Lie, presentation, attitude, and position

How to examine the gravid uterus.

1. LIE, PRESENTATION, ATTITUDE,
AND POSITION
LONGWAP A.S
600L
JUTH

2. Fetal Lie.
•The lie is the relation of the long axis of the
fetus to that of the mother, and is either
longitudinal or transverse.
•Occasionally, the fetal and the maternal axes
may cross at a 45-degree angle, forming an
oblique lie, which is unstable and
•always becomes longitudinal or transverse
during the course of labo

3. Fetal Presentation.
•The presenting part is that portion of the fetal
body that is either foremost within the birth
canal or in closest proximity to it.
•It can be felt through the cervix on vaginal
examination. Accordingly, in longitudinal lies,
• the presenting part is either the fetal head or
breech, creating cephalic and breech
presentations, respectively. When the fetus lies
with the long axis transversely,
•the shoulder is the presenting part and is felt
through the cervix on vaginal examination.

4. TYPES OF CEPHALIC PRESENTATION.
•Such presentations are classified according to
the relationship between the head and body
of the fetus
•Ordinarily, the head is flexed sharply so that
the chin is in contact with the thorax.
•The occipital fontanel is the presenting part,
and this presentation is referred to as a vertex
or occiput presentation

5. TYPES OF CEPHALIC PRESENTATION.
•Much less commonly, the fetal neck may be
sharply extended so that the occiput and back
come in contact and the face is foremost in
the birth canal face presentation
•The fetal head may assume a position
between these extremes, partially flexed in
some cases, with the anterior (large) fontanel,
or bregma, presenting sinciput presentation

6. TYPES OF CEPHALIC PRESENTATION.
•or partially extended in other cases to have a
brow presentation. These latter two
presentations are usually transient. As labor
•progresses, sinciput and brow presentations
almost always are converted into vertex or
face presentations by neck flexion or
extension, respectively
•Failure to do so can lead to dystocia

7. BREECH PRESENTATION.
•When the fetus presents as a breech, the
three general configurations are frank,
complete, and footling presentations
•When the buttocks of the fetus enter the
pelvis before the head, the presentation is
breech

8. PREDISPOSING FACTORS
•Gestational age (B4 TERM)
• Hydramnios, (>2,000ml )
•Uterine relaxation associated with great parity,
•Multiple fetuses,
•Oligohydramnios, (<300ml at term)
•Hydrocephaly,
•Anencephaly,
•Previous breech delivery,
•Uterine anomalies, and
•Pelvic tumors
•Implantation in the cornual-fundal region
•Placenta previa

9. COMPLICATIONS OF BREECH
•1. Perinatal morbidity and mortality from
difficult delivery.
•2. Low birthweight from preterm delivery,
growth restriction, or both.
•3. Prolapsed cord.
•4. Placenta previa.
•5. Fetal, neonatal, and infant anomalies.
•6. Uterine anomalies and tumors

10. TYPES OF BREECH
With a frank breech
presentation, the lower
extremities are flexed at
the hips
and extended at the knees,
and thus the feet lie in
close proximity to the head

11. TYPES OF BREECH
A complete breech
presentation
differs in that one or both
knees are flexed

12. TYPES OF BREECH
With incomplete breech presentation,
one or both hips are not flexed
and one or both feet or knees lie
below the breech, such that a foot or
knee is lowermost in the birth canal
Footling breech is an incomplete
breech with one or both feet below
the breech

13. Fetal Attitude or Posture.
•In the later months of pregnancy the fetus
assumes a characteristic posture described as
attitude or habitus
•As a rule, the fetus forms an ovoid mass that
corresponds roughly to the shape of the uterine
cavity.
•The fetus becomes folded or bent upon itself in
such a manner that the back becomes markedly
convex;
•the head is sharply flexed so that the chin is
almost in contact with the chest

14. Fetal Position.
•Position refers to the relationship of an
arbitrarily chosen portion of the fetal presenting
part to the right or left side of the maternal
birth canal
•Accordingly, with each presentation there may
be two positions, right or left
•Because the presenting part may be in either the
left or right position, there are left and right
occipital, left and right mental, and left and right
sacral presentations

15. Varieties of Presentations and
Positions.
•For still more accurate orientation, the
relationship of a given portion of the
presenting part to the anterior, transverse, or
posterior portion of the maternal pelvis is
considered.
•Because the presenting part in right or left
positions may be directed anteriorly (A),
transversely (T), or posteriorly (P), there are
six varieties of each of the three presentation

16. Occiput prest, the presentation,
position, & variety may be abbreviated
in clockwise fashion as:

17. Longitudinal lie. Cephalic presentation
(A) vertex, (B) sinciput (C) brow (D) face presentations

18. Longitudinal lie. Vertex presentation
B. Left occiput posterior (LOP).A. Left occiput anterior (LOA).

19. Longitudinal lie. Vertex presentation.
A. Right occiput posterior (ROP).
B. Right occiput transverse
(ROT).

20. Longitudinal lie. Vertex presentation.
Right occiput anterior (ROA)

21. Longitudinal lie. Breech presentation.
Left sacrum posterior (LSP)

22. Transverse lie. Right
acromiodorsoposterior (RADP)
The shoulder
of
the fetus is to
the mother's
right, and the
back is
posterior.

23. RIGHT ACOMIODORSOPOSTERIO
Transverse lie.
The shoulder of
the fetus is to the
mother's right,
and the back is
posterior.

24. Face presentation. The occiput is the
longer end of the head lever.
The chin is
directly
posterior.
Vaginal delivery
is impossible
unless the chin
rotates
anteriorly.

25. Brow posterior presentation.

26. CONCLUSION
•The understanding of the above description of
the fetus in the mothers womb is very critical
in understanding the mechanism of lalour.
•THANKS

27. •Thanks
•Dr. longwap
•JUTH