3. 3
Abnormal presentation-2.
Specific objctives:
Define abnormal presentation.
Name the different abnormal presentations.
Discuss the risk factors and mode delivery of the
different types.
Name the common complications associated with
abnormal presentation.
4. 4
Abnormal presentation-3.
Lie: axis of foetus to axis of mother.
• Longitudinal ( cephalic, breech).
• Transverse (shoulder).
• Oblique. (cephalic / breech).
Presentation: foetus two poles (cephalic / caudal). Pole
of foetus found at the inlet of pelvis or nearest.
• Normal presentation, cephalic
• Any other presentation is abnormal.
5. 5
Abnormal presentation-4.
Types of abnormal pesentations:
Breech: caudal part at the brim or inlet.
Three types of breech presentations, complete.
Frank.
single or double footling.
13. 13
Abnormal presentation-12.
Face prsentation:
Head is hyperextended, occiput in contact with foetal
back, chin (mentum) the presenting part.
Incidence varies .0.1-0.3%.
Diagnosis: rest on vaginal examinaton, nose, mouth,
malar bones, orbital ridges.
X-ray may show a hyperextended head.
14. 14
Abnormal presentation-13.
Etiology: factors that favour extension or hinder
flexion, contracted pelvis, large/macrosomic
foetuses, multiparous women with pendulous
abdomen, cord round neck, anencephalia.
Delivery, by C/S chin posterior, vaginal chin
anterior and adequate pelvis.
15. 15
Abnormal presentation-14.
Brow presentation:
Portion of foetal head between orbital ridge and anterior
fontanelle presents at inlet.
Foetal head midway between full flexion (occiput) and
full extension (face)
Etiology: same as for face, usually unstable
Treatment as for face presentation.
16. 16
Abnormal presentation-15.
Shoulder presentation: transverse lie, sometimes in
oblique lie.
Incidence 0.3-0.4%, increases with parity 10 folds after
parity 4.
Etiology: grandmulti-parity, prematurity, placenta
praevia, contracted pelvis.
Diagnosis: examination AC >UH
Delivery by C/S.
17. 17
Abnormal presentation-16.
Compound presentation:
An extremity spontaneous enters pelvis with the
presenting part.
vertex /hand 1:700 deliveries.
Rarely lower limbs/ vertex, hand/breech.
Cause usually unkown, but prematurity seen in two folds.
18. 18
Abnormal presentation-17.
Conclusion:
Abnormal presentation is a common cause of maternal
morbidity, foetal morbidity and mortality.
Prompt diagnosis, proper decision taking and treatment
is capital to better outcome.
Early referrals for better management is therefore
paramount for better outcome.