Managing Complications in Pregnancy and Childbirth: - IAWG

Malpositions and malpresentationsS-77TRANSVERSE LIE ANDSHOULDER PRESENTATIONoccur when the long axis of the fetus istransverse (Fig S-23). The shoulder istypically the presenting part.FIGURE S-23On abdominal examination, neitherthe head nor the buttocks can be felt atthe symphysis pubis and the head isusually felt in the flank.On vaginal examination, a shouldermay be felt, but not always. An armmay prolapse and the elbow, arm orhand may be felt in the vagina.For management, see page S-81.MANAGEMENTOCCIPUT POSTERIOR POSITIONSSpontaneous rotation to the anterior position occurs in 90% of cases.Arrested labour may occur when the head does not rotate and/ordescend. Delivery may be complicated by perineal tears or extension ofan episiotomy.• If there are signs of obstruction or the fetal heart rate is abnormal(less than 100 or more than 180 beats per minute) at any stage,deliver by caesarean section (page P-43).• If the membranes are intact, rupture the membranes with anamniotic hook or a Kocher clamp (page P-17).• If the cervix is not fully dilated and there are no signs ofobstruction, augment labour with oxytocin (page P-25).• If the cervix is fully dilated but there is no descent in the expulsivephase, assess for signs of obstruction (Table S-10, page S-57):- If there are no signs of obstruction, augment labour withoxytocin (page P-25).