1- seat presentation:
* Terms and conditions: the seat is said to be complete when the legs are bent on the thighs flexed on the abdomen.The seat is said décomplété fashion buttocks when the legs are extended to the trunk, legs fully extended, this variety is the most common.
* Varieties: the left anterior sacroiliac (SIGA) is the most common variety.
* Etiology: “There is no presentation seat without cause! “. Three levels of requirements have to breech presentation: hypotonicity uterine (multiparity); abnormal shape and trophicity (uterus of some heifers: narrow and cylindrical);superadded element that reverses the volume ratios between the bottom and the lower part of the uterus (polyhydramnios; background fibroma; twins; shortness of cord; previa tumor, hydrocephalus). The two first conditions are the most common. The décomplété mode is almost constant in the uterine hypotrophy primiparous.Other: uterine malformations.
* Palpation: the seat is recognized by his character bulky mass, irregular and firm but not hard, not balottante not surmounted by a furrow; but when the seat is décomplété, it is less accessible, less bulky, more round. At the bottom of the uterus, the head (smaller volume, rounded contour, hard, sloshing) is separated from the back of the neck groove.
* Touch: the entire seat is seen above the DS. The lower segment is thick and malformed. The breech is often engaged, the in-férieur segment is well trained, confusion with the cephalic pole is possible.
NB: the deflection of the fetal head (radiography) indicates a caesarean.
A- CHILDBIRTH:
* Mechanical Phenomena: 3 successive deliveries (seat, shoulder, head). The commitment of always easy and early seat on the breech, is more laborious in the complete seat. The rotation causes the bitrochantérien diameter in the anteroposterior diameter of the pelvic outlet. The clearance of the seat is easy in the complete seat; it is more difficult in the breech (to point upwards as a monolith). The shoulders emerge in cross. The head engages flexed …
+ Abnormalities: fetal arm recovery is observed only in the artificial delivery.
When the back, instead of turning forward, turn back, chin clings to the upper edge of the symphysis render impossible the delivery of the last head.
The retention of the head in the excavation is harmless and easily treated; by against the retention of the head to the DS is of the utmost severity (related to a maternal-fetal disproportion).
* Visual Phenomena: BSS (heel, buttock, EMB); aplasia of the angle of the mandible (during pregnancy); congenital dislocation of the hip.
* Dynamic Phenomena: particularity in primiparas (uterine hypotrophy) => uterine hypertonia sometimes located: DEMELIN dystocia; abnormalities of cervical dilation; membrane rupture is often early.
* Prognosis: in primiparas fetal PC always a reserve. The age of the woman (if it is primipare) influences the PC; the child’s weight (older heifers often have a big child); premature infants who often come by the headquarters are exposed to brain damage.
* Ray pelvimetry: In all cases (primipare especially) the importance of a potential maternal-fetal disproportion forced to practice this examination and the extent of the biparietal diameter of the fetus on ultrasound.
B- What to do:
* The external version should be made after 37th SA (bêtamimé sub-ticks). RCF is done before and after the operation.
* Cesarean section principle can be decided during pregnancy if limits basins; tumor praevia; Most uterine malformation; scarred uterus; primipare old; excess volume or severe intrauterine growth restriction; no work 10 hours after RPM; maternal disease (diabetes, toxemia, heart disease, obesity).
* The expulsion phase can be conducted in different ways: expectation (Vermelin method); Bracht maneuver (delivery of the head by the reversal of the fetus in the womb at the onset of the shoulders); Power expulsion (helping the legs to cross the introitus). In décomplétée variety, extraction of the lower limbs reduces the rigid monolith gene the output trunk. ; Sometimes it can help to release the head maneuver Mauriceau (introduce the index and middle fingers in the mouth of the fetus ….).
* Obstructed labor by holding the last head into the excavation => Mauriceau maneuver.
* Retention of the head to DS: This is the most serious of expulsion dystocia, it often ends in fetal death => forceps.But the real preventive treatment (maternal and fetal pelvimetry GDP).
* Fetus death breech presentation => spontaneous delivery.
2- Presentation of the shoulder:
* Transverse position or usually oblique. The spontaneous delivery is impossible. They are still obstructed.
* The great cause of transverse positions is multiparity (relaxation of uterine walls); twin pregnancy; others (polyhydramnios, short cord, tumor praevia); uterine malformation (uterus spur)
* Complication: neglected shoulder (unknown shoulder). For the shoulder is neglected, the woman should be in labor, the egg must be opened and retracted uterus. The presentation is immobilized; ovular infection; deceased child; possible release. In the absence of intervention => fracture of the lower segment.
* Treatment during pregnancy: VME (absolute indication in multiparas); in the primipara => Caesarean.
* Treatment at work: in primiparas is the only treatment-Saharan caesarean. In multiparas, cesarean section is indicated when the membranes are ruptured and that the expansion and incomplete. If the membranes are intact and the expansion is complete (second twin) => Version by internal maneuvers followed by a large breech extraction. The version is prohibited when the membranes are ruptured and the uterus retracted; cesarean section if living child; if he died (neglected shoulder) => cesarean too.
3- Presentation of the face:
* This is the presentation of the deflected head; the spine is in high-dose lor; the chin is the mark; mentoposterior the right posterior variety is the most common.
* The display face is most often primitive: original attitude in the former tension. It differs with the presentation of the forehead which is a secondary presentation of contemporary work. The presentation of the face goes with the flat basin.
* The front is not perceived on palpation; ax depression above the projection of the occiput (sign Tarnier). The presentation of the face is usually a discovery of the TV while working. The presentation stays long high. The nose (free of infiltration) is an essential reference point in case of BSS. Nostrils can differentiate the nose of the sacrum (P. seat).
* Commitment Diameter -> sub-mento-bregmatic (= 9.5 cm). The forward rotation is an absolute necessity (unlike P. summit which takes place back). Risk of isolation if no high early rotation.
* Complications:
– Visual Phenomena: BSS; dolichocephaly transient; spinal lordosis.
– Special dystocia of the face: the DS -> brow presentation; in excavating -> isolation of the face (backward rotation).
+ Note: maneuvers to transform the top face must be rejected
* Childbirth is often natural. If the delivery does not end spontaneously: CAT
– Head up above DS => Cesarean
– Head up committed => forceps (rotation)
– Head landlocked => Caesarean.
4- Brow presentation:
Head * in an intermediate position between the deflection (peak) and the deflection (face).
* This is the most obstructed cephalic presentations
* The nose is the benchmark
* The presentation of the front is always a presentation of the work. It is secondary maternal causes (moderate narrowing of the basin); fetal causes (dolichocephaly) …
* Depending on the degree of bending or deflection should be distinguished: the typical frontal presentations;bregmatiques the presentations (closer to the bending).
* Commonalities among with P. bregma: absence in the chin area and presentation of the posterior fontanelle;obstructed the work pace
* Commitment Diameter: syncipito-chin = 13 cm.
* The vaginal delivery of a normal weight fetus is impossible => Caesarean.