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Fetal Malpresentation

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1. Rupture of the maternal renal calyx secondary to fetal malpresentation: a case report. (PubMed)

Rupture of the maternal renal calyx secondary to fetal malpresentation: a case report. Rupture of the renal collecting system is a potentially life-threatening condition in pregnancy. Most cases are associated with obstruction from nephrolithiasis or diseased renal parenchyma.A 24-year-old, nulliparous, African American woman at 38 weeks + 3 days' gestation presented with left flank pain refractory to conservative pain management. Computed tomography was negative for a stone but significant (...) for infrarenal fluid and rupture of a left renal calyx. The fetal head was not flexed and appeared to be compressing the left ureter. A face presentation became apparent during her labor course, and she underwent a cesarean delivery when labor did not progress.This represents the first reported case of a ruptured renal collecting system secondary to fetal malpresentation. A high index of suspicion is essential to diagnose collecting system rupture, and it may occur in the absence of parenchymal disease

2017 Journal of Reproductive Medicine

2. Fetal Malpresentation

Fetal Malpresentation Fetal Malpresentation Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Fetal Malpresentation Fetal (...) Malpresentation Aka: Fetal Malpresentation From Related Chapters II. Precautions Avoid in most malpresentations except Twin Consider SC before Consider maternal position changes III. Presentations (10%) (<0.2%) Mentum Anterior or Face Anterior Mentum Posterior or Face Posterior Brow (0.02%) and not converted to face or occiput (<0.5%) Transverse Presentation (0.3%): Attempt for failed version Consider uterine vertical incision Images: Related links to external sites (from Bing) These images are a random

2018 FP Notebook

3. The use of intrapartum ultrasound to diagnose malpositions and cephalic malpresentations. (PubMed)

The use of intrapartum ultrasound to diagnose malpositions and cephalic malpresentations. Fetal malpositions and cephalic malpresentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications. Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intrapartum ultrasound is far (...) more precise. The objective of this review is to summarize the current body of literature and provide recommendations to identify malpositions and cephalic malpresentations with ultrasound. We propose a systematic approach consisting of a combination of transabdominal and transperineal scans and describe the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head. The management of malpositions and cephalic malpresentation is currently

2017 American Journal of Obstetrics and Gynecology

4. Fetal Malpresentation

Fetal Malpresentation Fetal Malpresentation Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Fetal Malpresentation Fetal (...) Malpresentation Aka: Fetal Malpresentation From Related Chapters II. Precautions Avoid in most malpresentations except Twin Consider SC before Consider maternal position changes III. Presentations (10%) (<0.2%) Mentum Anterior or Face Anterior Mentum Posterior or Face Posterior Brow (0.02%) and not converted to face or occiput (<0.5%) Transverse Presentation (0.3%): Attempt for failed version Consider uterine vertical incision Images: Related links to external sites (from Bing) These images are a random

2015 FP Notebook

5. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. (PubMed)

Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. How is endometriosis associated with adverse maternal, fetal and neonatal outcomes of pregnancy?Women with endometriosis are at elevated risk for serious and important adverse maternal (pre-eclampsia, gestational diabetes, placenta praevia and Cesarean section) and fetal or neonatal outcomes (preterm birth, PPROM, small for gestational age, stillbirth and neonatal death).A number of studies (...) have shown an association between endometriosis and certain adverse maternal and fetal outcomes, but the results have been conflicting with potential for confounding by the use of assisted reproductive technology.A systematic review and meta-analysis of observational studies (1 January 1990-31 December 2017) that evaluated the effect of endometriosis on maternal, fetal and neonatal outcomes was conducted.Studies were considered for inclusion if they were prospective or retrospective cohort or case

