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Fetal Malpresentation Fetal malpresentation refers to fetal presenting part other than vertex and includes breech, transverse, face, brow, and sinciput. Malpresentations may be identified late in pregnancy or may not be discovered until the initial assessment during labor.
Related Factors • The woman has had more than one pregnancy • There is more than one fetus in the uterus • The uterus has too much or too little amniotic fluid • The uterus is not normal in shape or has abnormal growths, such as fibroids • placenta previa • The baby is preterm
Types of Malpresentation BREECH Complete (Flexed) Breech Presentation Footling Breech Presentation Frank (Extended) Breech Presentation Kneeling Breech Presentation VERTEX Brow Presentation Face Presentation Sincipital Presentation TRANSVERSE The diagnosis of abnormal fetal presentations is commonly made with a combination of Leopold’s Maneuver, Vaginal examination, and Ultrasound
Types of Malpresentation BREECH Breech presentation means that either the buttocks or the feet are the first body parts that will contact the cervix. Breech presentations occurs in approximately 3% of the births and are affected by fetal attitude. Breech presentations can be difficult births, with the presenting point influencing the degree of difficulty.
Types of Breech Presentation Frank breech The baby's bottom comes first, and the legs are flexed at the hip and extended at the knees (with feet near the ears). 65 -70% of breech babies are in the frank breech position. Complete Breech The baby's hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.
Types of Breech Presentation Footling Breech One or both feet come first, with the bottom at a higher position. This is rare at term but relatively common with premature fetuses. Kneeling Breech The baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees. This is extremely rare.
Maternal Risks Prolonged labor r/t decreased pressure exerted by the breech on the cervix. PROM may expose client to infection. Cesarean or forceps delivery. Trauma to birth canal during delivery from manipulation and forceps to free the fetal head. Intrapartum or postpartum hemorrhage.
Fetal Risks: Compression or prolapse of umbilical cord. Entrapment of fetal head in incompletely dilated cervix. Aspiration and asphyxia at birth. Birth trauma from manipulation and forceps to free the fetal head.
Management If the woman is in early labor and the membranes are intact, attempt External Cephalic Version. Tocolytics, such as Terbutaline 0. 25 mg IM, can be used before ECV to help relax the uterus. If ECV is successful, proceed with normal childbirth. If EVC fails or is not advisable, deliver by caesarean section.
Management Attempt external version if: Breech presentation is present at or after 37 weeks (before 37 weeks, a successful version is more likely spontaneously revert back to breech presentation) Vaginal delivery is possible Membranes are intact and amniotic fluid is adequate; There are no complications (e. g. fetal growth restriction, uterine bleeding, previous caesarean delivery, fetal abnormalities, twin pregnancy, HPN, fetal death).
Management VAGINAL BREECH DELIVERY A vaginal breech delivery by a skilled health care provider is safe and feasible under the following conditions: - complete or frank breech - adequate clinical pelvimetry - fetus is not too large - no previous caesarean section for cephalopelvic disproportion - flexed head.
Management CESAREAN SECTION for breech presentation. A cesarean section is safer than vaginal breech delivery and recommended in cases of: Double footling breech Small or malformed pelvis Very large fetus Previous cesarean section for cephalopelvic disproportion Hyperextended or deflexed head.