Anatomy

Question 1

names of fetal skull points

Answer 1

1. suboccipito bramati
2. suboccipito frontal
3. occipitp-frontal
4. mento-vertical
5. submento-bregmatic

Question 2

diameters of fetal skull

Answer 2

1. suboccipito bregmatic (9,5cm)
2. suboccipito frontal (10,5cm)
3. occipitp-frontal (11,5cm)
4. mento-vertical (13cm)
5. submento-bregmatic (9,5cm)

Question 3

positions of the fetal skull

Answer 3

1. suboccipito bramati ( flexed vertex)
2. suboccipito frontal (partial deflexed vertex)
3. occipitp-frontal (deflexed vertex)
4. mento-vertical (brow)
5. submento-bregmatic (face)

Question 4

types of fetal presentations

Answer 4

1. vertex
2. face/brow
3. frank breech
4. complete breech
5. incomplete/flooting breech
6. transverse

Question 5

Considerations for normal labour

Answer 5

1. The lie is longitudinal
2. The presentation is cephalic
3. The position is LOA or ROA
4. The attitude is one of good flexion
5. The denominator is occiput
6. The presenting part is the posterior part of the parietal bone

Question 6

Pelvic inlet diameters

Answer 6

Anterior-posterior diameter (API) = 11cm. The line between the narrowest points formed by the sacral promontory and the upper inner border of the symphysis pubis (=obstetrical conjugate)

Transverse diameter (TDI) = 13 cm. Taken between the widest points on the iliopectineal lines

Question 7

pelvic outlet diameters

Answer 7

Anterior-posterior diameter (APO) = 13 cm. From the tip of the sacrum to the lower border of symphysis pubis

Transverse diameter (TDO) = 11 cm The line between the inner surfaces of the ischial tuberosities

Oblique diameters = 12 cm

Question 8

names of sutures

Answer 8

1. frontal
2. sagital
3. coronal
4. lambdoid

Question 9

names of fontanels

Answer 9

1. anterior fontanel (bregma)
2. posterior fontanel (lambda)
3. sphenoid fontanel
4. mastoid fontanel

Question 10

what do each of the sutures connect

Answer 10

1. frontal - joins the two frontal bones together
2. sagital - joins the two parietal bones together
3. coronal - joins the frontal bone to the two parietal bones
4. lambdoid - forms the junction between the occipital and the two parietal bones

Question 11

what is moulding

Answer 11

Overlapping (overriding) of the fetal skull bones during labour; movement of sutures and fontanelles

Question 12

grades of moulding

Answer 12

0 – no moulding
1+ sutures are approximate
2+ reducible overlapping of sutures
3+ irreducible overlapping of sutures

Question 13

what can moulding indicate

Answer 13

may be a sign of CPD

Question 14

Fetal causes of a breech presentation

Answer 14

Congenital abnormalities e.g.. Hydrocephalus
Prematurity
Macrosomia
Multiple pregnancy
IUGR and IUFD

Question 15

maternal causes of a breech presentation

Answer 15

• Pelvic abnormalities e.g. Pelvic tumours, contracted pelvis.
• Abnormal placentation like previae
• Uterine abnormalities e.g. Septate, fibroids
• Multiparity (lax abdominal muscles)
• Poly - oligohydramnios

Question 16

vaginal breech delivery methods

Answer 16

1. spontaneous breech delivery
2. Assisted breech deliver (partial breech extraction)
3. Breech extraction (total)

Question 17

mechanisms of labour in breech presentation

Answer 17

1. Descent and engagement
2. Flexion (lateral)
3. Internal rotation
4. Flexion

Question 18

Wigard-Martin’s method

Answer 18

• The baby’s body lies on the attendant’s left hand
• The middle finger is inserted into the baby’s mouth, the index and ring fingers on the maxillae to improve and maintain head flexion
• Suprapubic pressure is exerted by the right hand to deliver the fetal head

Question 19

Mauriceau – Smellie – Veit’s method

Answer 19

• The baby’s body lies on the attendant and left hand
• The ring and index fingers of the other hand are placed across fetal shoulders while the middle finger is place on the occiput to maintain head flexion.

-Traction is exerted on the fetal shoulders

Question 20

Burns-Marchall’s method

Answer 20

• The attendant stands with his left side against the patient’s right leg.
• Baby’s feet are held in the left hand
• Gentle traction is exerted with the legs lifted in a wide arc
• Delivery of the head is controlled with the right hand, with index and middle fingers placed on the cheek bones.

Question 21

Lovset’s method

Answer 21

It is a combination of traction and rotation

Question 22

complications of breech

Answer 22

1. birth asphyxia (cord prolapse and presentation)
2. birth injuries (brachial palsy, long bone fructures, spinal cord disruptions, tears in the tentorium cerebellum)

Question 23

indications of C/S in breech

Answer 23

1. EFW of more than 3700g or less than 1500g
2. Contracted pelvis
3. Footling breech
4. Deflexed head
5. Any other obstetric complications

Question 24

what is a compound presentation

Answer 24

Compound presentation is prolapse of a fetal extremity into the lower uterine segment alongside the presenting part.

Occurs when an arm prolapses alongside
the presenting part. Both the prolapsed arm and the fetal head present in the pelvis
simultaneously.

Question 25

what are the causes of compound presentation

Answer 25

1. The ill-fitting presenting part predisposes to extremities prolapse: 2. Prematurity 3. Cephalopelvic disproportion 4. Multiple pregnancies 5. Polyhydramnios 6. Abnormal lie (transverse)

Question 26

what is the management of compound presentation

Answer 26

1. Confirm the diagnosis by ultrasound or XR 2. Establish fetal viability - Allow vaginal delivery in previable fetuses. - In viable fetuses perinatal outcome is better with caesarean section than vaginal delivery Umbilical cord prolapse is a risk in compound presentations.

Question 27

what is the prognosis of compound presentation

Answer 27

Perinatal mortality rates of about 25%. Prematurity, cord prolapse and traumatic vaginal delivery are the main causes

Question 28

complete breech

Answer 28

both thighs and legs are flexed

Question 29

frank breech

Answer 29

thigh flexed on the abdomen and both legs extended at the knee