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2018 Human Reproduction

6. Measurement of the Fetal Occiput-spine Angle During the First Stage of Labor as Predictor of the Outcome of Labor

Measurement of the Fetal Occiput-spine Angle During the First Stage of Labor as Predictor of the Outcome of Labor Measurement of the Fetal Occiput-spine Angle During the First Stage of Labor as Predictor of the Outcome of Labor - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved (...) studies (100). Please remove one or more studies before adding more. Measurement of the Fetal Occiput-spine Angle During the First Stage of Labor as Predictor of the Outcome of Labor The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03264599 Recruitment Status : Completed First Posted : August 29, 2017

2017 Clinical Trials

7. Evaluation of a Quality Improvement Project on Impacted Fetal Head at Cesarean Section

Evaluation of a Quality Improvement Project on Impacted Fetal Head at Cesarean Section Evaluation of a Quality Improvement Project on Impacted Fetal Head at Cesarean Section - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies (...) before adding more. Evaluation of a Quality Improvement Project on Impacted Fetal Head at Cesarean Section The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03387189 Recruitment Status : Enrolling by invitation First Posted : January 2, 2018 Last Update Posted : May 22, 2018 Sponsor: HealthPartners

2017 Clinical Trials

8. Intrauterine death following intraamniotic triiodothyronine and thyroxine therapy for fetal goitrous hypothyroidism associated with polyhydramnios and caused by a thyroglobulin mutation (PubMed)

, malpresentation at delivery and neonatal respiratory distress. We report an Indian kindred in which the proband (first-born son) had congenital hypothyroidism (CH) without obvious neonatal goitre. His mother's second pregnancy was complicated by fetal hypothyroid goitre and polyhydramnios, prompting amniotic fluid drainage and intraamniotic therapy (with liothyronine, T3 and levothyroxine, T4). Sadly, intrauterine death occurred at 31 weeks. Genetic studies in the proband demonstrated compound heterozygous (...) Intrauterine death following intraamniotic triiodothyronine and thyroxine therapy for fetal goitrous hypothyroidism associated with polyhydramnios and caused by a thyroglobulin mutation In the absence of maternal thyroid disease or iodine deficiency, fetal goitre is rare and usually attributable to dyshormonogenesis, for which genetic ascertainment is not always undertaken in the UK. Mechanical complications include tracheal and oesophageal compression with resultant polyhydramnios

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2017 Endocrinology, diabetes & metabolism case reports

9. Malpresentations - impact on mode of delivery. (PubMed)

Malpresentations - impact on mode of delivery. Fetal malpresentation, including persistent occipitoposterior position, is a major cause of dystocia resulting in obstetric interventions. We studied malpresentation among 11 957 consecutive singleton deliveries from 1995 to 2004. There were 1 030 deliveries with a malpresentation (8.6%). Cephalic malpresentations occurred in 5.4% of deliveries (persistent occipitoposterior 5.2%, face 0.1%, brow 0.14%), and 3.1% had breech presentation and 0.12 (...) % a transverse lie. The odds ratios (OR) for cesarean section were 14.89 (95%CI 11.91-18.63) in breech presentation and 4.57 (95% CI 3.85-5.42) in persistent occipitoposterior presentation. With persistent occipitoposterior position, the OR for instrumental vaginal delivery was 3.84 (95%CI 3.14-4.70). Primiparity was associated with increased malpresentation risks, as 54.6% of those with malpresentations were primiparous compared with 41.7% of those without (OR 1.68, 95%CI 1.48-1.91, p < 0.001). Primiparous

2011 Acta Obstetricia et Gynecologica Scandinavica

10. Cross sectional study in China: fetal gender has adverse perinatal outcomes in mainland China. (PubMed)

retrospective survey collected data from thirty-nine hospitals in 2011 in mainland China. A total of 109,722 women with singleton pregnancy who delivered after 28 weeks of gestation were included.Of these pregnancies, the male-to-female sex ratio was 1.2. The rates of preterm birth (7.3% for males, 6.5% for females) and fetal macrosomia (8.3% for males, 5.1% for females) were higher for male newborns, whereas fetal growth restriction (8.0% for females, 5.4% for males) and malpresentation (4.3% for females (...) Cross sectional study in China: fetal gender has adverse perinatal outcomes in mainland China. The association between fetal gender and pregnancy outcomes has been thoroughly demonstrated in western populations. However, this association has not been thoroughly documented in China. The primary objective of the present study is to determine whether the association of adverse pregnancy and labour outcomes with male fetuses applies to the Chinese population.This cross-sectional hospital-based

