DIGNOSTIC LANDMARKSEYESNOSE MOUTH AND CHIN POSITIONMENTO ANTERIORPOSTERIORMENTO TRANSVERSE MANAGEMENT GUIDELINESFETUS IS DEAD OR ALIVES WITH ANOMALIES INCOMPATABLE WITH LIFEALLOW VAGINAL DELIVERY ID: 179010
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FACE PRESENTATION
DIGNOSTIC LANDMARKS-EYES,NOSE MOUTH AND CHIN
POSITION-MENTO ANTERIOR/POSTERIOR,MENTO TRANSVERSE
MANAGEMENT GUIDELINES-FETUS IS DEAD OR ALIVES WITH ANOMALIES INCOMPATABLE WITH LIFE,ALLOW VAGINAL DELIVERY
MENTO ANTERIOR ,R/O FPD Slide2
FACE PRESENTATION AND BROW
IF LABOUR IS PROGRESSING WELL
MENTO POSTERIOR- C/S
BROW -NORMALLY INCOMPATABLE WITH VAGINAL DELIVERY
DIAGNOSTIC LANDMARKS-ROOT OF THE NOSE,SUPRAORBITAL
RIDGES,ANTERIOR
FONTANEL
MANAGEMENT -
CESARIAN SECTIONSlide3
SHOULDER PRESENTATION
DIAGNOSTIC LANDMARKS
UTERUS IS ENLARGED TRANSVERSLY AND SHORTENED VERTICALLY
EMPTINESS AT THE LOWER POLE
ON PV PALPABLE CLAVICLE ,RIBS ARM PROLAPSESlide4
MANAGEMENT
WITH FETUS ALIVE –C/SECTION
WITH FETUS DEAD-DESTRUCTIVE OPERATION,OR C/S
COMPOUND PRESENTAION
PROLAPSE OF ONE OR MORE LIMBS IN CEPHALIC PRESENTATION
PROLAPSE OF HAND OR ARM IN BREECH PRESEENTATIONSlide5
COMPOUND PRESENTATION
PUSH THE HAND ABOVE THE FETAL HEAD
ARM MAY BE DIFFICULT TO REPLACE AND CESARIAN SECTION MAY BE NECESSARY
MALPOSITION
INCORRECT POSITIONING OF THE VERTEX
OCCIPITO POSTERIOR POSITION
PERSISTENT O.P.P Slide6
0CCIPITO POSTERIOR POSITION
DIAGNOSIS
PALPATION
AUSCULTATION
VAGINAL EXAMINATION
LONG ROTATION-135° --OCCIPITO ANTERIOR-SVD EXPECTED
SHORT ROTATION- 45°--FACE TO PUBIS—AVD OR C/SECTIONSlide7
MALPRESENTATION
ANY PRESENTATION OTHER THAN THE NORMAL VERTEX OF THE FETAL HEADSlide8
MALPRESENTAION
FACE
BROW
SHOULDER
BREECH
COMPOUNDSlide9
CAUSES OF MALPRENTATION
HIGH PARITY
PREMATURITY
FETAL ANOMALIES
POLYHYDRAMNIOS
MILD CPDSlide10
BREECH PRESENTATION
WHEN THE BUTTOCKS AND/OR THE FEET ARE THE PRESENTING PARTS
THE COMMONEST MALPRESENTATION
HAS HIGHER PERINATAL MORTALITY AND MORBIDTY
CAUSES OF BREECH PRESENTATION-PREMATURITY,MULTIPLE PREGNANCY,FETAL MALFORMATION,HYDRAMNIOUSSlide11
CLASSIFICATION AND RISKS
COMPLETE
FRANK
FOOTLING
INTRAPARTUM RISK TO THE FETUS-CORD ACCIDENTS,FRACTURE AND DISLOCATION OF LIMBS,DAMAGE TO INTRA-ABDOMINAL ORGANS,INTRACRANIAL HAEMORRHAGE,DAMAGE TO THE CERVICAL SPINE AND BRACHIAL PLEXUSSlide12
MANAGEMENT
UNCOMPLICATED BREECH
ELECTIVE C/S?
PLANNED VAGINAL DELIVERY?
FRANK BREECH
C0MPLETE BREECH
FOOTLINGSlide13
VAGINAL DELIVERY
KEEP MEMBRANES INTACT AS LONG AS POSSIBLE
BREECH IS SMALLER THAN THE AFTER COMING HEAD
BEFORE BEARING DOWN THE CERVIX MUST BE FULLY DILATED
LET THE BREECH DESCEND TO THE PERINEUMSlide14
ANATOMICAL LANDMARKS
ANTERIOR BUTTOCKS BEGIN TO DISTEND PERINEUM- ACTION?
THEN POSTERIOR BUTTOCKS- ACTION?
HIPS –LEGS FLEXED- ACTION?
HIPS- LEGS EXTENDED-ACTION?
UMBILICUS- ACTION?
SCAPULA- ACTION?
NAPE OF THE NECK-ACTION?Slide15
SPECIAL MANOEUVRES
PINARDS
MAURICEAU-SMELLIE-VEIT
LØVESET
PRAGUE
REVERSE PRAGUE
FORCEPSSlide16
Complications of breech delivery
EXTENDED ARMS
NUCHAL ARM
OCCIPUT POSTERIOR
OF THE AFTERCOMING HEAD
HEAD ENTRAPMENT BY INCOMPLETELY DILATED CERVIXSlide17
BREACH EXTRACTION
IS THERE A PLACE FOR BREECH EXTRACTION?