Abnormal lie & breech presentation

 Afif -
Q : What is definition of 'lie' & presentation?
A : 🐥lie is the relation between the long axis of fetus to the long axis of the gravid uterus
🐥presentation is the pole of the fetus which lies over the pelvic inlet

😀😀😀😀😀😀😀😀😀😀😀😀

Azei Sam 2: Homework. Maaf lambat. Reference Obs Today and senior notes.

ABNORMAL LIE

What is lie?
- relationship between longitudinal axis of fetus ti longitudinal axis of maternal uterus

Type of abnormal lie
- tranverse
- oblique
- unstable lie (lie of fetus change after 37 weeks of pog)

Causes
a) maternal causes
     - multiparity (due to laxity of uterine musculature with each pregnancy)
     - polyhydroamnios (greater freedom of movement)
     - uterine septa
     - placenta previa (physical obstruction to fetal engagement)
     - obstruction suh as fibroid or ovarian cyst
     - transient factor (full bladder)

b) fetal causes
     - prematurity
     - multiple pregnancy
     - hydrocephaly
     - tumor of neck and sacrum
     - fetal neuromuscular dysfunction (impede engagemnet due to reduce fetal movement)

Complication
- obstructed labor
- uterine rupture
- cord prolapse

Management
- admission to hosp from 37 weeks  if in labor or ROM LSCS is carried out
- if remain unstable, remain in the hosp observe for 24hours, if stable observe another 3 days
- if the lie is not stabilize do LSCS
- stabilizing induction
  (> Involve stabilizing the lie
   > Oxytocin infusion for uterine contraction
   > Controlled amniotomy)

 Azei Sam 2: BREECH PRESENTATION

Introduction
- 3-4% occurs in deliveries
- decreases with advancing gestational age

Predisposing factor
- prematurity
- uterine abnormalities (malformation, fibroids)
- fetal abnirmalities (CNS malformation, neck masses, aneuploidy)
- amniotic fluid abnormality
- abnormal placentation (placenta previa)
- pelvic tumor

Types of breech
- frank breech
- complete breech
- footling or incomplete

Management
Options available:
a) ECV

- manipulation of fetus through maternal abdomen to a cephaluc presentation

- contraindication to ECV
       > indication for CS
       > antepartum haemorrhages within the last 7 days
       > abnormal CTG
       > major uterine anomaly
       > ruptured membranes
       > multiple pregnancy
       > small for gestational age fetus
       > proteinuric pre eclampsia
       > oligohydroamnios
       > major fetal anomalies
       > scarred uterus
       > unstable lie

b) vaginal breech delivery

- Factors that increase successful vaginal delivery
  > normal size baby
  > flexed neck
  > mental attitude
  > breech deeply engaged
  > adequate pelvis
  > multiparous

- Complications
   > placenta abruption
   > fetomaternal hemorrhage
   > transplacental hemorrhagr
   > PPROM
   > pain precipitation of labor
   > cord prolapsed
   > fetal bradycardia

c) Cesearean section
- indication
  > large or small fetus (>3.5kg and <2.5kg)
  > extended neck
  > small pelvis
  > primigravida
  > previous c section

😊😊😊😊😊😊😊😊😊😊😊😊

Dr Shaiful Ehsan: Assalam arif...
I have already ask 2 O&G specialists , 4 registrars ...
All are frens of mine...
NO such thing as breech engagement on palpation....
Similar as what I told you guys just now...
Only fetal head engagement is present...
Thank you...

 Arif Pauzi: Orait tq dr.

Dr Shaiful Ehsan: Guys any doubts....please ask...please do not hesitate to ask...
Tq

Nevertheless.....in certain setting for example before do ECV.......we try to palpate either the breech is totally on lower part or not....as its important to give a PROGNOSTIC factor for succsssful ECV or not...
In this situation....not using the term how many fifth palpable......some said just mentioned breech engaged or not....but NEVER EVER TELL how many fifth palpable....
Tq.
Overall, it is not something common to be mentioned. Tq.

 Alif Hussaini: Oblique also never tell how many fifth palpable 😅

Dr Shaiful Ehsan: 👍🏻👍🏻
Liza: Jadinya doktor, kalau breech, tak perlu buat VE lah ye ?

Alif Hussaini: Hari tu nampak mo buat sebab ho tu tertakut masuk dalam anus fetus
 Alif Hussaini: Takut jari masuk anus

 Dr Shaiful Ehsan: Sama mcm cephalic...kalau ada leaking buat speculum....
Takut2 cord prolapse...
Kalau contraction pain kena buat VE....in order to expect time of delivery and expedite your EMLSCS if pt in labour...

 But jgn buat ARM....unless mother opt for vaginal delivery...

 Liza: Owh macam tu. Thank you dr