Fetal Malpresentation

by Veronica Gillispie, MD, FACOG

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    Now let's discuss malpresentation of the fetus. So here's our patient. She's a 27 year old gravida 3 para 2 female that presents for her 36 week prenatal visit. Her pregnancy has been uncomplicated. She's had two prior vaginal deliveries. By Leopold's, the fetal position is felt to be in the breech presentation. Ultrasound confirms the fetus is frank breech. How would you counsel this patient on her delivery options? Let's go through the lecture to see. First let's talk about malpresentation. We can have Face presentation, Brow presentation or Breech. Now in a normal vaginal delivery in the cephalic presentation, the fetal head is flexed and in the vertex presentation. With that the fetal head is about 9 and half centimeters. That's what needs to pass through the pelvis. The pelvis at it's widest diameter is about 10 centimeters. When the fetal head is in the face presentation or the brow presentation, you have a large diameter trying to get through the pelvis. If the brow presentation particularly, there's about 14 centimeters of the fetal head trying to traverse the pelvis. As you can see here in the picture. So because of that brow presentation cannot be delivered vaginally. With face presentation you also have a large diameter trying to get through the pelvis but not as large as brow. And sometimes face presentation can be delivered vaginally. Now, with the face presentation, when the fetus is mentum anterior, you can see that as the head goes through the pelvis, then the head is allowed to flex, meaning that the chin touches the chest. That creates a fetal diameter about 9 and half centimeters. Again this can be delivered vaginally. However, when the fetus is in the mentum posterior presentation, you have a larger diameter trying to get through...

    About the Lecture

    The lecture Fetal Malpresentation by Veronica Gillispie, MD, FACOG is from the course Antenatal Care. It contains the following chapters:

    • Malpresentation of the Fetus
    • Face Presentation
    • Breech Presentation
    • External Cephalic Version (ECV)
    • Cesarean Section

    Included Quiz Questions

    1. Cesarean section
    2. Expectant management for spontaneous vaginal delivery
    3. External cephalic version followed by expectant management for spontaneous vaginal delivery
    4. Operative vaginal delivery using a vacuum or forceps
    5. Episiotomy followed by expectant management for spontaneous vaginal delivery
    1. Mentum anterior cephalic presentation
    2. Mentum posterior cephalic presentation
    3. Mentum posterior face presentation
    4. Mentum anterior brow presentation
    5. Complete breech presentation
    1. Shoulder distocia
    2. Cord prolapse
    3. Fetal head entrapment
    4. Fetal injury
    5. Fetal death
    1. At 39 weeks gestational age
    2. At 35 weeks gestational age
    3. At 40 weeks gestational age
    4. At 38 weeks gestational age
    5. At 42 weeks gestational age
    1. Platelet count over 110,000
    2. 37 weeks gestational age
    3. No contraindications for vaginal delivery
    4. Availability to perform an emergent cesarean section
    5. Maternal consent for the procedure
    1. Fetal head entrapment
    2. Placental abruption
    3. Rupture of membranes
    4. Fetal distress
    5. Fetal hemorrhage
    1. Placenta previa
    2. 38 weeks gestational age
    3. History of cord prolapse in a previous delivery
    4. First time pregnancy with no history of vaginal delivery
    5. Maternal gestational diabetes

    Author of lecture Fetal Malpresentation

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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