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MALPRESENTATION And CORD PROLAPSE

MALPRESENTATION And CORD PROLAPSE. MALPRESENTATION. Malpresentation is the situation where a fetus within the uterus is in any position that is not cephalic. Maternal Great parity Pelvic tumors Pelvic contracture Uterine malformation. Fetal Prematurity

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MALPRESENTATION And CORD PROLAPSE

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  1. MALPRESENTATION And CORD PROLAPSE

  2. MALPRESENTATION • Malpresentation is the situation where a fetus within the uterus is in any position that is not cephalic

  3. Maternal Great parity Pelvic tumors Pelvic contracture Uterine malformation Fetal Prematurity Multiple gestation Hydramnios Macrosomia Hydrocephaly Trisomies Anencephaly Myotonic dystrophy Placenta previa Etiologic factors in malpresentation

  4. Breech Presentation

  5. IntroductionBreech presentation occurs in3-4% of all deliveries. The occurrence of breech presentation decreases with advancing gestational age. Breech presentation occurs in 25% of births that occur before 28 weeks’ gestation, in 7% of births that occur at 32 weeks, and 1-3% of birthsthat occur at term. . Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. Deaths most often are associated with malformations, prematurity, and intrauterine fetal demise.

  6. Predisposing factors • prematurity, uterine abnormalities (eg, malformations, fibroids), fetal abnormalities (eg, CNS malformations, neck masses, aneuploidy), and multiple gestations. AF abnormality.Abnormal placentation. Contracted pelvis.MG.Pelvic tumor.

  7. Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. • Congenital malformation 6%

  8. Types of breeches • Frank breech (50-70%) - Hips flexed, knees extended • Complete breech (5-10%) - Hips flexed, knees flexed • Footling or incomplete (10-30%) - One or both hips extended, foot presenting

  9. position SA,SP,LST,RST LSP,RSP.LSA,RSA

  10. STATION

  11. DIAGNOSIS • Palpations and ballottement • Pelvic exam • X-ray studies • Ultrasound

  12. MANAGEMENT • Antepartum • During labor • Delivery

  13. VD Frank GA>34w FW=2000-3500gr Adequate pelvis Flexed head Nonviable fetus No indication Good progress labor CS FW<1500or> 3500gr Footling Small pelvis Deflexed head Arrest of labor GA24-34w Elderly PG Inf or poor history Fetal distress Criteria for VD orCS

  14. VAGINAL BREECH DELIVERY • Three types of vaginal breech deliveries: • Spontaneous breech delivery • Assisted breech delivery • Total breech extraction

  15. Footling breech presentation

  16. Assisted vaginal breech delivery • Thick meconium passage is common as the breech is squeezed through the birth canal. This usually is not associated with meconium aspiration because the meconium passes out of the vagina and does not mix with the amniotic fluid.

  17. Picture 3. Assisted vaginal breech delivery: The Ritgen maneuver is applied to take pressure off the perineum during vaginal delivery. Episiotomies often are cut for assisted vaginal breech deliveries, even in multiparous women, to prevent soft-tissue dystocia.

  18. Picture 4. Assisted vaginal breech delivery: No downward or outward traction is applied to the fetus until the umbilicus has been reached.

  19. Risks • Lower Apgar scors • An entrapped head • Nuchal arms • Cervical spine injury • Cord prolapse ,

  20. PROGNOSIS

  21. Table 1. Zatuchni-Andros Breech Scoring If the score is 0-4, cesarean delivery is recommended

  22. VERSION • External • Internal

  23. Internal podalic version

  24. COMPOUND PRESENTATION

  25. COMPLICATION SD • Immediate neonatal;birth asphyxia ,traumatic injury • Maternal;PPH,lacerations

  26. SHOULDER DYSTOCIA (Sh.D)

  27. Shoulder dystocia will still the obstetric nightmare

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