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Fetal Malpresentation

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141. Vesicovaginal Fistula (Diagnosis)

. Previous Next: Etiology Developing countries Numerous factors contribute to the development of VVF in developing countries. Commonly, these are areas where the culture encourages marriage and conception at a young age, often before full pelvic growth has been achieved. Chronic malnutrition further limits pelvic dimensions, increasing the risk of cephalopelvic disproportion and malpresentation. In addition, few women are attended by qualified health care professionals or have access to medical (...) facilities during childbirth; their obstructed labor may be protracted for days or weeks. [ , ] The effect of prolonged impaction of the fetal presenting part in the pelvis is one of widespread tissue edema, hypoxia, necrosis, and sloughing resulting from prolonged pressure on the soft tissues of the vagina, bladder base, and urethra. Typically in these countries, the UGF is large and involves the bladder, urethra, bladder trigone, and the anterior cervix. Complex neuropathic bladder dysfunction

2014 eMedicine.com

142. Uterine Rupture in Pregnancy (Diagnosis)

=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2FydGljbGUvMjc1ODU0LW92ZXJ2aWV3 processing > Uterine Rupture in Pregnancy Updated: Jul 05, 2018 Author: Gerard G Nahum, MD, FACOG, FACS; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Uterine Rupture in Pregnancy Overview Overview Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. Numerous factors are known to increase the risk of uterine rupture, but even in high-risk subgroups, the overall incidence (...) clinically significant fetal morbidity becomes inevitable. Fetal morbidity occurs as a result of catastrophic hemorrhage, fetal anoxia, or both. The premonitory signs and symptoms of uterine rupture are inconsistent, and the short time for instituting definitive therapeutic action makes uterine rupture in pregnancy a much feared event for medical practitioners. Definition Uterine rupture during pregnancy is a rare event and frequently results in life-threatening maternal and fetal compromise. It can

2014 eMedicine.com

143. Cesarean Delivery (Diagnosis)

clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. The most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the primary cesarean delivery rate will require different approaches for these indications, as well as others. Increasing (...) . [ ] The emerging consensus is that a randomized prospective study is required to address this issue. [ ] Fetal indications Fetal indications for cesarean delivery include the following: Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma Malpresentations Certain congenital malformations or skeletal disorders Infection Prolonged acidemia A fetus in a nonvertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation

2014 eMedicine.com

144. Cervical Ripening (Diagnosis)

with an "unfavorable" or unripened cervix. Previous Next: Contraindications to Cervical Ripening Contraindications to cervical ripening include, but are not limited to, the following: Active herpes Fetal malpresentation Nonreassuring fetal surveillance History of prior traumatic delivery Regular contractions Unexplained vaginal bleeding Placenta previa Vasa previa Prior uterine myomectomy involving the endometrial cavity or classical cesarean delivery Previously, a history of a prior low transverse cesarean (...) in response to uterine contractions, allowing the cervix to easily pass over the presenting fetal part during labor. In late pregnancy, hyaluronic acid content increases in the cervix. This leads to an increase in water molecules that intercalate among the collagen fibers. The amount of dermatan sulfate decreases, leading to reduced bridging among the collagen fibers and a corresponding decrease in cervical firmness. Chondroitin sulfate also decreases. Cervical ripening is associated with decreased

2014 eMedicine.com

145. Assisted Reproduction Technology (Diagnosis)

, retained products of conception, or postpartum curettage should alert the clinician to a possible uterine factor. A history of abnormal bleeding, such as heavy menses, midcycle spotting, or irregular bleeding, may represent an intrauterine fibroid, polyp, or synechiae. Malpresentation during pregnancy or often suggests a uterine anomaly, such as a septum or bicornuate uterus. A screening transvaginal ultrasonography performed immediately following the cessation of menses may demonstrate a uterine (...) and the physician. This goal is also less vulnerable to misinterpretation than the pregnancy rate (single positive hCG vs serial increases) or the clinical pregnancy rate (gestational sac vs fetal pole vs fetal pole with heartbeat). IVF outcomes 2005 data for IVF outcomes are summarized and results can be viewed on the and Society for Web sites. Outcomes are stratified based on cycle type (fresh IVF, frozen embryo IVF, donor IVF, and maternal age). Overall, 134,260 ART cycles were performed in the United States

