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Malposition & Malpresentation

The document discusses malpositions and malpresentations during childbirth. It defines position and presentation, describes the pelvis and discusses occipito-posterior position. It discusses breech presentation, its causes and clinical manifestations. Other malpresentations discussed include face, brow, transverse lie and unstable lie. Compound presentations are also defined. The document lists objectives of the class and asks questions to check understanding of key topics. It assigns a short note on external cephalic version as homework and provides evaluation criteria. Reference sources for the topic are also listed.

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N. Siva
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10K views36 pages

Malposition & Malpresentation

The document discusses malpositions and malpresentations during childbirth. It defines position and presentation, describes the pelvis and discusses occipito-posterior position. It discusses breech presentation, its causes and clinical manifestations. Other malpresentations discussed include face, brow, transverse lie and unstable lie. Compound presentations are also defined. The document lists objectives of the class and asks questions to check understanding of key topics. It assigns a short note on external cephalic version as homework and provides evaluation criteria. Reference sources for the topic are also listed.

Uploaded by

N. Siva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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IS IT THE NORMAL

PRESENTATION……..????
MALPOSITION
AND
MALPRESENTATION

PRESENTED BY- DEBALINA GHOSH


M.SC NURSING, 1 ST YEAR
MCON, MANIPAL
OBJECTIVE OF THE CLASS ARE…….
Define the malposition and
malpresentation
Enumarate different types of
malpresentation
Describe the causes of malposition
and malpresentation
List down the clinical manifestation
Describe the different management
for various malpresentation
DEFINITION
Position: It is the relation of the
denominator to the different quadrants of
the pelvis.
There are 8 position, most common left
occipito anterior
Presentation: The part of the foetus which
occupies the lower pole of the uterus is
called the presentation of the foetus
DESCRIPTION OF PELVIS
OCCIPITO-POSTERIOR POSITION
AETIOLOGY OF OCCIPITO-POSTERIOR
POSITION
Shape of the inlet
Back of the right side
Anterior insertion of placenta
Foetal factor-
High pelvic inclination
Primary brachycephalic
Uterine factor
Clinical manifestation
Per abdomen:
 Normal findings, difficult to auscultate
the foetal heart sound
• Vaginal examination-(early labour)
 Elongated bag of membrane
 Sagittal suture in oblique diameter
 Anterior & posterior fontanels palpable
(late labour)
 Large caput
 Gaping of perineum
BREECH PRESENTATION

If the foetal buttocks or legs enter the


pelvic before the head, the presentation is
called Breech
Incidence:20-25% at 20 week
7-16% at 34th week &
3-4% at term
AETIOLOGICAL FACTOR
 Maternal:
-Multiparty
-Polyhydramnios/ oligohydramnios
-Placenta praevia
-Pelvic tumor
-Congenital uterine abnormality
-Cornual implantation of the placenta
-Previous breech presentation
-Contracted maternal pelvis
-Maternal anticonvulsant therapy
AETIOLOGICAL FACTOR

Foetal factor:
Prematurity
Multiple pregnancy
Foetal abnormality
Foetal kicking
Short umbilical cord
Fetal asphyxia
Female sex
Fetal growth restriction
Fetal abnormality
CLINICAL MANIFESTATION
Per abdomen
Per vagina
During Pregnancy
During labour
Ultrasonography
CT scan and MRI
EXTERNAL CEPHALIC VERSION
 There is protagonists &
antagonists to ECV
 Success rate is 60%
Successful version reduces
the risk of caesarean section
 Time of version
 Benefits are remarkable
 Contraindication
 Causes of failure
COMPLICATION OF BREECH DELIVERY

 Injury
 Nerve damage
 Asphyxia
 Intracranial haemorrhage
 Problem of foetus itself
 Death
Face presentation
Incidence- 1:500 delivery
Position- Right mento-posterior

Left mento-posterior
Left mento-anterior
Right mento-anterior
• Comonest one is the left mento-
anterior
• Types- Primary & secondary face
presentation
Aetiology of face presentation
Maternal:
Multi parity
Lateral obliquity of uterus
Contracted pelvis
Pelvic tumour
Cephalopelvic disproportion
Polyhydramnios
Previous caesarean delivery
Black race
Aetiology of face presentation
Foetal:
Congenital malformation
Twist of cord around neck
Increased tone of neck muscle
Intrauterine death
Prematurity
Macrosomia
Diagnosis of face presentation
Abdominal palpation

Vaginal examination
Sonography
Radiography
Complication of face presentation
Maternal Fetal
Prolonged labour Oedematous and
Increased risk for swollen
operative delivery Laryngeal oedema
Obstructed labour Congenital asphyxia
Brow presentation


TRANSVERS LIE/ SHOULDER
PRESENTATION (Aetiology)
Maternal Foetal
 Multi parity  Prematurity
 Contracted  Intrauterine
pelvis foetal death
 Placenta praevia  Foetal
 Uterine anomaly congenital
 Hydramnios abnormality
 Twins
 Pelvic tumor
DIAGNOSIS OF TRANSVERS LIE

