Disorder of Lies and Position

7/30/2019 Disorder of Lies and Position

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Disorder of Lies, Presentation, Attitude and

Positions

Dr Paryanto, SpOG


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Definition (1)

Lie : Relation between long fetal and maternal long

axis axis.a. Longitudinal

b. Transverse

c. Oblique

Attitude: Position of the head toward the longitudinalaxis of the body

a. Flexion

b. Mild deflexion

c. Moderate deflexiond. Maximal deflexion

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Presentation : The lowermost part of the fetus inthe birth canal

a. Cephalic

b. Breech

c. Shoulder

Position : Position of the presenting part to the

quadrant of the inlet or the outlet of the bony

pelvis. Usually refers to a clock. Exp: Occiput inthe 10 o clock position.

ROA (right occiput anterior), LOP etc.

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Definition (2)


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Essential Diagnosis in Obstetrics

1. Anamnesis or history taking2. Physical examination:

a. Inspection, general and local

b. Palpationc. Auscultation

d. Bimanual examination

3. Supporting examination:a. Laboratory ex

b. Ultrasound ex

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Essential treatment in obstetrics

1. Always based on the diagnosis2. Considering: age of mother, age of gestation,

EFW, parity, fertility, fetal and maternalcondition

3. Vaginal delivery must be the first consideration.4. Cesarean section if it should be taken, must not

be late.

5. Both mother and fetus should be considered as

one unity.

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Transverse Lie (1)

Predisposing factor:1. Multiparity

2. Contracted Pelvis

3. Multiple pregnancy.

4. Anomaly of the uterus (arcuate uterus)

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Transverse Lie (2)

Essential diagnosis:

1. Inspection: lateral enlargement

2. Palpation: fetal head on one side, the

back may be on the upper side or lower.

3. Vaginal ex: shoulder is the presenting part

4. Confirmation diagnosis: ultrasound ex.

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Transverse Lie (3)

Essential treatment:

1. During pregnancy: knee-chest position or

external version

2. Full-term pregnancy or during labor:

CS is the best preference

Internal podalic version under trained

and skilled attendant

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Transverse Lie (4)

Complications:

1. Prolonged labor

2. PROM3. Cord and arm prolapse

4. Uterine rupture

5. Perinatal death

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Breech Presentation (1)

Predisposing factor:

1. Multiparity

2. Contracted pelvis3. Multiple pregnancy.

4. Extended leg

5. Hydrocephali.

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1. Inspection: Not specific

2. Palpation: fetal head on the upper part of

the uterus.

3. Vaginal ex: sacrum is the presenting part

4. Confirmation diagnosis: ultrasound ex.

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Essential Treatment

1 During pregnancy: knee-chest position or

external version (week 34-36)

2 Preterm labor: CS

3 Full term or during labor:

Primigravida, CS is the best preference Multigravida with EFW 3500 g or more, CS

is better

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Complications:

1. Prolonged labor

2. PROM3. Cord prolapse

4. Fracture of the humerus, Erbs paralysis,

intracranial hemorrhage5. Perinatal death

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Face Presentation (1)

Predisposing factor:

1. Multiparity

2. Anencephaly.3. Tumor of the neck

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1. Inspection: Not specific

2. Palpation: Cephalic prominent on the back

side of the fetus

3. Vaginal ex: mouth and lips are palpable, noresistance, chin is the presenting part. The

two zygomatic bones and the chin form atriangle.

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Essential Treatment

1 Anterior chin: vaginal delivery

2 Posterior chin: CS

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Complications:

1. Prolonged labor

2. Dystocia3. Perinatal death

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TERIMA KASIH

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Disorder of Lies and Position

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