MALPRESENTATION

Made by ABDUL SAMI (245)

4th Year MBBS 27’
What is presentation?

• Lower most fetal part in relation to cervix

and lower uterine segment
• NORMAL PRESENTATION VERTEX
(Head)
WHAT IS MALPRESENTATION?

• Malpresentation in pregnancy refers to a

baby being positioned in a way other than
the standard head-first (vertex) position as
it approaches the birth canal.

• This can include breech presentation

(butts or feet first), shoulder presentation,
face presentation, or brow presentation.
COMPLICATION

• Malpresentation can lead to difficulties

during labor and delivery, potentially
requiring interventions like a Cesarean
section.
TYPES OF MALPRESENTATIONS

• 1 Breech 3 in 100 (3%)

• 2 Face 1 in 500 (0.5%)
• 3 Brow 1 in 1000 (0.001%)
• 4 Shoulder 1 in 300 (0.3%)
• 5 Compound 1 in 1000 (0.01%)
BREECH PRESENTATION

• Breech presentation, in pregnancy, refers

to a situation where the baby is positioned
bottom or feet first (rather than head first)
in the uterus at the time of birth.
• Commonest type
of malpresentation.
TYPES OF BREECH PRESENTATION

• There are three types of breech presentation

• Extanded (frank) breech (commonest)
• Flexed (complete) breech (less common)
• Footling (Foot) breech (least common)
RISK FACTORS OF BREECH
PRESENTATION
MANAGEMENT OF BREECH
PRESENTATION
• By three ways
• 1 External cephalic version
• 2 Vaginal Breech Delivery
• 3 Cesarean section
1 External cephalic version ECV

• Definition
External cephalic version is a method used to
turn a breech baby to a head-down position
during pregnancy.
This is done through the mother's abdominal
wall, aiming to improve the chances of a vaginal
delivery and reduce the need for a Cesarean
section.
Maximum time taken should not more then
10 minutes.
Contraindications to ECV
• Fetal abnormality (e.g. hydrocephalus).
• Placenta praevia.
• Oligohydramnios or polyhydramnios.
• History of antepartum haemorrhage.
• Previous caesarean or myomectomy scar on
the uterus.
• Multiple gestation.
• Pre-eclampsia or hypertension.
• Plan to deliver by caesarean section anyway.
Risks of ECV
• Placental abruption.
• Premature rupture of the membranes.
• Cord accident.
• Transplacental haemorrhage (remember
anti-D administration to rhesus-negative
women).
• Fetal bradycardia.
Loveset’s manoeuvre
Rotation of the trunk of the fetus during a breech birth to facilitate delivery of
the arms and the shoulders.
TECHNIQUE FOR DELIVERY
It should must performed by skilled person.
Problems may occur more likely due to the obstetrician tries to speed up the process by
pulling on the baby, and this should be avoided.

Delivery of buttocks
1. Full cervical dilatation and breech descent occur naturally.
2. Preparations for delivery are made when buttocks become visible and distend the
perineum.
3. An episiotomy(incision through the area between vaginal opening and anus) is
performed only when:
1. The anterior buttock is delivered.
2. The anus is visible over the fourchette.
The goal is to facilitate a safe delivery while minimizing perineal trauma.
Delivery of the legs and lower body
1. Leg position: If legs are flexed, they may deliver spontaneously. If extended, assistance may be
needed.
2. Pinard's manoeuvre: A technique used to deliver extended legs by flexing the leg at the knee and
extending at the hip.
3. Delivery: With contractions and maternal effort, the lower body is delivered.
4. Cord management: A loop of cord is drawn down to ensure it's not too short, reducing the risk of cord
complications.

Pinard's manoeuvre is an important technique in breech delivery, helping to facilitate a safe and
controlled birth.
Delivery of buttocks,Legs and lower body
Delivery of the shoulders
1. Shoulder rotation: The shoulders rotate into the anterior-posterior diameter, making the
spine or scapula visible.
2. Arm delivery: A finger can be used to gently deliver the arm as it becomes visible.
3. Rotation and delivery: The posterior arm/shoulder rotates anteriorly, and delivery of the
second arm follows.
4. Natural movement: The process can be likened to a "rocking boat" motion.
Loveset's Manoeuvre
1. Description: Loveset's manoeuvre mimics the natural movements of shoulder rotation and
arm delivery.
2. Usefulness: However, it's considered unnecessary and potentially meddlesome to perform
routinely, as it may cause more harm than good.

Delivery of head
1. Baby's position: The baby lies on the obstetrician's arm.
2. Downward traction: Gentle downward traction is applied to the head via a finger in the
mouth and one on each maxilla.
3. Delivery movement: The head is delivered with a downward and then upward movement.
Alternative: Forceps Application
1. Difficulty with manoeuvre: If the Mauriceau-Smellie-Veit manoeuvre is difficult, forceps may
be applied.
2. Assistant's role: An assistant holds the baby's body upwards while forceps are applied.

This technique requires careful handling to ensure a safe delivery.

Delivery of Shoulders
Delivery of Head
Vaginal breech delivery complications:

Risks
1. Baby getting stuck: The greatest fear in vaginal breech delivery is that the baby
may become obstructed or stuck.
2. Inappropriate interventions: Using oxytocic agents or attempting to pull the
baby out (breech extraction) can increase the risk of obstruction.

Importance of Experienced Care

1. Reducing risks: Experienced obstetricians can reduce the risk of death or
serious injury when complications arise, particularly with delivery of the shoulders
or head.

Careful management and experienced care are crucial in minimizing risks

associated with vaginal breech delivery.
FACE PRESENTATION
Management
MENTO ANTERIOR

Forcep delivery

MENTO POSTERIOR

Cesarean section
Etiological causes
Bicornuate uterus
Septate uterus
Polyhydramnios
Oligohydramnios
Large fetal head
Congenital abnormalities
Cord around neck
Neck tumor
TRANSVERSE LIE
Most dangerous
Large uterus with poor tone
fetus lie in transverse postion

CAUSES
Multiparity
Atonic uterus
placenta Praevia
DIAGNOSIS
P/A Examination
Uterus enlarged transversely
Fetus lying across
transverse ovoid

P/V Examination
Shoulder
Elbow
Hand
Cord

Ultrasound
MANAGEMENT

36 Weeks admission
Do caesarean section
Prevent labour
COMPLICATIONS
Morbidity and mortality

Prolonged Obstructed Labour

Rupture of uterus

Fetal distress

Fetal death

Infection
THANK YOU!