Abnormal lie & presentations; basic concepts
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Abnormal lie and presentation refers to any fetal position other than longitudinal lie with cephalic presentation. This document defines normal and abnormal lie and presentations and discusses their implications. An abnormal lie or presentation may indicate an underlying issue like macrosomia, pelvic obstruction, or fetal anomaly. It impacts labor, requiring c-section for any non-longitudinal lie or breech presentation. Diagnosis involves history, ultrasound, and physical exam to determine the cause and manage the high-risk pregnancy appropriately.
Abnormal lie & presentations; basic concepts
- 1. Abnormal lie & presentation - concepts A basic understanding of the issues Associate Professor Dr Hanifullah Khan May 2020
- 3. Normal lie • lie of the fetus - the relationship between the long axis of the fetus with respect to the long axis of the mother • Normal lie - longitudinal lie • longitudinal lie can either be cephalic or breech presentation • Any other lie apart from this is abnormal
- 4. Presentation • This is the part of the fetus that is overlying the maternal pelvic inlet It is the part that will engage the birth canal • The most common presentation is cephalic • However, presentations can be any part of the fetus e.g. breech, cord, hand, face etc • Only cephalic presentation is normal
- 6. Abnormal lies • Any lie apart from longitudinal • Oblique and transverse lies are usually similar and need not be strictly differentiated • In both these lies, there is usually no presenting part
- 7. Abnormal presentations • Any fetal presentation that is not cephalic • Face, brow, cord, hand, breech • Face and brow presentations • Usually per abdomen, felt as cephalic • diagnosed via vaginal exam (V/E)
- 8. • Can be felt per abdomen • Soft fetal pole lower part of uterus Breech presentations • Can be frank, complete or footling breech • Footling breech presents as foot presentation
- 9. 9 1. Implications 2. Labour Why is the lie important?
- 10. Implications May signify underlying problem with pregnancy Causes of abnormal lie or presentation has to be investigated Is the fetus too big? Is the inlet obstructed? Is there an abnormality? Too much or too little?
- 11. Differential diagnoses May signify underlying problem with pregnancy Causes of abnormal lie or presentation has to be investigated Is the fetus too big? Is the inlet obstructed? Is there an abnormality? Too much or too little? Macrosomia Polyhydramnios Preterm Fetal Maternal Placenta Cervical tumour Problem Diabetes mellitus Diabetes mellitus Fetal anomaly Uterine anomaly Praevia Fibroid Diagnosis
- 12. Implications Underlying abnormalities Any fetal anomaly may cause abnormal lie Cause unknown
- 14. Macrosomia is most common
- 15. Preparation for labour • The lie at term prepares the presenting part for engagement during labour • A combination of longitudinal lie and cephalic presentation is ideal Greatest chance of successful vaginal delivery • Any other lie apart from longitudinal cannot lead to vaginal delivery • However, cephalic presentation is not the only presentation that can lead to vaginal delivery • Face and breech presentation can also have successful vaginal delivery The chances are much less than cephalic
- 16. Lie and presentation in labour • During labour, any lie that is not longitudinal has to be dealt with by Caesarean section (LSCS) • If diagnosed antenatally, prior to labour, the patient may have to be prepared for elective LSCS • Same applies for breech presentation • Only breech presentation with low station and advanced cervical dilation may be allowed to attempt vaginal delivery • Breech in early labour has to be delivered by LSCS
- 17. Face and cord presentation • Both of these can only be diagnosed through vaginal examination • Cord presentation is an obstetric emergency • Face presentation • ⅓ may achieve normal delivery • ⅔ will cause obstructed labour
- 19. Diagnostic process Patient presents with problem Clinical assessment Diagnosis Manage History U/S P/E
- 20. Clinical process
- 22. Abnormal lies and fetal presentations are high risk situations that need a proper diagnosis of the underlying cause to avoid delivery complications and morbidity and mortality
- 23. “Abnormal lie is not what you tell your wife” Thank you