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2014 BMC Pregnancy and Childbirth

11. Fetal Growth Restriction (Overview)

be appropriate (1) in the presence of evidence of fetal distress by nonstress testing or reversed diastolic flow or (2) for traditional obstetrical indications for cesarean delivery (ie, malpresentation, prior cesarean delivery). A population-based cohort study by Monier et al that investigated the impact of gestational age at diagnosis of fetal growth restriction on rates of live birth and survival reported fetal growth restriction before 28 weeks in 436 of 3698 fetuses (11.8%) of which 66.9% were live born (...) Fetal Growth Restriction (Overview) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

12. Fetal Growth Restriction (Diagnosis)

be appropriate (1) in the presence of evidence of fetal distress by nonstress testing or reversed diastolic flow or (2) for traditional obstetrical indications for cesarean delivery (ie, malpresentation, prior cesarean delivery). A population-based cohort study by Monier et al that investigated the impact of gestational age at diagnosis of fetal growth restriction on rates of live birth and survival reported fetal growth restriction before 28 weeks in 436 of 3698 fetuses (11.8%) of which 66.9% were live born (...) Fetal Growth Restriction (Diagnosis) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

13. Fetal Growth Restriction (Treatment)

be appropriate (1) in the presence of evidence of fetal distress by nonstress testing or reversed diastolic flow or (2) for traditional obstetrical indications for cesarean delivery (ie, malpresentation, prior cesarean delivery). A population-based cohort study by Monier et al that investigated the impact of gestational age at diagnosis of fetal growth restriction on rates of live birth and survival reported fetal growth restriction before 28 weeks in 436 of 3698 fetuses (11.8%) of which 66.9% were live born (...) Fetal Growth Restriction (Treatment) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

14. Fetal Growth Restriction (Follow-up)

be appropriate (1) in the presence of evidence of fetal distress by nonstress testing or reversed diastolic flow or (2) for traditional obstetrical indications for cesarean delivery (ie, malpresentation, prior cesarean delivery). A population-based cohort study by Monier et al that investigated the impact of gestational age at diagnosis of fetal growth restriction on rates of live birth and survival reported fetal growth restriction before 28 weeks in 436 of 3698 fetuses (11.8%) of which 66.9% were live born (...) Fetal Growth Restriction (Follow-up) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

15. Breech presentation

of preterm birth, small fetal size, congenital anomalies, and perinatal mortality. Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies. Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned caesarean section, the optimal gestation being 37 and 39 weeks, respectively. Planned caesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term (...) . Definition Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill

2018 BMJ Best Practice

16. Placenta Praevia and Placenta Accreta: Diagnosis and Management

urgently. Grade of recommendation: ✓ Maternal complications at caesarean section increase when the primary surgeon is a trainee rather than an experienced surgeon. Placenta praevia is often associated with additional complications, including fetal malpresentation (transverse or breech presentation) requiring complex intraoperative manoeuvres to deliver the baby. Evidence level 4 6.2 What anaesthetic procedure is most appropriate for women having a caesarean section for placenta praevia? Regional (...) praevia or a low‐lying placenta, if so, at what gestation and with what follow‐up? The midpregnancy routine fetal anomaly scan should include placental localisation thereby identifying women at risk of persisting placenta praevia or a low‐lying placenta. [ New 2018 ] Grade of recommendation: ✓ The term placenta praevia should be used when the placenta lies directly over the internal os. For pregnancies at more than 16 weeks of gestation the term low‐lying placenta should be used when the placental

