Fetal malpresentations

Question 1

What are the risk factors for fetal malpresentations?

Answer 1

1. Decreased polarity of the uterus.
   - fibroids
   - low lying placenta
   - grand multiparity (>5 x)
2. Decreased ability for fetus to move: polyhydramnios
3. Increased mobility of the fetus: oligohydramnios
4. Cephalo-pelvic disproportion
   - Severe hydrocephalus
   - Narrowed/contracted pelvis.
5. Fetal malpresentation
   - Anencephaly (part of skull missing)
   - Hypotonic disorders

Question 2

What is the definition, management and complications of:

UNSTABLE/ABNORMAL LIE.

Answer 2

D- Frequent change in fetal presentation after 37 weeks, with intact membranes.

RF
- polyhydramnios

M- ECV + induction after 37 weeks. C-section if persistent unstable lie.

C-

• cord prolapse (20x higher)
• increased maternal morbidity

Question 3

What is the definition, causes, management and complications of:

FACE PRESENTATION

Answer 3

D- extension of head, instead of flexion, causing face to present instead of occiput.

“Mono-anterior” = chin passes under pubic symphysis.
“Mono- posterior” = chin passes posteriorly.

Causes

• anencephaly
• fetal goitre
• maternal contracted pelvis
• cephalopelvic disproportion.

M
Mono anterior - Vaginal - flexion of head required prior to extraction.
Mono posterior - LSCS
- diagnosed on VE.

C

• prolonged labor
• fetal distress

Question 4

What is the definition, RF, management and complications of:

BROW POSITION

Answer 4

D - head is only partially flexed so that the brow is the presenting part

RF

• Multiparity
• cepahlopelvic disproportion
• prematurity

Dx - VE

M

• vaginal birth - can spontaneously correct.
• LSCS if failure to progress.

Question 5

What is the definition, RF, diagnosis, management and complications of:

COMPOUND PRESENTATION

Answer 5

D - extremity accompanies occiput as presenting part.

• most commonly arm (safer)
• foot = most dangerous.

RF
- preterm delivery

M -

• 75% will deliver spontaneously.
• Most hand presentations will correct.
• LSCS IF:
  > cord prolapse
  > fetal distress
  >prolonged labor

Question 6

What is the definition, RF, management and complications of:

BREECH PRESENTATION

Answer 6

D - baby is lying in longitudinal axis with head in the fundal position, and feet pointing towards the pelvis.

Categories

• extended/ frank
• flexed/ complete
• footling/ incomplete.

RF

• prematurity
• multiple gestation
• abnormal placenta
• congenital trisomies
• oligo/polyhydramnios

Diagnosis

• Abdo exam
• VE
• US

Mx

• ECV >37 weeks and induction of labor
• Elective LSCS

Complications

• Cord prolapse (and compression -> hypoxia)
• Fetal asphyxiation due to obstructed labor
• PPH - prolonged labor.

Question 7

When is ECV done? What are the complications? What is the success rate?

Answer 7

36 weeks +

Effects - pain and discomfort.

Complications

• Placental abruption
• PROM
• cord prolapse
• preterm labor
• LSCS due to unsuccess

Success rate - 50-60% (don’t quote this)