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Appreciating Complex Midwifery Care > Malpresentations and positions > Flashcards

Flashcards in Malpresentations and positions Deck (26)
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1

What does Malposition means?

Where the occiput is in one or other posterior quadrant of the pelvis

2

What does Malpresentation means?

any presentation other than vertex

3

What does Lie mean?

the relationship of the long axis of the fetus to the long axis of the uterus

4

What does presentation mean?

Part of the fetus lying in the lower pole of the uterus

5

When discussing the position of the fetus what does it mean by the denominator?

The denominator is the part of the presentation used to determine the position
Occiput in ...
Sacrum in...
Mentum
(chin)...

6

what does position mean?

The position is the relationship of the denominator to six areas of the woman’s pelvis
Left and right ...
Left and right ...
Left and right ..

7

What does attitude mean?

The relationship of the fetal head and limbs to its body. May be flexed, deflexed or partially extended

8

What is the diameter and presenting part of BI- PARIETAL?

9.5cm, Widest Transverse Diameter

9

What is the diameter and presenting part of BI-TEMPORAL?

8cm

10

What is the diameter and presenting part of SUBOCCIPITO-BREGMATIC ?

9.5cm
Vertex (well flexed)

11

What is the diameter and presenting part of SUBOCCIPITO-FRONTAL?

10cm
Vertex (less well flexed/ deflexed)

12

What is the diameter and presenting part of OCCIPITO-FRONTAL?

11.5cm
deflexed occipito posterior (face to pubes)

13

What is the diameter and presenting part of MENTOVERTICAL?

13cm
Brow ( head partially extended)

14

What is the diameter and presenting part of SUB-MENTO-BREGMATIC?

9.5cm
Face (head fully extended)

15

What is the diameter and presenting part of SUB-MENTO-VERTICAL?

11cm
Face (head not fully extended)

16

What is the Normal mechanism of labour?

Descent
Flexion
Internal Rotation
Crowning of the Head
Extension
Restitution
Internal Rotation of the Shoulders
Lateral Flexion

17

What can cause an OP position and give reference.

Maternal posture and lifestyle Android/anthropoid pelvis
Anterior placenta
Epidural analgesia plus oxytocin augmentation
Nulliparity
Increased maternal age Increased gestation
(Lewis,2010)

18

How would you diagnose an OP position in an antenatal assessment?

Inspection of abdomen
•Palpation
•FH auscultation

In labour:
Listen to woman
FH auscultation
'VE
Progress of labour (Lewis,2010)

No evidence of getting into all fours; helping position of baby (RCM), only gives women comfort(Guitten, et.al.,2014)

19

Name four complications of OK and it's reference

Episitomy
Third and fourth degree tear
Increase blood loss
Length of stay in hospital
( Stephen Ratcliffe, 2008)

20

What is the mechanism of occipito position- long rotation

Occipito frontal diameter engages (11cms) in R oblique diameter 12cms)

Increasing flexion and descent- Sub-occipito bregmatic diameter (9.5cms) in the pelvic cavity

Occiput meets the resistance of the pelvic floor and rotates 3/8th circle forwards

Head now in same position as occipitor anterior mechanism

The shoulders follow the head turning 2/8th from left to right oblique

Head is born by extension

Restitution

Internal rotation of shoulders

External rotation of head to mothers right

Lateral flexion

21

Incidence of OP and reference

15-32% women experience OP
Simkin(2010)

22

Care in labour for OP

Communication with mum and support(NMC,2015)
One to one care
General pain relief
Comfortable position
Assessment of progress
Monitor Mother and fetal welling

23

Normal mechanisms of Labour

Descent
Flexion
Internal rotation
Crowning
Extension
Restitution
Internal rotation of shoulders
Lateral flexion

24

Incidence of Brow presentation

1 in 500- 1in 1400 deliveries

25

Diagnosis for brow presentation

Large on engaged head
Not usually detected before onset of Labour
Present part is difficult to reach
No descent on presenting part

26

Complications and management of Brow

Complications:
Cord Prolapse
Fetal Distress
Excessive moulding


Management
Obstetricians involved
High risk care
DRs may want to see if head conversion to vertex
LSCS