 Abdominal examination
 Inspection
 Palpation
 Auscultation
o Ultrasonography
o Vaginal examination

 During pregnancy
 During labour
UNSTABLE LIE (AETIOLOGY)
 Grand multipara with lack of uterine tone
 Pendulous abdomen
 Hydramnios
 Contracted pelvis
 Placenta praevia
 Pelvic tumour
COMPOUND PRESENTATION

when the cephalic presentation is


complicated by the presence of a hand or a foot
or the both alongside head or presence of one
or both hands by the breech, it is called
compound presentation.
Aetiology of compound presentation
Maternal factor:
 Contracted pelvis
 Prematurity
 Pelvic tumour
 Multiple pregnancy
 Polyhydramnios
 Large pelvis
 Premature rupture of membrane
 Cord prolapse
• Fetal: Low birth weight baby
Nursing management of
malposition & malpresentation
Journal article
The Impact of an ECV Service is Limited by
Antenatal Breech Detection: A Retrospective
Cohort Study...External Cephalic Version- The aim
of this study was to investigate the reasons for
breech presentation at term birth Methods: they
performed a retrospective cohort study of 394
consecutive babies who were in breech presentation
at term birth in a large United Kingdom maternity
unit that offers ECV. The cohort was analysed over
two time periods 10 years apart: 1998-1999 and
2008-2009, study concluded that although ECV
counselling, referral, and attempt rates have
increased, failure to detect breech presentation
antenatally is the principal barrier to successful
ECV. Improved breech detection would have a
greater impact than methods to increase ECV
success rate. (Hemelaar, Lim, & Impev, 2015)
Management of breech presentation at term: a
retrospective cohort study of 10 years of
experience- this study done to evaluate the impact
of management of childbirth (external cephalic
version plus planned vaginal delivery) of breech
presentation at term (⩾37 weeks of gestation).
Study Design: This retrospective cohort study was
based on data collected of singleton breech
presentations at term in the Obstetrics and
Gynaecology Service, Cruces University Hospital
(Biscay, Spain), from January 2003 to December
2012, this study concluded that management of
breech presentation with a protocol that includes
ECV, careful selection criteria and active
management of vaginal delivery achieve a great
decrease in the rate of CS for breech
presentation. (Sharshiner & Silver, 2015)
Do you have any question……??????


Do you know………..
What is malposition ?

What is malpresentation ?
What is the commonest malpresentation ?
Tell some Tell two complication of
compound presentation ?
aetiological factor for Breech
presentation ?
How you diagnose transverse lie?
What is compound presentation?
One assignment for you………
Statement- Write a short note on
external pelvic version 
Date of submission- 09.12.15
Evaluation criteria-
Criteria Marks Marks
allotted obtained

 Procedure 2  
 Indication 2
 Complication 2
 Presentation of content 2
 Arrangement 1
 On date submission 1

Total 10  
 Reference: Books -
 Arulkumaran, S., Sivanesaratnam, V., Chatterejee, A., & Kumar, P. (2011).
Essentials of obstetrics (2nd edition ed.). New Delhi, New Delhi, India: Jaypee
brothersmedical publishers (p) ltd.


 Balakrishna, S. (2010). Textbook for obstetrics (1st edition ed.). Hyderabad,
India: Paras.
 Daftary, S. N., & Chakravarti, S. (2002). Manual of obstetrics (1st edition
ed.). Noida, New Delhi, India: B.I. churchill livingstone pvt ltd.
 Dutta, D. C. (2013). Textbook of obstetrics including perinatology and
contraception (7th edition ed.). Kolkata, WestBengal, India: New central book
agency.
 Fraser, D. M., Cooper, M. A., & Fletcher, G. (2007). Myles textbook for
midwives (14th edition ed.). China: ELSEVIER.
 Jacob, A. (2008). A comprehensive textbook of midwifery (2nd edition ed.).
New Delhi, New Delhi, India: Jaypee brothers medical publishers (p) ltd.
 Majhi, A. K. (2011). Bedside clinics in obstetrics, a practical approach (1st
edition ed.). Kolkata, West Bengal, India: Academic publishers.
 Rao, K. A. (2011). Textbook pf midwifery and obstetrics for nurses (1st edition
ed.). Kundli: ELSEVIER.
Reference: Journal-
 Hemelaar, J., Lim, L. N., & Impev, L. W. (2015,

June). The impact of an ECV service is limited
by antenatal Breech detection: A
retrospective cohort study..... External
Cephalic version. Birth issues in perinatal care,
165-172.
 Sharshiner, R., & Silver, R. M. (2015, October).
Management of breech presentation at term: a
retrospective cohort study of 10 years of
experience. Journal of perinatology, 803-808.

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