Managing Complications in Pregnancy and Childbirth: - IAWG

Malpositions and malpresentationsS-73• If the fetal head is not the presenting part or the fetal head is notwell-flexed, identify and manage the malpresentation (Table S-12,page S-73).TABLE S-11Diagnosis of malpositionsSymptoms and SignsFigureOCCIPUT POSTERIORPOSITION occurs when the fetalocciput is posterior in relation to thematernal pelvis (Fig S-13 and FigS-14).FIGURE S-13On abdominal examination, thelower part of the abdomen isflattened, fetal limbs are palpableanteriorly and the fetal heart may beheard in the flank.On vaginal examination, theposterior fontanelle is towards thesacrum and the anterior fontanellemay be easily felt if the head isdeflexed.FIGURE S-14For management, see page S-75.OCCIPUT TRANSVERSEPOSITION occurs when the fetalocciput is transverse to the maternalpelvis (Fig S-15). If an occiputtransverse position persists into thelater part of the first stage of labour, itshould be managed as an occiputposterior position (page S-75).FIGURE S-15