malpresentation,breech

Malpositions and malpresentations
Malpositions are abnormal positions of the vertex of the fetal head (with the occiput as the reference
point) relative to the maternal pelvis. Malpresentations are all presentations of the fetus other than vertex.
PROBLEM
?
The fetus is in an abnormal position or presentation that may result in prolonged or obstructed
labour.
GENERAL MANAGEMENT
?
Make a rapid evaluation of the general condition of the woman including vital signs (pulse, blood
pressure, respiration, temperature
).
?
Assess fetal condition:
-
Listen to the
fetal heart rate
immediately after a contraction:
-
Count the fetal heart rate for a full minute at least once every 30 minutes during the active phase and
every 5 minutes during the second stage;
-
If there are
f
etal heart rate abnormalities
(less than 100 or more than 180 beats per minute),
suspect
fetal distress
.
-
If the
membranes have ruptured
, note the col
our of the draining amniotic fluid:
-
Presence of thick meconium indicates the need for close monitoring and possible intervention for
management of
fe
tal distress
;
-
Absence of fluid draining after rupture of the membranes is an indication of reduced volume of amniotic
fluid, which may be associated with fetal distress.