malpresentation

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.
Types of Malpresentation
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The position of a baby at the end of a pregnancy is an important part of how
the delivery will go. Although most babies enter the pelvis head first, with
their chin tucked against their chests, some do not. Malpresentation is the
term that some health prof
essionals use when a baby is in the wrong position
for birth.
Several of the more common types of malpresentation are:
Sunny Side Up
Some babies present in an occiput posterior position, more commonly known
as “sunny side up.” In this situation, a baby has her head down with her nose
and chin facing upward toward your front rather than your backside. During
labor they frequently are rot
ated by either uterine forces during contractions
or maternal forces during pushing. Some, however, never rotate and are
delivered looking upward. Women with occiput posterior presentations may
experience more back pain, slower labor, or spend more time pu
shing than
when the baby is facing your back.
Breech Presentation
A breech presentation is when a baby’s bottom or feet, instead of her head, are
in position to come out first. If a baby is breech, the provider may try to adjust
her position before the mom
goes into labor by pressing on her abdomen with
ultrasound guidance. Regional anesthesia may be offered. If adjusting the
baby’s position doesn’t work, a vaginal delivery may still be possible, or
depending on the circumstances, a Cesarean section may be
required.