2018 Royal College of Obstetricians and Gynaecologists

17. Primary postpartum haemorrhage

the need for episiotomy o Refer to Queensland Clinical Guideline: Perineal care 38 Emergency CS · Ensure IV access · Send urgent blood for: o FBC o Group and hold (if no valid group and hold available) o Cross match in selected circumstances if indicated · Experienced obstetrician required if: o Increased risk of extensions or lacerations (e.g. deep engagement of the fetal head, failed assisted vaginal birth) o Malpresentation o Evidence of abnormal coagulation o History of previous PPH or other (...) haemorrhage 3.5.3 Uterine rupture Uterine rupture can occur spontaneously or be associated with previous obstetric surgery. The severity of the haemorrhage depends upon the extent of the rupture. Table 25. Uterine rupture Aspect Considerations Risk factors 68,69 · Previous uterine surgery or CS · Oxytocin administration · Malpresentation or undiagnosed cephalopelvic disproportion · Dystocia during second stage of labour · Grand multiparity · Macrosomic fetus · Placenta percreta · Uterine abnormalities

2019 Queensland Health

18. Obstetric Management at Borderline Viability

, magnesium sulfate should be administered in the extreme preterm population in accordance with local protocols and the existing SOGC guideline (Strong, Moderate). 7. Other than for maternal indications, routine Caesarean delivery in the extreme preterm population should be avoided (Strong, High). In cases of fetal malpresentation or other obstetric indications, the limitations of evidence should be discussed and a multidisciplinary approach should be used to come to a decision that considers both (...) , including maternal transfer and consultation, administration of antenatal corticosteroids and magnesium sulfate, fetal heart rate monitoring, and considerations in mode of delivery. Medline, EMBASE, and Cochrane databases were searched using the following keywords: extreme prematurity, borderline viability, preterm, pregnancy, antenatal corticosteroids, mode of delivery. The results were then studied, and relevant articles were reviewed. The references of the reviewed studies were also searched, as were

2017 Society of Obstetricians and Gynaecologists of Canada

19. Management of Pregnancy

may be planned for breech presentation, prior uterine surgery, or as a response to unexpected maternal or fetal complications such as abnormal labor or a concerning fetal heart rate.[ ] Cesarean delivery is a major surgery with associated risks (e.g., risk of infection, hemorrhage). Cesarean delivery requires a longer period for maternal recovery than vaginal birth and has also been associated with neonatal complications, primarily respiratory.[ ] There has been a downward trend in cesarean births (...) to make informed decisions. Clinicians must be adept at presenting information to their patients regarding individual treatments, expected outcomes, and levels and/or locations of care. During pregnancy, this includes presenting the mother, and her support system as appropriate, information about maternal and fetal risks of untreated symptoms and maternal and fetal benefits and risks of proposed care. Clinicians are encouraged to use SDM to individualize treatment goals and plans based on patient

2018 VA/DoD Clinical Practice Guidelines

20. CRACKCast E180 – Labor & Delivery

biophysical profile Fetal tachycardia Decreased variability of fetal heart rate Management: Ampicillin PLUS gentamicin Cefoxitin Pip-tazo Ertapenem If post partum: Ampicillin PLUS gentamicin PLUS (Clindamycin or metronidazole) 10) List four types of malpresentation. What are most common problems of malpresentation? Complicated deliveries, involving dystocia, malpresentation, and multiple gestations, are potentially life-threatening emergencies. The emergency clinician cannot solve these obstetric problems (...) of cord prolapse are unexpected and develop during the second stage of labor. Risk factors: We’ll just list the Fetal and Maternal causes (from Uptodate) Malpresentation (breech, transverse, oblique, or unstable lie) Prematurity Low birth weight Second twin Low lying placentation Pelvic deformities Uterine malformations/tumors External fetal anomalies Multiparity Polyhydramnios Long umbilical cord Unengaged presenting part Prolonged labor Cord prolapse has a variable rate of association with different

2018 CandiEM

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