abnormal presentation.m2ppt

gyneco

1. 1
Abnormal presentation.
Pr. Mbu / Dr.Nana
M2 2009-14/05/09.

2. 2
Abnormal presentation-1.
General objectives:
Student should be able to define,
diagnose and advise women with
abnormal presentation.

3. 3
Abnormal presentation-2.
Specific objctives:
Define abnormal presentation.
Name the different abnormal presentations.
Discuss the risk factors and mode delivery of the
different types.
Name the common complications associated with
abnormal presentation.

4. 4
Abnormal presentation-3.
Lie: axis of foetus to axis of mother.
•Longitudinal ( cephalic, breech).
•Transverse (shoulder).
•Oblique. (cephalic / breech).
Presentation: foetus two poles (cephalic / caudal). Pole
of foetus found at the inlet of pelvis or nearest.
•Normal presentation, cephalic
•Any other presentation is abnormal.

5. 5
Abnormal presentation-4.
Types of abnormal pesentations:
Breech: caudal part at the brim or inlet.
Three types of breech presentations, complete.
Frank.
single or double footling.

6. 6
Abnormal presentation-5.
Incomplete breech-1

7. 7
Abnormal presentation-6.
Incomplete breech-2

8. 8
Abnormal presentation-7.
Risk factors for breech presentation:
Preterm pregnancy
Multiple pregnancy
Placenta praevia
Grand-multi-parity
P/H breech
Borderline / contracted pelvises, uterine malformation.
Foetal malformations, hydrocephalus, conjoint twins,
short cord, hydramnios, proms, oligohydramnios,
anencephalus, tumours e.g teratomas..

9. 9
Abnormal presentation-8.
•Cephalic, breech, others
29-32wks 78.1%
(cephalic)
14%(breech)7.9%
(other
s)
33-36wks 88.7% 8.8% 2.5%
37-40wks 91.5% 6.7% 1.7%
Foetal presentation at various GA (US).
Occurs in 4-6% pregnancies.

10. 10
Abnormal presentation-9.
Diagnosis:
Physical examination, Leopold´s manoeuver.
Vaginal examination
Ultrasonography
X-ray

11. 11
Abnormal presentation-10.
Delivery:
C/S delivery is advisable and is indicated in the following
situations ( breech/large foetus, contracted to borderline
pelvis, hyperextended head, PET, ROM ≥12hrs, uterine
dysfunction, footling breech, prematurity <34 weeks,
severe IUGR, poor obstetrical Hx, desire for BTL.
Spontaneous, prematurity
Assisted breech delivery
Breech extractions.

12. 12
Abnormal presentation-11.
Complications:
Maternal, increased morbidity C/S
Foetal, increased cord prolapse , increased
perinatal loss, prematurity, congenital
malformation, birth trauma (brain, spinal cord,
liver, adrenal glands, spleen, brachial plexus).

13. 13
Abnormal presentation-12.
Face prsentation:
Head is hyperextended, occiput in contact with foetal
back, chin (mentum) the presenting part.
Incidence varies .0.1-0.3%.
Diagnosis: rest on vaginal examinaton, nose, mouth,
malar bones, orbital ridges.
X-ray may show a hyperextended head.

14. 14
Abnormal presentation-13.
Etiology: factors that favour extension or hinder
flexion, contracted pelvis, large/macrosomic
foetuses, multiparous women with pendulous
abdomen, cord round neck, anencephalia.
Delivery, by C/S chin posterior, vaginal chin
anterior and adequate pelvis.

15. 15
Abnormal presentation-14.
Brow presentation:
Portion of foetal head between orbital ridge and anterior
fontanelle presents at inlet.
Foetal head midway between full flexion (occiput) and
full extension (face)
Etiology: same as for face, usually unstable
Treatment as for face presentation.

16. 16
Abnormal presentation-15.
Shoulder presentation: transverse lie, sometimes in
oblique lie.
Incidence 0.3-0.4%, increases with parity 10 folds after
parity 4.
Etiology: grandmulti-parity, prematurity, placenta
praevia, contracted pelvis.
Diagnosis: examination AC >UH
Delivery by C/S.

17. 17
Abnormal presentation-16.
Compound presentation:
An extremity spontaneous enters pelvis with the
presenting part.
vertex /hand 1:700 deliveries.
Rarely lower limbs/ vertex, hand/breech.
Cause usually unkown, but prematurity seen in two folds.

18. 18
Abnormal presentation-17.
Conclusion:
Abnormal presentation is a common cause of maternal
morbidity, foetal morbidity and mortality.
Prompt diagnosis, proper decision taking and treatment
is capital to better outcome.
Early referrals for better management is therefore
paramount for better outcome.