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FETAL MALPOSITIONS

POSITION
RELATIONSHIP OF ASSIGNED AREA OF THE PRESENTING PART OR
LANDMARK TO THE MATERNAL PELVIS OR THE RELATIONSHIP OF
THE FETUS PRESENTING PART TO THE MOTHER'S PELVIS.

Maternal Pelvis is divided


into four quadrants
according to mothers
right and left:

Right Anterior
Left Anterior
Right Posterior
Left Posterior

MALPOSITIONS
Malpositions are abnormal position of the
vertex of the fetal head (with the occiput
as the reference point) relative to the
maternal pelvis.

PROBLEM:
The fetus is in an abnormal
position that may result in
prolonged or obstructed labour.

TYPES OF FETAL
MALPOSITION

VERTEX
PRESENTATION
(OCCIPUT)
LOA Left Occipitoanterior
LOP Left Occipitoposterior
LOT Left Occipitotransverse
ROA Right Occipitoanterior
ROP Right Occipitoposterior
ROT Right Occipito Transverse

FACE
PRESENTATION
(MENTUM)
LMA Left Mentoanterior
LMP Left Mentoposterior
LMT Left Mentotransverse
RMA Right Mentoanterior
RMP Right Mentoposterior
RMT Right Mentotransverse

BREECH
PRESENTATION
(SACRUM)
LSaA Left Sacroanterior
LSaP Left Sacroposterior
LSaT Left Sacrotransverse
RSaA Right Sacroanterior

SHOULDER PRESENTATION
(ACROMION PROCESS)
LAA Left Scapuloanterior
LAP Left Scapuloposterior
RAA Right Scapuloanterior
RAP Right Scapuloposterior

VERTEX PRESENTATION
(OCCIPUT)

BREECH PRESENTATION (SACRUM)

FACE PRESENTATION (MENTUM)

SHOULDER PRESENTATION
(ACROMION PROCESS)

ASSESSMENT
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
If the membranes have ruptured,
note encouragement
the colour of the draining
Provide
fluid.
andamniotic
supportive
care.
Review progress of
labour using a
partograph.

NURSING DIAGNOSIS
DETERMINE THE PRESENTING PART
The most common presentation is the vertex of the fetal head.
If the vertex is the presenting part, use landmarks of the fetal skull to determine the
position of the fetal head.
DETERMINE THE POSITION OF THE FETAL HEAD
The fetal head is normally engages in the maternal pelvis in an occiput transverse
position, with the fetal occiput transverse in the maternal pelvis.
With descent, the fetal head rotates so that the fetal occiput is anterior in the
maternal pelvis.
An additional feature of a normal presentation is a well-flexed vertex, with the fetal
occiput lower I the vagina than the sinciput.
If the fetal head is well-flexed with occiput anterior or occiput transverse (in early
labor) proceed with delivery.
If the fetal head is not occiput anterior, identify and manage the malpositions.
If the fetal head is not the presenting part or the fetal head is not well-flexed, identify

PROCEDURES
Paracervical block
Pudental block
Local anesthesia for
cesarean section
Spinal (subarachnoid)
anesthesia
Ketamine
External version
Induction and
augmentation of labour
Vacuum extraction

Cesarean section
Symphysontomy
Craniotomy and
craniocentesis
Dilatation and curettage
Manual vacuum
aspiration
Cesarean section
Symphysontomy
Craniotomy and

Manual removal of
placenta
Repair of cervical
tears
Repair of vaginal and
perinatal tears
Correcting uterine
inversion
Repair of ruptured
uterus
Uterine and uteroovarian artery
ligation
Postpartum

IMPLEMENTATION
Admit to the birthing
home.
Determine if the
clients membranes
have ruptured.
Encourage family
participation.
Perform leopold
maneuver and
vaginal exams as
appropriate.
Monitoring maternal
VS and fetal heart
rate and pattern.
Apply electronic

Provide ice chips.


Encouraging voiding at least
every 2 hours.
Assisting with anesthetic
administration.
Assisting with amniotomy with
assessment of fetal heart rate,
fetal positioning, and fetal
cord after amniotomy.
Cleansing perineum and
assisting with pad changes
regularly.
Monitoring progress including
vaginal discharge, cervical
dilation, and effacement,
position, and fetal descent.
Performing vaginal

Encouraging
spontaneous bearingdown efforts for second
stage.
Assisting coach and
supporting client and
partner.
Preparing supplies and
equipment for delivery.
Notifying primary health
care provider at
appropriate time to
scrub for attending
delivery.

OUTCOME

ping mechanisms.

hniques to facilitate labour.

erine contraction frequency, duration and intensity within expected ra

ysiologic parameters such as VS, neurologic reflexes, urine output,


blood glucose levels within expected range.

gressive cervical dilation.

END