Первый слайд презентации: Fetal positions in uterus
By – GARGI KULSHRESTHA GROUP – 173 B
Слайд 2: importance
The baby must pass through pelvic bones to reach the vaginal opening. The ease at which this passage will take place depends on how the baby is positioned during delivery. The understanding of this description of the fetus in the mother's womb is very critical in understanding the mechanism of labor.
Слайд 3: Fetal Presentation
The presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it. It can be felt through the cervix on vaginal examination. The presenting part is either the fetal head or feet, creating cephalic and breech presentations, respectively. CEPHALIC – if the head is close to the birth canal BREECH – if feet/ sacrum are close to the birth canal
Слайд 4: TYPES OF CEPHALIC PRESENTATION
Such presentations are classified according to the relationship between the head and body of the fetus Ordinarily, the head is flexed sharply so that the chin is in contact with the thorax. The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation. Much less commonly, the fetal neck may be sharply extended so that the occiput and back come in contact and the face is foremost in the birth canal face presentation
The fetal head may assume a position between these extremes, partially flexed in some cases, with the anterior (large) fontanel, or bregma, presenting sinciput presentation or partially extended in other cases to have a brow presentation. These latter two presentations are usually transient because As labor progresses, sinciput and brow presentations almost always are converted into vertex or face presentations by neck flexion or extension, respectively Failure to do so can lead to dystocia
Слайд 6: Vertex/ occiput presentation
The head is flexed sharply so that the chin is in contact with the thorax. The occipital fontanel is the presenting part It can be – OCCIPUT ANTERIOR OCCIPUT POSTERIOR
Слайд 7: Occiput Anterior (OA)
The best position for the baby to be in to pass through the pelvis is with the head down and the body facing towards the mother's back. This position is called occiput anterior (OA). It is usually the easiest position for the fetal head to traverse the maternal pelvis. Shown here is the "direct OA" position. While some fetuses deliver in this position, others deliver slightly rotated clockwise (LOA) or counterclockwise (ROA). Either way, the fetus is still considered to be an an "anterior" position.
Слайд 8: Left Occiput Anterior (LOA)
The fetal occiput is directed towards the mother's left, anterior side.
Слайд 9: Right Occiput Anterior (ROA)
The fetal occiput is directed towards the mother’s righ t, anterior side.
Слайд 10: Occiput Posterior
When the baby passes through the pelvis with the head down and the body facing towards the mother’s front then, This position is called occiput pos terior (OP). Occiput posterior positions, including direct OP, LOP (Left Occiput Posterior) and ROP (Right Occiput Posterior) are positions favored by certain internal pelvic shapes. This position has some obstetrical significance.
Babies can deliver in the posterior position, but the pelvis needs to be large enough and it usually takes longer time. Forceps are often used to deliver babies in this position, but there is controversy whether the fetus should be delivered in the posterior position or rotated with the forceps to the anterior position. Much depends on the clinical circumstances and the experience of the operator.
Слайд 12: Transverse OCCIPUT Position
There can again be 2 types of Transverse positions – Left Right LOT (Left, Occiput, Transverse) position and its' mirror image, ROT, are common in early labor.
As labor progresses and the fetal head descends, the occiput usually rotates anteriorly, converting this LOT to a LOA or OA as the head delivers and similarly ROT to a ROA or OA. If the head fails to rotate despite steady descent, this is called a " DEEP TRANSVERSE ARREST," and is common among: Babies who are too big to come through, and Mothers with flat pelvises that favor a transverse delivery Women with this condition who fail to deliver spontaneously are treated with cesarean section, forceps, or vacuum extraction, depending on the clinical circumstances, available resources, and experience of the operator.
Слайд 14: BREECH PRESENTATION
When the buttocks of the fetus enter the pelvis before the head, the presentation is breech When the fetus presents as a breech, there are three general configurations – frank, complete, and footling presentations
With a frank breech presentation, the lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head. A complete breech presentation differs in that one or both knees are flexed With incomplete breech presentation, one or both hips are not flexed and one or both feet or knees lie below the breech, such that a foot or knee is lowermost in the birth canal Footling breech is an incomplete breech with one or both feet below the breech
Слайд 16: PREDISPOSING FACTORS
Gestational age (Before TERM) Hydramnios, (>2,000ml ) Uterine relaxation associated with great parity, Multiple fetuses, Oligohydramnios, (<300ml at term) Hydrocephaly, Anencephaly, Previous breech delivery, Uterine anomalies Pelvic tumors Implantation in the cornual-fundal region Placenta previa
Слайд 17: COMPLICATIONS OF BREECH
1. Perinatal morbidity and mortality from difficult delivery. 2. Low birthweight from preterm delivery, growth restriction, or both. 3. Prolapsed cord. 4. Placenta previa. 5. Fetal, neonatal, and infant anomalies. 6. Uterine anomalies and tumors
Слайд 18: Breech Positions
The terms used for breech positions are the same as for cephalic positions, except the sacrum of the fetus is used as the identifying landmark, instead of the occiput. Sacrum Anterior (SA) means the fetal sacrum is closest to the mother's symphysis. Left Sacrum Anterior (LSA) means the fetal sacrum is closest to the mother's symphysis and rotated slightly to the mother's left (clockwise from direct SA). Right Sacrum Anterior (RSA) means the fetal sacrum is closest to the mother's symphysis and rotated slightly to the mother's right (counterclockwise from direct SA). Right Sacrum Transverse (RST) Left Sacrum Transverse (LST) Sacrum Posterior (SP) Right Sacrum Posterior (RSP) Left Sacrum Posterior (LSP)