Compound Presentations
Face Presentations
Brow Presentations
Breech Presentations
Shoulder Dystocia
100
Most frequent complication of compound presentation
What is cord prolapse? • 11-20% of cases due to incomplete filling of pelvic inlet. • Hence CEFM very important during labor
100
Designation of fetus presenting by the face whose chin is in the right posterior quadrant of the maternal pelvis
What is right mentum posterior?
100
Point of designation for brow presentations
What is frontal bone?
100
Score historically use to predict successful vaginal breech delivery
What is Zatuchni-Andros System? • Parity, GA, EFW, previous breech delivery, dilation, station
100
Incidence of shoulder dystocia
What is 0.15-1.7%? • Really this is highly variable due to lack of uniformity in definition • Proposed definitions: prolonged head to body delivery time >60sec &/or necessitated use of ancillary measures
200
Most consistent risk factor associated with compound presentation
What is prematurity? • Other risk factors: maternal age, race, parity, pelvic size all associated
200
Strongest associated cause with face presentations
What are fetal malformations? • Ancencephaly is found in 1/3 of face presentations • Fetal goiter & tumor of neck can cause deflexion • Maternal factors – contracted pelvis, CPD
200
True or false: Pitocin can be used during labor?
• True – can be used cautiously to correct hypotonic contractions • CI: conversion of presentation manually or with forceps
200
Success rate of external cephalic version
What is 60-75% • Factors associated with failure are maternal obesity, olio, pelvic engagement of breech, posterior positioning of back
200
Name for delivery of posterior arm
What is Barnum’s or Jacquemier’s maneuver
300
Definition of compound presentation
What is when an extremity is found prolapsed beside main presenting fetal part?
300
Designation point during vaginal exams in face presentations
What is mentum (fetal chin)?
300
Name this position: anterior fontanel on maternal Lt side, sagittal suture in transverse pelvic axis
What is Lt frontum transverse?
300
Engagement of breech fetus occurs when this passes beyond the plane of pelvic inlet
What is bitrochanteric diameter? • Presenting part may be palpated only at -2 to -4 station
300
Maneuver of dropping maternal legs down toward floor w/ concurrent suprapubic pressure
What is Walcher position? • Pressure is doral-caudal direction & maintained into McRoberts • Idea is to disimpact by increasing AP diameter of inlet before increasing outlet
400
Most common compound presentation
What is vertex/upper extremity? • 75% of vertex/upper extremity presentations deliver spontaneously
400
Percentage that present in mentum anterior
What is 60-80% • Most achieve SVD or easily assisted vaginal delivery • 10-12% transverse –most rotate to anterior & deliver • 20-25% posterior -25-33% will rotate & deliver • Presence of mentum posterior w/ normal size infant, less likely to result in safe SVD
400
Most common brow presentation
What is frontum anterior?
400
Maneuver of delivering head in breech delivery
What is Mauriceau-Smellie-Veit maneuver • Simple manual effort to max flexion of vertex using pressure on fetal maxilla • Done with suprapubic pressure & gentle downward traction • Alternative Piper forceps
400
Neonatal morbidity of greatest concern
What is brachial plexus injury? • CN roots 5 & 6 • Most cases are transient w/ full recovery in 90-95%
500
Indications for c/s
What is when there is cord prolapse, NRFHT, arrest of labor? • 2-25% require c/s • More likely to deliver if small or premature • Anything other than vertex/hand in term size infant have poorer prognosis for safe SVD
500
FSE should be placed here if needed
What is chin? • 10 fold increased fetal compromise w/ face presentations thus CEFM is required • TOL is recommended, CI only if macroscomia or small maternal pelvis ID • If c/s required, take care to flex head gently to elevated & avoid nerve damage
500
Amount of brow presentations that undergo spontaneous labor
What is <50% • 30-50% have prolonged labors • Secondary arrest of labor is not uncommon
500
This is the point of designation for breech presentation
What is fetal sacrum?
500
Clinical factor that has strongest correlation with dystocia
What is macrosomia? • Up to ½ of cases of dystocia are associated w/ neonates <4000g • Macrosomia occurs more w/ GDMA & prolonged pregnancies, abnormal 1hr w/ non diagnostic 3hr, obesity, previous >4000g infant, DM, prolonged 2nd stage of labor, prolonged deceleration phase, instrumental mid-pelvic delivery, previous shoulder dystocia
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