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FETAL

MALPRESENTATION
by: LAYRE V. TALENTO
Flexion
-As descent occurs and the fetal
head reaches the pelvic floor, the
head bends forward onto the
chest, making the smallest
anteroposterior diameter (the
suboccipitobregmatic diameter)
present to the birth canal. Flexion
is also aided by abdominal
muscle contraction during
pushing.
Extension
- As the occiput is born, the
back of the neck stops beneath
the pubic arch and acts as a pivot
for the rest of the head. The head
extends, and the foremost parts of
the head,
the face and chin, are born.
Two other factors play a part in
whether a fetus is lined up in the
best position to be born: fetal
presentation and position
Attitude
- describes the degree of
flexion a fetus assumes during
labor or the relation of the fetal
parts to each other.

A fetus in good attitude is in
complete flexion: the spinal
column is bowed forward, the
head is flexed forward so much
that the chin touches the sternum,
the arms are flexed and folded on
the chest, the thighs are flexed
onto the abdomen, and the calves
are pressed against the posterior
aspect of the thighs.
This normal fetal positionis
advantageous for birth because it
helps a fetus present the smallest
anteroposterior diameter of the
skull to the pelvis and also
because it puts the whole body
into an ovoid shape, occupying
the smallest space possible.
A fetus is in moderate flexion if the
chin is not touching the chest but is in
an alert or military position . This
position causes the next-widest
anteroposterior diameter, the occipital
frontal diameter, to present to the birth
canal. A fair number of fetuses
assume a military position during the
early part of labor. This does not
usually interfere with labor, because
later mechanisms of labor (descent
and flexion) force the fetal head to
fully flex.
A fetus in partial extension presents
the brow of the head to the birth
canal.
If a fetus is in complete extension, the
back is arched, and the neck is
extended, presenting the
occipitomental diameter of the head to
the birth canal, a face presentation.

This unusual position presents too
wide a skull diameter to the birth canal
for normal birth.
Such a position may occur if there is
less than the normal amount of
amniotic fluid present
(oligohydramnios), which does not
allow a fetus adequate movement.

It also may reflect a neurologic
abnormality in thefetus causing
spasticity.
Fetal Lie
- is the relationship between
the long (cephalocaudal)
axis of the fetal body and the long
(cephalocaudal) axis of a
womans body; in other words,
whether the fetus is
lying in a horizontal (transverse)
or a vertical (longitudinal)
position.
Longitudinal lies are further
classified as cephalic, which
means the head will be the first
part to contact the
cervix, or breech, with the breech,
or buttocks, as the first portion to
contact the cervix.
Fetal presentation denotes the body
part that will first contact the cervix or
be born first. This is determined by a
combination of fetal lie and the
degree of fetal flexion (attitude).
TYPES OF FETAL
PRESENTATION
TYPES OF FETAL PRESENTATION
Cephalic Presentation
Breech Presentation
Shoulder Presentation
CEPHALIC PRESENTATION
A cephalic presentation is the most
frequent type of presentation
With this type of presentation, the
fetal
head is the body part that will first
contact the cervix.
The four types of cephalic
presentation (vertex, brow, face,
and mentum)
BREECH PRESENTATION
A breech presentation means that
either the buttocks or the feet are the
first body parts that will contact the
cervix.
A good attitude brings the fetal knees
up against the fetal abdomen; a poor
attitude means that the knees are
extended.
BREECH PRESENTATION
Breech presentations can be difficult
births, with the presenting
point influencing the degree of
difficulty.
Three types of breech
presentation (complete, frank, and
footling) are possible.
CAUSES
Uterine relaxation due to multiparity
Fetal abnormalities hydrocepahlus,
anencephalus
Hydramnios and oligohydrmanios
Congenital abnormalities of the
uterus bicornuate uterus
Contracted pelvis

CAUSES
Previous breech delivery
Space occupying mass in the uterus
that prevents the head from fitting
into the lower portion such as
placenta previa and fibroids
Prematurity
Multiple pregnancy

SHOULDER PRESENTATION
In a transverse lie, a fetus lies
horizontally in the pelvis so that the
longest fetal axis is perpendicular to
that of the mother.
The presenting part is usually one of
the shoulders (acromion process),
an iliac crest, a hand, or an elbow.
CAUSES
Lax uterine and abdominal muscles
due to multiparity is most common
cause
Contacted pelvis
Fibroids and congenital abnormality
of the uterus
Preterm fetus, hydrocephalus
Placenta previa
Multiple pregnancy