Malpresentation and malposition PowerPoint presentation

Briefly highlights the fetal positions not suitable for delivery

1. MALPRESANTION AND
MALPRESANTATION
Moderator: Dr
Presenter: Akufunah Simandi

2. MALPOSITION
MALPOSITION , refers to an abnormal position of the
fetal occiput(the back of the head) in a vertex
presentation (head-first), where the fetal head is
presenting normally but is rotated abnormally in
relation to the mother’s pelvis.

3. TYPES OF MALPOSITION
• Types of Malposition
•Occipito-Posterior (OP): Occiput facing the
mother’s sacrum (back).
•Occipito-Transverse (OT):Occiput directed towards
the maternal hip (left or right transverse).
•Persistent OP or OT: When these positions do not
rotate to the normal anterior position during labor.

4. CAUSES OF MALPOSITION
•- Pelvic abnormalities (android or anthropoid
pelvis).
• Poor uterine tone.
•- Prematurity (small baby less likely to engage
properly).
• Flat sacrum or high parity.
• Abnormal fetal attitude (deflexion of the head).
•Inadequate contractions.

5. CLINICAL FEATURES
• Prolonged labor (especially second stage).-
• Back pain during labor ("back labor").-
• Slow cervical dilation.
•Early rupture of membranes.-
•Moulding and caput formation.
• Fetal heart sounds heard laterally.

6. DIAGNOSIS
Abdominal palpation : fetal back difficult to palpate.
Vaginal examination – anterior fontanelle more easily
felt than the posterior fontanelle

7. MANAGEMENT
•Adequate hydration and monitoring.
•- Maternal position changes (e.g., hands and knees,
lateral positions)
•Artificial rupture of membranes if not done.-
•Oxytocin if contractions are weak.
•Operative delivery (vacuum, forceps, or C-section) if
labor fails to progress.

8. MALPRESANTION
•Malpresentation refers to any fetal presentation
other than vertex (head-first, flexed) .This means
the part of the fetus entering the birth canal is not
the top of the head

9. TYPES OF MALPRESANTION
•Breech Presentation: This is where the foetus lies
with the buttocks in the Lower pole ( segment) of
the uterus. There are three main types of breech
presentation:
•Frank Breech- The baby's buttocks are presenting
first, with legs folded up towards the chest, The
feet are near the baby's head, and the legs are
flexed at the hips and knees.

10. •Footling Breech: One or both of the baby's feet are
presenting first, with the legs extended
downwards.- This type of breech presentation is
more common in preterm births.
•Complete Breech (Full Breech)- The baby is sitting
cross-legged in the birth canal, with buttocks
presenting first.- The baby's feet and legs are flexed,
with feet near the buttocks.

12. •Face presentation, This is where the foetus
presents with the face first .
•Brow presentation, This is where the presenting
part of the foetus is the forehead. The forehead is
the one presenting first . (forehead first)
•Shoulder/Transverse lie , This is where the foetus is
lying in transverse lie and the presentating part you
will see is the shoulder or arm.(shoulder or arm
presents)
• Compound presentation (e.g., hand with head)

13. CAUSES
•- Prematurity
•Uterine abnormalities (fibroids, septate uterus).
•- Polyhydramnios or oligohydramnios
•Placenta previa
•Multiparity
• Fetal anomalies (anencephaly, hydrocephalus).
•-Pelvic tumors.

14. CLINICAL FEATURES
•- Abnormal lie felt on abdominal palpation
•Fetal heart sound is heard in abnormal position
•Vaginal exam may reveal presenting part (e.g., face,
buttocks)
•Non-engagement of presenting part late in
pregnancy

15. DIAGNOSIS
•Leopold’s maneuvers (abdominal palpation)
•Ultrasound to confirm presentation and position
•Vaginal examination, to feel presenting par

17. MANAGEMENT
. Expectant management for spontaneous correction
before labor (e.g., in breech before 36 weeks).-
.External cephalic version (ECV) – turning fetus to
vertex after 36 weeks if breech.
.Cesarean section – often indicated for transverse,
brow, or persistent malpresentations
.Assisted vaginal delivery – in selected breech or face
presentations with strict criteria and experienced
clinicians.

18. External cephalic version

19. COMPLICATIONS
.Obstructed labor
•Cord prolapse
•Uterine rupture
•Birth trauma
•Neonatal asphyxia
•Postpartum hemorrhage.