Managing Complications in Pregnancy and Childbirth: - IAWG

S-78 Malpositions and malpresentations• If the cervix is fully dilated and if:- the fetal head is more than 3/5 palpable above the symphysispubis or the leading bony edge of the head is above -2 station,perform caesarean section (page P-43);- the fetal head is between 1/5 and 3/5 above the symphysispubis or the leading bony edge of the head is between 0station and -2 station:- Delivery by vacuum extraction (page P-27) andsymphysiotomy (page P-53);- If the operator is not proficient in symphysiotomy,perform caesarean section (page P-43);- the head is not more than 1/5 above the symphysis pubis orthe leading bony edge of the fetal head is at 0 station, deliverby vacuum extraction (page P-27) or forceps (page P-33).BROW PRESENTATIONIn brow presentation, engagement is usually impossible and arrestedlabour is common. Spontaneous conversion to either vertexpresentation or face presentation can rarely occur, particularly when thefetus is small or when there is fetal death with maceration. It is unusualfor spontaneous conversion to occur with an average-sized live fetusonce the membranes have ruptured.• If the fetus is alive , deliver by caesarean section (page P-43).• If the fetus is dead and:- the cervix is not fully dilated, deliver by caesarean section(page P-43);- the cervix is fully dilated:- Deliver by craniotomy (page P-57);- If the operator is not proficient in craniotomy, deliver bycaesarean section (page P-43).Do not delive r brow presentation by vacuum extraction, outletforceps or symphysiotomy.