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Deep transverse Arrest

The head is deep into the cavity; the sagittal suture is placed in the transverse bispinous diameter and there is no progress in descent of the head even after 1/21 to 1 hour following full dilatation of the cervix

Causes:

  1. Faulty pelvic architecture such as prominent ischial spines, flat sacrum and convergent side walls
  2. Deflexion of the head
  3. Weak uterine contraction
  4. Laxity of the pelvic floor muscles.

Diagnosis:

  1. The head is engaged
  2. The sagittal suture lies in the transverse bispinous diameter
  3. Anterior fontanelle is palpable
  4. Faulty pelvic architecture may be detected.

Management:

  1. Vaginal delivery is found not safe (big baby and or inadequate pelvis): Cesarean section.
  2. Vaginal delivery is found safe (any of the methods may be employed):
    1. Ventouse-Excessive traction force should not be used
    2. Manual rotation and application of forceps
    3. Forceps rotation and delivery with Kielland in the hands of an expert

Management of deep transverse arrest, oblique posterior arrest, and occipito sacral arrest in modern-day obstetrics is done by cesarean section.

Face Presentation

Attitude of the fetus means the relationship between the different parts of fetus:
  • Normally all the parts of fetal body are flexed, i.e the fetus lies in an attitude of flexion. Now this is common sense that when there is face presentation the head has to be extended, i.e a deviation from the normal attitude.

Important Terms Frequently Asked

  • Fetal lie: Refers to relation of long Axis of fetus to long axis of mother
    • Fetal lie M/C-Iongitudnal
    • Transverse
    • Oblique
  • Fetal presentation- Refers to the part of the fetus which occupies the lower part of the uterus.

 Lie Presentation

 

 Longitudnal M/c- Cephalic followed by Breech.

 

 Cephalic is normal presentation. ,

 

 Breech is M/c malpresentation.

 

 Transverse Shoulder

 

So whether in question it mentions fetus is in Transverse lie or whether they say Shoulder presentation it means the same and should be managed by cesarean. Also in dead fetus with transverse lie, best management is cesarean

section.

 

Presentation

  • Fetal presenting part-It is that part of the presentation which overlies the internal os.
  • In cephalic presentation the most common presenting part is Vertex, since head of the fetus is flexed mostly.
  • Others could be Brow or face presentation, depending on the degree of extension.
Note: In brow-always cesarean section is done whereas in face presentation if it is mentoanterior, vaginal delivery can be tried but if it is mentoposterior, cesarean section has to be done.
  • Fetal position is the relationship of point of direction of presenting part to one of the four quadrants of maternal pelvis.
     
    Most common being Left Occipito transverse followed by Left occipito anterior.

Extra Edge:
 

LIE

PRESENTATION

PRESENTING PART

DENOMINATOR

POSITION

1. Longitudinal (99.5%)

1. Cephelic (96.5%)

1. Vertex (96%)

2. Brown & Face 0.5%

MC – GCMF FETUS (ANENCEPHALY)

Occiput (Vertex)

Glabella (Brow)

Mentum /chin (Face)

OccipitoAnt

LOA (Cest), ROA

OccipitoPost (Cest Malposition)

ROP (Cest), LOP

Occipito Transverse (Cest head is engaging)

 

 

2.Breech

(Cest Malpresentation)

MCCause – prematurity

MCBreech –Frank

ECVat 34-36 weeks (relaxed uterus with good liquor)

Persistent Br-ABD/CS

2. Fetal legs / Foot/ genitaria

2. Sacrum

LSA (Cest)

2. Transverse Lie (0.5%)

(oblique / unstable lie)

MC Cause- Multiparity

ECVat 34-36 weeks

Management – CS

CI – IPV & Breech Ext

Shoulder presentation

Shoulder

Acromion

Dorsoant Cest

DP, DS,DI

 

Type of Pelvis

 

Type of Pelvis

Gynacoid

Anthropoid

Android

Platy poid

Incidence

Most common 50%

25%

20%

5%

Shape

Round

AP Oval

Heart Shape

Transverse Oval

Ant Segment

Normal

Narrow

Very Narrow

Broad

Presentation

OA

OP (Face to pubis delivery)

DTA

Face


Skull diameter, Pelvis type and Delivery outcome

 

Position

Eng Diameter

Pelvis

Outcome

Delivery of head

VERTEX

a) OA

 

b) OP

 

 

SOB 9.5cm

 

SOF 10cm

OF 11.5cm

 

Gynaocoid

 

Anthropoid

 

 

 

Android

 

ND

 

ND (90%)

POP (10%)

 

 

DTA

 

Extension

 

Extension

Face to pubis del

 

Instrumental Del / CS

FACE

 

SMB9.5cm

SMV 11.5CM

Platypoid

MA-ND

MP

Flexion

LSCS

BROW

MV14 cm

Platypoid

LSCS

---

BREECH

BTD 10cm

Platypoid

ABD / LSCS

 





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