DR MANAL BEHERY Assistant Professor Faculty of Defintion

DR MANAL BEHERY Assistant Professor, Faculty of

Defintion Definition v. Fetal presenting part other than vertex includes breech, face, brow, transverse, and compound presention.

Related Factors v. More than one pregnancy (e. g. Multipara, Grand multipara ) v. More than one fetus (e. g. Twins) v. Too much or too little amniotic fluid (e. g. Poly hydramnious, oligohydramnios) v. Abnormal uterine shape (e. g. Arcuate , septate, supseptate) or abnormal growth (e. g Fibroid) v. Placenta previa v. The baby is preterm

Incidence of malpresentation Defintion • Breech 3 in 100 (3%) • Face 1 in 500 (0. 5%) • Brow 1 in 2000 (0. 02%) • Shoulder 1 in 300 (0. 3%) • Compound 1 in 5000 ( 0. 05%)

Shoulder presentation q. It is a Transverse lie in which the long axis of the fetus is perpendicular( 900) to long axis of mother. v. Shoulder of baby comes in – the lower segment of uterus(0. 5%)

4 position in Shoulder presentation Acrimon- anterior(60%) Left Right Acrimo- posterior(40%) Right Left Acrimo anterior position is more common as the concavity of front of fetus fix in convexity of maternal spine ü Placenta is posterior in 60% of cases q Ø Ø ü

Lt Acrimoanterior Rt Acrimoposterior Lt Acrimoposterior

Diagnosis q. Abdominal examination, Ø the head is usually felt in one iliac fossa or in the flank. Ø The breech in the other iliac fossa but at a higher level Ø Fundal level just above umbilicus Ø FH sound heard below the umbilicus

On vaginal examination q. Early in labor Ø the cervix is elevated Ø lower uterine segment is imperfectly filled q. Late in labor Ø The cervix is sufficiently dilated: We can feel: scapula, acromion, clavicle, axilla and ribs q. Confirm position: If the arm is prolapsed and supinated the dorsum points to the back and the thumb points to the head.

Neglected shoulder ØProlonged labor ØMembrane ruptured Øliquor drained ØArm may be prolapsed ØFetus dead or dying ØLower segment overstretched ØSigns and symptoms of obstructed labor

Management During pregnancy Ø A-External cephalic version Ø Can be tried up to full term, Ø Even early in labour before ROM Ø * Laxity of the abdominal & uterine walls makes the procedure easier than in breech Ø * The fetus will be rotated only 90 degrees. Ø B. If fails, do external podalic version. head.

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