Prepared by:
Dr. Gehanath Baral
MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of
Nepal
Visiting Professor: CTGU
29th March,2007
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Position: Position of head on left or right
1. Left / Right Dorsoanterior
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Compound presentation
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Cause
Physiological factors Adaptive factors
1. Prematurity 1. Contracted pelvis
5. IUFD
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Diagnosis:
O/E: • Fundal ht. Less
1. P/A • Obstetric grips:
1. Fundal No fetal
2. P/V pole
2. Lateral:
3. USG – Head hard, smooth,
globular
– Breech soft,
irregular, broad
3. Pelvic Empty
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Diagnosis: P/V exam
• Not in labor Nothing palpable
• In labor
1. Elongated bag of membrane
2. Presentation:
– Shoulder:
• Axilla, Clavicle, Acromion, Scapula;
• Ribs, Intercostal spaces
– Cord
– Arm/Hand
– Compound
3. PositionThumb of the prolapsed hand when
supinated points towards HEAD.
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Complication
1. Cord prolapse
2. Perinatal death=25-50%
3. Uterine rupture
4. Hemorrhagic shock
5. Septicemia
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Management
1. External Cephalic Version
2. Risk of version: Transverse lie
1. Placental abruption
2. Rupture of uterus
3. Cord entanglement
ECV
4. Fetal distress/death
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Management: ExternalCephalicVersion
Failed ECV
+ IPV Decapitation
other complication
CS
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Mode of delivery
Favourable events
1. Spontaneous
rectification(Vx) or
• No mechanism of version(Br.)
labor CS 2. Spontaneous
evolution
3. Spontaneous
expulsion
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Favourable Mode 1
Transverse lie
Spontaneous Spontaneous
rectification version
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Favourable Mode 2
Spontaneous evolution
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Favourable Mode 3
Spontaneous expulsion
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