Managing Complications in Pregnancy and Childbirth: - IAWG

S-80 Malpositions and malpresentationsCHIN-POSTERIOR POSITION• If the cervix is fully dilated, deliver by caesarean section (pageP-43).• If the cervix is not fully dilated, monitor descent, rotation andprogress. If there are signs of obstruction, deliver by caesareansection (page P-43).• If the fetus is dead:- Deliver by craniotomy (page P-57);- If the operator is not proficient in craniotomy, deliver bycaesarean section (page P-43).Do not perform vacuum extraction for face presentation.COMPOUND PRESENTATIONSpontaneous delivery can occur only when the fetus is very small ordead and macerated. Arrested labour occurs in the expulsive stage.• Replacement of the prolapsed arm is sometimes possible:- Assist the woman to assume the knee-chest position(Fig S-25);- Push the arm above the pelvic brim and hold it there until acontraction pushes the head into the pelvis.- Proceed with management for normal childbirth (page C-71).FIGURE S-25Knee-chest position• If the procedure fails or if the cord prolapses, deliver by caesareansection (page P-43).