Managing Complications in Pregnancy and Childbirth: - IAWG

MALPOSITIONS AND MALPRESENTATIONS S-69Malpositions are abnormal positions of the vertex of the fetal head(with the occiput as the reference point) relative to the maternal pelvis.Malpresentations are all presentations of the fetus other than vertex.PROBLEM• The fetus is in an abnormal position or presentation that may resultin prolonged or obstructed labour.GENERAL MANAGEMENT• Make a rapid evaluation of the general condition of the womanincluding vital signs (pulse, blood pressure, respiration,temperature).• Assess fetal condition:- Listen to the fetal heart rate immediately after a contraction:- Count the fetal heart rate for a full minute at least onceevery 30 minutes during the active phase and every 5minutes during the second stage;- If there are fetal heart rate abnormalities (less than 100 ormore than 180 beats per minute), suspect fetal distress(page S-95).- If the membranes have ruptured, note the colour of thedraining amniotic fluid:- Presence of thick meconium indicates the need for closemonitoring and possible intervention for management offetal distress (page S-95);- Absence of fluid draining after rupture of the membranesis an indication of reduced volume of amniotic fluid, whichmay be associated with fetal distress.• Provide encouragement and supportive care (page C-57).• Review progress of labour using a partograph (page C-65).Note: Observe the woman closely. Malpresentations increase the riskfor uterine rupture because of the potential for obstructed labour.