DIAGNOSIS OF MALPRESENTATION

1. ABDOMINAL EXAMINATION

• A lie other than longitudinal will lead to malpresentation.
• If the lie is longitudinal the presentation is either head or breech.
• If the head presents the leading part is either vertex, face or brow.The last two may be suspected by recognising unusual width of the head.

2.VAGINAL EXAMINATION

• The mouth and anus may be mistaken.
• The mouth may be mistaken for the anus because of oedema masking laxity of the orifice.
• If in doubt do not use force as other tissues such as eyes or genitalia may be damaged.

Sacrum
The sacrum is recognised by the shape, nodular ridge of the spines and possibly the foramina and the posterior portion of iliac crest.The spine nodules are continuous with the vertebrae above.

Supra-orbital ridges
Supra-orbital ridges are recognised by double curve, root of nose, orbits and frontal suture.
All may be partly obscured by caput.

Nose
The nose is recognised by the ‘saddle’, and its firm elasticity.The foot and hand may be mistaken.


Right or left is identifiable by the position of the great toe or thumb.

Shoulder

The shoulder is identified by the humerus, scapula, acromion process, coracoid process,
clavicle and ribs. All of these cannot be palpated at once.

The knee and elbow may be mistaken.
The knee has a hollow as the knee cap is not yet formed.
The elbow has the point of the olecranon process.

Category: Obstetrics Notes