Fetal Position Quiz: LSA, RSA, and More

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Questions and Answers

What is felt through the mouth during cervical or internal examination?

The triangular shape of the malar eminences

Bony structure of the jaws and palate (correct)

Muscular resistance of the anus

The position of the feet in a breech presentation

In a breech presentation, which anatomical landmarks are typically aligned?

Malar eminences and feet

Breech and mouth

Bony structure of the jaws and palate

Ischial tuberosities and anus (correct)

What indicates the presence of meconium during an internal examination?

Staining of the finger during removal from the mouth

Bony resistance felt in the mouth

Presence of the feet alongside the buttocks

Staining of the finger during removal from the anus (correct)

What is a characteristic of a complete breech presentation?

Feet felt alongside the buttocks Signup and view all the answers

What does left sacrum anterior (LSA) indicate about the fetus's orientation?

The fetus's back is up Signup and view all the answers

Which shape is formed by the mouth and malar eminences?

Triangle Signup and view all the answers

Which position refers to the fetal sacrum being in the right upper quadrant of the mother's pelvis?

Right sacrum anterior (RSA) Signup and view all the answers

How is fetal position generally designated?

By the relations of the fetal sacrum to the maternal pelvis Signup and view all the answers

What does the abbreviation RST stand for in terms of fetal position?

Right sacrum transverse Signup and view all the answers

What can be inferred if the fetal sacrum is palpated during an internal examination?

The position of the fetal sacrum is assessed Signup and view all the answers

What is a clinical characteristic that favors a cesarean delivery for a breech fetus?

Prior cesarean delivery Signup and view all the answers

Which sonographic fetal characteristic increases the likelihood of cesarean delivery for a breech presentation?

Fetal weight between 3800 and 4000 g Signup and view all the answers

What is a maternal characteristic that can lead to unfavorable conditions for vaginal delivery of a breech fetus?

Pelvic contraction or unfavorable pelvic shape Signup and view all the answers

Which of the following conditions would exclude vaginal delivery for a breech presentation?

Footling breech presentation Signup and view all the answers

What is a potential fetal complication associated with a breech presentation?

Higher rates of umbilical cord prolapse Signup and view all the answers

How does maternal request for cesarean delivery influence the management of breech presentations?

It can lead to planning for a cesarean delivery Signup and view all the answers

In assessing maternal pelvic adequacy for breech delivery, which method can be utilized?

Pelvimetry Signup and view all the answers

What complication is associated specifically with footling breech presentations?

Increased risk of brachial plexus injury Signup and view all the answers

What is the first step in delivering the fetal leg during a breech presentation?

Slightly abduct the thigh Signup and view all the answers

In the second method of delivery, which body part is delivered first?

Posterior shoulder Signup and view all the answers

What technique is used to aid in the delivery of a nuchal arm?

Rotate the fetus through a half circle Signup and view all the answers

When delivering a fetus, how should pressure be applied to the legs?

Lateral to sweep each leg away from the midline Signup and view all the answers

What happens to the posterior shoulder during the delivery process?

It slides out over the perineal margin Signup and view all the answers

What is the desired outcome when applying pressure to the popliteal fossa during delivery?

To cause knee flexion Signup and view all the answers

In cases of a right nuchal arm, how should the body be rotated?

Counterclockwise to the right Signup and view all the answers

Which maneuver is typically used for the extraction of the fetal head?

One of three specific maneuvers Signup and view all the answers

What is a primary indication for performing an external cephalic version (ECV)?

Transverse or breech presentation Signup and view all the answers

Which position should the woman be placed in during the ECV procedure?

Left lateral tilt / Trendelenburg position Signup and view all the answers

Which of the following is an absolute contraindication for ECV?

Same contraindication to vaginal delivery Signup and view all the answers

What must be confirmed through sonographic examination before performing an ECV?

Amniotic fluid volume Signup and view all the answers

What is the purpose of having ready access to an emergency cesarean section during ECV?

To ensure immediate action can be taken if complications arise Signup and view all the answers

Which of the following is NOT a relative contraindication for ECV?

Maternal diabetes Signup and view all the answers

What role does the IV access play during the ECV procedure?

To prepare for a potential cesarean section if needed Signup and view all the answers

During an ECV, what is the initial attempt made to manipulate the fetus?

Rolling the fetus forward Signup and view all the answers

Study Notes

Fetal Positions

Fetal sacrum palpation helps establish its position relative to the maternal pelvis.
Left Sacrum Anterior (LSA): Fetus's back is up, sacrum occupies the left upper quadrant.
Other positions include Right Sacrum Anterior (RSA), Right/Left Sacrum Posterior (RSP/LSP), and Right/Left Sacrum Transverse (RST/LST).

Internal Examination

Identification of fetal positions done through assessment of the face and breech presentations.
In breech presentations, both buttocks can be palpated, and potential staining with meconium indicates passage through the anus.

Factors Favoring Cesarean Delivery for Breech Fetuses

Lack of operator experience with vaginal delivery of breech.
Maternal pelvic contraction or unfavorable shape identified via pelvimetry.
Previous cesarean deliveries or perinatal complications increase cesarean likelihood.

Sonographic Fetal Characteristics

Large fetuses (>3800 to 4000 grams) might be excluded from vaginal delivery.
Breech types include complete breech (buttocks and feet aligned) and footling breech (feet below buttocks).

Fetal Complications

Higher congenital anomaly incidence increases risks during vaginal delivery.
Possible umbilical cord prolapse is noted in breech types: 0.5% in frank breech, 5% in complete breech, and up to 15% in footling breech.

Delivery Techniques

Fetal delivery requires gentle, coordinated movements to avoid injury.
Instructions for each leg delivery segment include lateral pressure to separate legs and manipulation of the thighs for easier access.

Nuchal Arm Complications

Arm may trap at pelvic inlet, necessitating rotation of the fetus to aid in delivery.
Rotation direction depends on the arm's position: clockwise for left nuchal arms and counterclockwise for right.

Aftercoming Head Delivery

Three maneuvers exist to extract the head, prioritizing specific areas of the fetus for safe handling.

External Cephalic Version (ECV)

ECV aims to reposition transverse or breech presentations into cephalic.
Safety measures include continuous fetal heart monitoring and readiness for emergency cesarean if necessary.

Indications for ECV

Recommended at 37 weeks for transverse or breech presentations.
Contraindications include early labor, oligohydramnios, ruptured membranes, or fetal anomalies.

ECV Requirements

Access to emergency cesarean, IV access, and NPO status for 6 hours pre-procedure.
Sonographic exams confirm fetal position, assess amniotic fluid, and placental location before attempting ECV.

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Description

Test your understanding of fetal positions including left sacrum anterior (LSA), right sacrum anterior (RSA), and other related orientations. This quiz helps you identify the different positions a fetus can take in the mother's pelvis. Perfect for students in obstetrics or prenatal education.