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Abnormal Presentation.M2ppt

This document discusses abnormal presentations in pregnancy and provides objectives for understanding, diagnosing, and managing different types of abnormal presentations. It defines abnormal presentations as any non-cephalic presentation and describes common types like breech, face, brow, shoulder, and compound presentations. Risk factors, diagnosis, and delivery approaches are outlined for each presentation. The goal is for medical students to learn how to properly diagnose and treat abnormal presentations to improve maternal and fetal outcomes.

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IdiAmadou
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249 views

Abnormal Presentation.M2ppt

This document discusses abnormal presentations in pregnancy and provides objectives for understanding, diagnosing, and managing different types of abnormal presentations. It defines abnormal presentations as any non-cephalic presentation and describes common types like breech, face, brow, shoulder, and compound presentations. Risk factors, diagnosis, and delivery approaches are outlined for each presentation. The goal is for medical students to learn how to properly diagnose and treat abnormal presentations to improve maternal and fetal outcomes.

Uploaded by

IdiAmadou
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 18

Abnormal presentation.

Pr. Mbu / Dr.Nana


M2 2009-14/05/09.

Abnormal presentation-1.
General objectives:
Student should be able to define,
diagnose and advise women with
abnormal presentation.

Abnormal presentation-2.
Specific objctives:

Define abnormal presentation.


Name the different abnormal presentations.
Discuss the risk factors and mode delivery of the
different types.
Name the common complications associated with
abnormal presentation.
3

Abnormal presentation-3.
Lie: axis of foetus to axis of mother.
Longitudinal ( cephalic, breech).
Transverse (shoulder).
Oblique. (cephalic / breech).
Presentation: foetus two poles (cephalic / caudal). Pole of
foetus found at the inlet of pelvis or nearest.
Normal presentation, cephalic
Any other presentation is abnormal.
4

Abnormal presentation-4.
Types of abnormal pesentations:
Breech: caudal part at the brim or inlet.
Three types of breech presentations, complete.
Frank.
single or double footling.

Abnormal presentation-5.

Incomplete breech-1
6

Abnormal presentation-6.

Incomplete breech-2
7

Abnormal presentation-7.
Risk factors for breech presentation:
Preterm pregnancy
Multiple pregnancy
Placenta praevia
Grand-multi-parity
P/H breech
Borderline / contracted pelvises, uterine malformation.
Foetal malformations, hydrocephalus, conjoint twins, short cord,
hydramnios, proms, oligohydramnios, anencephalus, tumours e.g
teratomas..

Abnormal presentation-8.
Foetal presentation at various GA (US).

Cephalic, breech, others

29-32wks

78.1%
(cephalic)

14%(breech)

7.9%
(other
s)

33-36wks

88.7%

8.8%

2.5%

37-40wks

91.5%

6.7%

1.7%

Occurs in 4-6% pregnancies.

Abnormal presentation-9.
Diagnosis:
Physical examination, Leopolds manoeuver.
Vaginal examination
Ultrasonography
X-ray

10

Abnormal presentation-10.
Delivery:
C/S delivery is advisable and is indicated in the following
situations ( breech/large foetus, contracted to borderline pelvis,
hyperextended head, PET, ROM 12hrs, uterine dysfunction,
footling breech, prematurity <34 weeks, severe IUGR, poor
obstetrical Hx, desire for BTL.
Spontaneous, prematurity
Assisted breech delivery
Breech extractions.

11

Abnormal presentation-11.
Complications:
Maternal, increased morbidity C/S
Foetal, increased cord prolapse , increased
perinatal loss, prematurity, congenital
malformation, birth trauma (brain, spinal cord,
liver, adrenal glands, spleen, brachial plexus).
12

Abnormal presentation-12.
Face prsentation:
Head is hyperextended, occiput in contact with foetal
back, chin (mentum) the presenting part.
Incidence varies .0.1-0.3%.
Diagnosis: rest on vaginal examinaton, nose, mouth,
malar bones, orbital ridges.
X-ray may show a hyperextended head.
13

Abnormal presentation-13.
Etiology: factors that favour extension or hinder
flexion, contracted pelvis, large/macrosomic
foetuses, multiparous women with pendulous
abdomen, cord round neck, anencephalia.
Delivery, by C/S chin posterior, vaginal chin
anterior and adequate pelvis.

14

Abnormal presentation-14.
Brow presentation:
Portion of foetal head between orbital ridge and anterior
fontanelle presents at inlet.
Foetal head midway between full flexion (occiput) and
full extension (face)
Etiology: same as for face, usually unstable
Treatment as for face presentation.
15

Abnormal presentation-15.
Shoulder presentation: transverse lie, sometimes in

oblique lie.
Incidence 0.3-0.4%, increases with parity 10 folds after

parity 4.
Etiology: grandmulti-parity, prematurity, placenta praevia,

contracted pelvis.
Diagnosis: examination AC >UH
Delivery by C/S.
16

Abnormal presentation-16.
Compound presentation:
An extremity spontaneous enters pelvis with the
presenting part.
vertex /hand 1:700 deliveries.
Rarely lower limbs/ vertex, hand/breech.
Cause usually unkown, but prematurity seen in two folds.

17

Abnormal presentation-17.
Conclusion:
Abnormal presentation is a common cause of maternal
morbidity, foetal morbidity and mortality.
Prompt diagnosis, proper decision taking and treatment
is capital to better outcome.
Early referrals for better management is therefore
paramount for better outcome.
18

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