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FACE PRESENTATION

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 . FACE PRESENTATION AND BROW.

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FACE PRESENTATION

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  1. 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

  2. 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 SECTION

  3. SHOULDER PRESENTATION • DIAGNOSTIC LANDMARKS • UTERUS IS ENLARGED TRANSVERSLY AND SHORTENED VERTICALLY • EMPTINESS AT THE LOWER POLE • ON PV PALPABLE CLAVICLE ,RIBS ARM PROLAPSE

  4. 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 PRESEENTATION

  5. 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

  6. 0CCIPITO POSTERIOR POSITION • DIAGNOSIS • PALPATION • AUSCULTATION • VAGINAL EXAMINATION • LONG ROTATION-135° --OCCIPITO ANTERIOR-SVD EXPECTED • SHORT ROTATION- 45°--FACE TO PUBIS—AVD OR C/SECTION

  7. MALPRESENTATION ANY PRESENTATION OTHER THAN THE NORMAL VERTEX OF THE FETAL HEAD

  8. MALPRESENTAION • FACE • BROW • SHOULDER • BREECH • COMPOUND

  9. CAUSES OF MALPRENTATION • HIGH PARITY • PREMATURITY • FETAL ANOMALIES • POLYHYDRAMNIOS • MILD CPD

  10. 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,HYDRAMNIOUS

  11. 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 PLEXUS

  12. MANAGEMENT • UNCOMPLICATED BREECH • ELECTIVE C/S? • PLANNED VAGINAL DELIVERY? FRANK BREECH • C0MPLETE BREECH • FOOTLING

  13. 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 PERINEUM

  14. 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?

  15. SPECIAL MANOEUVRES • PINARDS • MAURICEAU-SMELLIE-VEIT • LØVESET • PRAGUE • REVERSE PRAGUE • FORCEPS

  16. Complications of breech delivery • EXTENDED ARMS • NUCHAL ARM • OCCIPUT POSTERIOR OF THE AFTERCOMING HEAD • HEAD ENTRAPMENT BY INCOMPLETELY DILATED CERVIX

  17. BREACH EXTRACTION • IS THERE A PLACE FOR BREECH EXTRACTION?

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