FETAL MALPOSITION

During pregnancy, babies move around constantly, but where they end up immediately prior to childbirth is extremely important. If a baby fails to turn so that the head is downward, the result could be fetal distress, neurological problems or death.
Significance

1. It is estimated that 3 to 4 percent of all pregnancies result in breech births. Although most babies are delivered in a normal head-first position, vaginal delivery from the breech position increases the baby's risk of physical, mental and developmental abnormalities.
Types

2. Head-first (normal) and breech are two main types of fetal positions during delivery. If a baby fails to turn his head down into the birth canal for delivery, the result is a breech birth.
Identification

3. A variety of positions qualify as breech. In Frank breech, the baby enters the birth canal buttocks first. In footling breech, which can be single or double, one or both of the baby's feet are positioned to be delivered first from the birth canal.
Prevention/Solution

4. If impending birth is not immediate, doctors may employ external cephalic version, a method of turning the baby so that the head is facing downward. Some doctors (very few) will proceed with vaginal births for breech babies, but most prefer to perform surgery to safely deliver the baby. Usually a C-section (Caesarian) is performed to eliminate any risks that breech babies face in normal vaginal births.
Considerations

5. Even a successful vaginal delivery of a breech baby can result in the baby's having a misshapen head and an increased risk of developing "soft" neurological disorders, such as Attention Deficit Disorder (ADD), hyperactivity and dyslexia.
MATERNAL PELVIS IS DIVIDED INTO QUADRANTS

‡ (a) Right and left side, viewed as the mother would. ‡(b) Anterior and posterior. This is a line cutting the pelvis in the middle from side to side. The top half is anterior and the bottom half is posterior.

‡2. LOA and ROA positions are the most common and permit relatively easy delivery. This refers to the Y sutures on the top of the head. This is the point of reference. Breech-S. 3 The last letter tells which half of the pelvis thereference point is in (anterior-A. CODING OF POSITIONS (a) Coding simplifies explaining the various positions. Shoulder-Sc or A). ‡3 Face or chin presentation (M).‡(c) The quadrants never change. posterior-P. OBSERVATIONS ABOUT POSITIONS A. (b) Breech or butt presentation. Mentum-M. This refers to the mentum or chin. 2 The second letter tells what reference point on the fetus is being used (Occiput-O. and the mother will experiEnce severe backache. ‡1 Occiput (O). L for left). Scapula (Sc) or its upper tip. This refers to the diamond sutures or anterior fontanel on the head. the acromion (A) would be used for the point of reference. B. SPECIFIC POINTS ON THE FETUS a) Cephalic or head presentation. transverseor in the middle-T). (c) Shoulder presentation. Fronto-F. 1 The first letter of the code tells which side of the pelvis the fetus reference point is on (R for right. ‡2 Brow or fronto (F). LOP and ROP positions usually indicate labor maybe longer and harder. ‡1 Sacrum or coccyx (S). ‡2 Breech birth is associated with a higher perinatal mortality. but sometimes it is confusing because the student or physician's viewpoint changes. ‡1 This would be seen with a transverse lie. .

An occiput in the posterior quadrant means that you will feel lumpy fetal parts. the infant will come out looking down at the floor. If delivered in thatposition. If delivered in that position. the infant will come outlooking up. arms and legs . . An occiput in the anterior quadrant means that you will feel a more smooth back.

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