canal, when the head lies in the attitude of complete
extension.Face presentation comprises of mouth with alveolar margins, nose, eyes, mentum and malar eminences.
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MALPRESENTATION
Содержание
- 1. MALPRESENTATION
- 2. Face presentation
- 3. Definition:- The face of the fetus comes
- 4. Position Left mento-anterior- commonestRight mento-anteriorLeft mento-posteriorRight mento-posterior
- 5. Слайд 5
- 6. Incidence: 0.2% Mechanics of presentation:Characterized by extreme
- 7. Diagnosis Abdominal examination :-Inspection :-there is no
- 8. Слайд 8
- 9. Vaginal examination:-Generally diagnosed on vaginal examination in
- 10. Слайд 10
- 11. May be confused with breech presentation REMEMBERanus
- 12. Слайд 12
- 13. Management First stage :-face presentation is conformed
- 14. Second stage:- .Face presentationMento-anteriorMento-posteriorDead fetus CraniotomyLSCS90% case
- 15. Слайд 15
- 16. Third stage:-Active management.Complications:-Maternal :-Prolonged labourHigh operative interference.Fetus:-cong. Malformation.Hypoxia Operative deliveryLaryngeal oedema.
- 17. Cause of delayed engagement in face presentation:-long diameter i.e. sub mento-vertical.No moulding.Weak uterine contraction.
- 18. Brow presentation
- 19. Definition:- brow or forehead presents when fetal
- 20. BROW PRESENTATIONMechanics of presentation:head is extended such
- 21. Слайд 21
- 22. Diagnosis Abdominal examination:-Finding are same as face
- 23. Слайд 23
- 24. MANGEMENT IN LABOURInitially expectant;50-75% will either flex
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Face presentation
Слайды и текст этой презентации
Слайд 3Definition:- The face of the fetus comes in the birth
Face presentation comprises of mouth with alveolar margins, nose, eyes, mentum and malar eminences.
Слайд 4Position
Left mento-anterior- commonest
Right mento-anterior
Left mento-posterior
Right mento-posterior
Слайд 6Incidence: 0.2%
Mechanics of presentation:
Characterized by extreme extension of the
fetal head so the face (rather than the skull) presents
to the birth canalAetiology
Any factor that favours extension such as fetal goitre, anencephaly
High maternal parity
Слайд 7Diagnosis
Abdominal examination :-
Inspection :-there is no visible bulging of
the flank, due to “S” shaped fetal spine.
Palpation :- the
diagnostic features in mento anterior and mento posterior are as follows:-
Слайд 9Vaginal examination:-
Generally diagnosed on vaginal examination in labour
The diagnostic features
are palpating the mouth with hard alveolar margins, nose, malar
eminences, supraorbital ridges and mentum.
Слайд 11May be confused with breech presentation REMEMBER
anus has sphincter tone
& meconium stained, the mouth has sucking reflex.
anus is in
line with the ischial tuberosities; mouth forms a traingle with the malar prominencesInvestigation :-
USG to conform diagnosis and exclude fetal abnormalities.
Слайд 13Management
First stage :-
face presentation is conformed by abdominal and
vaginal examination.
Fetal size, malformation and pelvis are assessed.
Partograph should
be maintained.Bed rest.
Maintain proper nutrition.
Sedation if necessary.
Слайд 14Second stage:-
.
Face presentation
Mento-anterior
Mento-posterior
Dead fetus
Craniotomy
LSCS
90% case normal spontaneous vaginal
(face to pubis) delivery with liberal episiotomy
If delay forceps delivery
Слайд 16Third stage:-
Active management.
Complications:-
Maternal :-
Prolonged labour
High operative interference.
Fetus:-
cong. Malformation.
Hypoxia
Operative delivery
Laryngeal
oedema.
Слайд 17Cause of delayed engagement in face presentation:-
long diameter i.e. sub
mento-vertical.
No moulding.
Weak uterine contraction.
Слайд 19Definition:- brow or forehead presents when fetal head lies midway
between full flexion and full extension(deflexion head).
Incidence: 1:1400
Position:-
Mento - anterior
browMento –posterior brow
Слайд 20BROW PRESENTATION
Mechanics of presentation:
head is extended such that attitude is
halfway between flexion (vertex) and hyperextension (face)
usually transitional- when the
head is in the process of converting from a vertex to a face or vice versapresenting part is between the facial orbits and anterior fontanelle
Слайд 22Diagnosis
Abdominal examination:-
Finding are same as face presentation except sinciput
and the groove between it and back are less prominent.
Vaginal
examination:-anterior fontanelle
supra-orbital ridges
eyes
Слайд 24MANGEMENT IN LABOUR
Initially expectant;
50-75% will either flex to a vertex,
or extend to a face with contractions from behind meeting
soft tissue and bony resistance below and will therefore deliver vaginallyHigh incidence of prolonged labour and dysfunctional labour
Persistent brow
the diameter is undeliverable vaginally
deliver by caesarean section
