L5: Malpresentation & Malposition (Complex)

Question 1

Def of Complex (Compound) Presentation

Answer 1

• Prolapse of ≥ 1 fetal limb beside head or breech (footling & shoulder presentations aren’t included in this group

Question 2

Incidence of Complex (Compound) Presentation

Answer 2

1 is complex per each 1000

Question 3

Types of Complex (Compound) Presentation

Answer 3

Question 4

Etiology of Complex (Compound) Presentation

Answer 4

• General causes of malpresentations.

Question 5

Dx of Complex (Compound) Presentation

Question 6

Dx of Complex (Compound) Presentation

• Suspicion

Answer 6

1) Delayed progress in active phase of labor.

2) Failure of engagement.

3) Fetal head remains high & deviated from midline during labor (especially after ROM).

Question 7

Dx of Complex (Compound) Presentation

• Definitive Dx

Answer 7

• Condition is only diagnosed on PV examination (limb is present beside head or breech).

Question 8

Dx of Complex (Compound) Presentation

• PV

Answer 8

Condition is only diagnosed on PV examination (limb is present beside head or breech).

Question 9

Management of Complex (Compound) Presentation

• Depends on

Answer 9

Question 10

Management of Complex (Compound) Presentation

• If Labor is ptogressing

Answer 10

• Don’t interfere (the best treatment for complex presentation in absence of complications is masterful inactivity).

Question 11

Management of Complex (Compound) Presentation

• If labor is arrested

Answer 11

Question 12

Management of Complex (Compound) Presentation

• If labor is arrested (Reposition)

Answer 12

Reposition of prolapsed limb:
- in normal pelvis, it is done under anesthesia & head is pushed into pelvis.

Question 13

Management of Complex (Compound) Presentation

• if labor is arrested (Forceps)

Answer 13

but take care not to include limb in forceps.
1. if the head is engaged
2. if cervix is fully dilated.

Question 14

Management of Complex (Compound) Presentation

• if labor is arrested (CS)

Answer 14

1. if head isn’t engaged.
2. if reposition isn’t feasible or is unsuccessful.
3. if there is other obstetric indication for CS.

Question 15

Management of Complex (Compound) Presentation

• if labor is arrested (IPV)

Answer 15

Has no role as it carries high risk of rupture uterus & fetal death.