Podcast
Questions and Answers
What is felt through the mouth during cervical or internal examination?
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?
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?
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?
What is a characteristic of a complete breech presentation?
What does left sacrum anterior (LSA) indicate about the fetus's orientation?
What does left sacrum anterior (LSA) indicate about the fetus's orientation?
Which shape is formed by the mouth and malar eminences?
Which shape is formed by the mouth and malar eminences?
Which position refers to the fetal sacrum being in the right upper quadrant of the mother's pelvis?
Which position refers to the fetal sacrum being in the right upper quadrant of the mother's pelvis?
How is fetal position generally designated?
How is fetal position generally designated?
What does the abbreviation RST stand for in terms of fetal position?
What does the abbreviation RST stand for in terms of fetal position?
What can be inferred if the fetal sacrum is palpated during an internal examination?
What can be inferred if the fetal sacrum is palpated during an internal examination?
What is a clinical characteristic that favors a cesarean delivery for a breech fetus?
What is a clinical characteristic that favors a cesarean delivery for a breech fetus?
Which sonographic fetal characteristic increases the likelihood of cesarean delivery for a breech presentation?
Which sonographic fetal characteristic increases the likelihood of cesarean delivery for a breech presentation?
What is a maternal characteristic that can lead to unfavorable conditions for vaginal delivery of a breech fetus?
What is a maternal characteristic that can lead to unfavorable conditions for vaginal delivery of a breech fetus?
Which of the following conditions would exclude vaginal delivery for a breech presentation?
Which of the following conditions would exclude vaginal delivery for a breech presentation?
What is a potential fetal complication associated with a breech presentation?
What is a potential fetal complication associated with a breech presentation?
How does maternal request for cesarean delivery influence the management of breech presentations?
How does maternal request for cesarean delivery influence the management of breech presentations?
In assessing maternal pelvic adequacy for breech delivery, which method can be utilized?
In assessing maternal pelvic adequacy for breech delivery, which method can be utilized?
What complication is associated specifically with footling breech presentations?
What complication is associated specifically with footling breech presentations?
What is the first step in delivering the fetal leg during a breech presentation?
What is the first step in delivering the fetal leg during a breech presentation?
In the second method of delivery, which body part is delivered first?
In the second method of delivery, which body part is delivered first?
What technique is used to aid in the delivery of a nuchal arm?
What technique is used to aid in the delivery of a nuchal arm?
When delivering a fetus, how should pressure be applied to the legs?
When delivering a fetus, how should pressure be applied to the legs?
What happens to the posterior shoulder during the delivery process?
What happens to the posterior shoulder during the delivery process?
What is the desired outcome when applying pressure to the popliteal fossa during delivery?
What is the desired outcome when applying pressure to the popliteal fossa during delivery?
In cases of a right nuchal arm, how should the body be rotated?
In cases of a right nuchal arm, how should the body be rotated?
Which maneuver is typically used for the extraction of the fetal head?
Which maneuver is typically used for the extraction of the fetal head?
What is a primary indication for performing an external cephalic version (ECV)?
What is a primary indication for performing an external cephalic version (ECV)?
Which position should the woman be placed in during the ECV procedure?
Which position should the woman be placed in during the ECV procedure?
Which of the following is an absolute contraindication for ECV?
Which of the following is an absolute contraindication for ECV?
What must be confirmed through sonographic examination before performing an ECV?
What must be confirmed through sonographic examination before performing an ECV?
What is the purpose of having ready access to an emergency cesarean section during ECV?
What is the purpose of having ready access to an emergency cesarean section during ECV?
Which of the following is NOT a relative contraindication for ECV?
Which of the following is NOT a relative contraindication for ECV?
What role does the IV access play during the ECV procedure?
What role does the IV access play during the ECV procedure?
During an ECV, what is the initial attempt made to manipulate the fetus?
During an ECV, what is the initial attempt made to manipulate the fetus?
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.
