FACE PRESENTATION DIGNOSTIC LANDMARKSEYES NOSE MOUTH AND CHIN

FACE PRESENTATION • DIGNOSTIC LANDMARKS-EYES, NOSE MOUTH AND CHIN • POSITION-MENTO ANTERIOR/POSTERIOR, MENTO TRANSVERSE • MANAGEMENT GUIDELINES-FETUS IS DEAD OR ALIVES WITH ANOMALIES INCOMPATABLE WITH LIFE, ALLOW VAGINAL DELIVERY • MENTO ANTERIOR , R/O FPD

FACE PRESENTATION AND BROW IF LABOUR IS PROGRESSING WELL MENTO POSTERIOR- C/S BROW -NORMALLY INCOMPATABLE WITH VAGINAL DELIVERY DIAGNOSTIC LANDMARKS-ROOT OF THE NOSE, SUPRAORBITAL RIDGES, ANTERIOR FONTANEL MANAGEMENT - CESARIAN SECTION

SHOULDER PRESENTATION • DIAGNOSTIC LANDMARKS • UTERUS IS ENLARGED TRANSVERSLY AND SHORTENED VERTICALLY • EMPTINESS AT THE LOWER POLE • ON PV PALPABLE CLAVICLE , RIBS ARM PROLAPSE

MANAGEMENT • WITH FETUS ALIVE –C/SECTION • WITH FETUS DEAD-DESTRUCTIVE OPERATION, OR C/S • COMPOUND PRESENTAION • PROLAPSE OF ONE OR MORE LIMBS IN CEPHALIC PRESENTATION • PROLAPSE OF HAND OR ARM IN BREECH PRESEENTATION

COMPOUND PRESENTATION • PUSH THE HAND ABOVE THE FETAL HEAD • ARM MAY BE DIFFICULT TO REPLACE AND CESARIAN SECTION MAY BE NECESSARY • MALPOSITION • INCORRECT POSITIONING OF THE VERTEX • OCCIPITO POSTERIOR POSITION • PERSISTENT O. P. P

0 CCIPITO POSTERIOR POSITION DIAGNOSIS PALPATION AUSCULTATION VAGINAL EXAMINATION LONG ROTATION-135° --OCCIPITO ANTERIOR -SVD EXPECTED • SHORT ROTATION- 45°--FACE TO PUBIS— AVD OR C/SECTION • • •

MALPRESENTATION ANY PRESENTATION OTHER THAN THE NORMAL VERTEX OF THE FETAL HEAD

MALPRESENTAION • • • FACE BROW SHOULDER BREECH COMPOUND

CAUSES OF MALPRENTATION • • • HIGH PARITY PREMATURITY FETAL ANOMALIES POLYHYDRAMNIOS MILD CPD

BREECH PRESENTATION WHEN THE BUTTOCKS AND/OR THE FEET ARE THE PRESENTING PARTS THE COMMONEST MALPRESENTATION HAS HIGHER PERINATAL MORTALITY AND MORBIDTY CAUSES OF BREECH PRESENTATIONPREMATURITY, MULTIPLE PREGNANCY, FETAL MALFORMATION, HYDRAMNIOUS

CLASSIFICATION AND RISKS • • COMPLETE FRANK FOOTLING INTRAPARTUM RISK TO THE FETUS-CORD ACCIDENTS, FRACTURE AND DISLOCATION OF LIMBS, DAMAGE TO INTRA-ABDOMINAL ORGANS, INTRACRANIAL HAEMORRHAGE, DAMAGE TO THE CERVICAL SPINE AND BRACHIAL PLEXUS

MANAGEMENT • UNCOMPLICATED BREECH • ELECTIVE C/S? • PLANNED VAGINAL DELIVERY? FRANK BREECH • C 0 MPLETE BREECH • FOOTLING

VAGINAL DELIVERY • KEEP MEMBRANES INTACT AS LONG AS POSSIBLE • BREECH IS SMALLER THAN THE AFTER COMING HEAD • BEFORE BEARING DOWN THE CERVIX MUST BE FULLY DILATED • LET THE BREECH DESCEND TO THE PERINEUM

ANATOMICAL LANDMARKS • ANTERIOR BUTTOCKS BEGIN TO DISTEND PERINEUM- ACTION? THEN POSTERIOR BUTTOCKS- ACTION? • HIPS –LEGS FLEXED- ACTION? • HIPS- LEGS EXTENDED-ACTION? • UMBILICUS- ACTION? • SCAPULA- ACTION? • NAPE OF THE NECK-ACTION?

SPECIAL MANOEUVRES • • • PINARDS MAURICEAU-SMELLIE-VEIT LØVESET PRAGUE REVERSE PRAGUE FORCEPS

Complications of breech delivery • EXTENDED ARMS • NUCHAL ARM • OCCIPUT POSTERIOR OF THE AFTERCOMING HEAD • HEAD ENTRAPMENT BY INCOMPLETELY DILATED CERVIX

BREACH EXTRACTION • IS THERE A PLACE FOR BREECH EXTRACTION?