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Department of Reproductive Health and Research (RHR), World Health Organization

Managing Complications in Pregnancy and Childbirth

A guide for midwives and doctors 

 


Section 2 - Symptoms


Table S-12 

Diagnosis of malpresentations

Symptoms  and Signs

Figure

BROW PRESENTATION is caused by partial extension of the fetal head so that the occiput is higher than the sinciput (Fig S-16).

On abdominal examination, more than half the fetal head is above the symphysis pubis and the occiput is palpable at a higher level than the sinciput.

On vaginal examination, the anterior fontanelle and the orbits are felt.

For management

FIGURE S-16

FACE PRESENTATION is caused by hyper-extension of the fetal head so that neither the occiput nor the sinciput are palpable on vaginal examination (Fig S-17 and Fig S-18).

On abdominal examination, a groove may be felt between the occiput and the back.

On vaginal examination, the face is palpated, the examiner’s finger enters the mouth easily and the bony jaws are felt.

For management

FIGURE S-17 

FIGURE S-18 

COMPOUND PRESENTATION occurs when an arm prolapses alongside the presenting part. Both the prolapsed arm and the fetal head present in the pelvis simultaneously (Fig S-19).

For management
 

FIGURE S-19

BREECH PRESENTATION occurs when the buttocks and/or the feet are the presenting parts. 

On abdominal examination, the head is felt in the upper abdomen and the breech in the pelvic brim.  Auscultation locates the fetal heart higher than expected with a vertex presentation.

On vaginal examination during labour, the buttocks and/or feet are felt; thick, dark meconium is normal.
For management


COMPLETE (FLEXED) BREECH PRESENTATION

occurs when both legs are flexed at the hips and knees (Fig S-20). 

FRANK (EXTENDED) BREECH PRESENTATION
occurs when both legs are flexed at the hips and extended at the knees (Fig S-21).

 

FOOTLING BREECH PRESENTATION occurs when a leg is extended at the hip and the knee (Fig S-22).

FIGURE S-20

FIGURE S-21 

FIGURE S-22 

TRANSVERSE LIE AND SHOULDER PRESENTATION occur when the long axis of the fetus is transverse (Fig S-23). The shoulder is typically the presenting part.

On abdominal examination, neither the head nor the buttocks can be felt at the symphysis pubis and the head is usually felt in the flank.

On vaginal examination, a shoulder may be felt, but not always. An arm may prolapse and the elbow, arm or hand may be felt in the vagina.

For management

FIGURE S-23 

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