2014 eMedicine.com

146. Face Presentation (Diagnosis)

along the longitudinal axis of the uterus. Nonvertex presentations (including breech, transverse lie, face, brow, and compound presentations) occur in less than 4% of fetuses at term. Malpresentation of the vertex presentation occurs if there is deflexion or extension of the fetal head leading to brow or face presentation, respectively. In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying (...) : Outcomes The incidence of perinatal morbidity and mortality and maternal morbidity has decreased due to the increased incidence of cesarean section delivery for malpresentation, including face and brow presentation. Neonates delivered in the face presentation exhibit significant facial and skull edema, which usually resolves within 24-48 hours. Trauma during labor may cause tracheal and laryngeal edema immediately after delivery, which can result in neonatal respiratory distress. In addition, fetal

2014 eMedicine.com

147. Early Pregnancy Loss (Diagnosis)

, and malpresentation, although many women with such defects may have uncomplicated pregnancies. Most commonly, the complications result from impaired vascularization and fetal growth restriction. The incidence of uterine anomalies is estimated to be 1 per 200-600 women, depending on the method used for diagnosis. When manual exploration is performed at the time of delivery, uterine anomalies are found in approximately 3% of women. However, uterine abnormalities are present in approximately 27% of women (...) with a history of pregnancy loss. Uterine müllerian anomalies The most common uterine defects include septate, unicornuate, bicornuate, and didelphic uteri. Of these, the unicornuate uterus is least common, but can result in malpresentation and fetal growth restriction. The highest rate of reproductive losses are found in bicornuate uteri (47%) compared with unicornuate uteri (17%), but both are frequently associated with second trimester loss and preterm delivery. Women with unicornuate and didelphys uteri

2014 eMedicine.com

148. Eclampsia (Diagnosis)

delivery until the acute phase of the seizure or coma has passed. The mode of delivery should be based on obstetric indications but should be chosen with an awareness that vaginal delivery is preferable from a maternal standpoint. Adequate maternal pain relief for labor and delivery is vital and may be provided with either systemic opioids or epidural anesthesia. In the absence of fetal malpresentation or fetal distress, oxytocin or prostaglandins may be initiated to induce labor. Cesarean delivery may (...) in the absence of hypertension with proteinuria has been demonstrated to occur in 38% of cases reported in the United Kingdom. [ ] Similarly, hypertension was absent in 16% of cases reviewed in the United States. [ ] The clinical manifestations of maternal preeclampsia are hypertension and proteinuria with or without coexisting systemic abnormalities involving the kidneys, liver, or blood. There is also a fetal manifestation of preeclampsia involving fetal growth restriction, reduced amniotic fluid

2014 eMedicine.com

149. Surgical Management of Mullerian Duct Anomalies (Treatment)

outcomes are generally poor in this group. Unicornuate uterus is associated with the poorest fetal survival among all müllerian anomalies. [ ] Cesarean delivery rates are high. Common obstetrical complications include malpresentation, intrauterine growth retardation, and preterm birth. [ , ] A review of compiled data from several studies of uterine anomalies and pregnancy outcomes revealed that the unicornuate uterus had the poorest overall reproductive outcomes of all the uterine anomalies. Problems

2014 eMedicine.com

150. Cesarean Delivery (Treatment)

clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. The most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the primary cesarean delivery rate will require different approaches for these indications, as well as others. Increasing (...) . [ ] The emerging consensus is that a randomized prospective study is required to address this issue. [ ] Fetal indications Fetal indications for cesarean delivery include the following: Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma Malpresentations Certain congenital malformations or skeletal disorders Infection Prolonged acidemia A fetus in a nonvertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation

2014 eMedicine.com

151. Cervical Ripening (Treatment)

with an "unfavorable" or unripened cervix. Previous Next: Contraindications to Cervical Ripening Contraindications to cervical ripening include, but are not limited to, the following: Active herpes Fetal malpresentation Nonreassuring fetal surveillance History of prior traumatic delivery Regular contractions Unexplained vaginal bleeding Placenta previa Vasa previa Prior uterine myomectomy involving the endometrial cavity or classical cesarean delivery Previously, a history of a prior low transverse cesarean (...) in response to uterine contractions, allowing the cervix to easily pass over the presenting fetal part during labor. In late pregnancy, hyaluronic acid content increases in the cervix. This leads to an increase in water molecules that intercalate among the collagen fibers. The amount of dermatan sulfate decreases, leading to reduced bridging among the collagen fibers and a corresponding decrease in cervical firmness. Chondroitin sulfate also decreases. Cervical ripening is associated with decreased

2014 eMedicine.com

152. Uterine Rupture in Pregnancy (Treatment)

=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2FydGljbGUvMjc1ODU0LW92ZXJ2aWV3 processing > Uterine Rupture in Pregnancy Updated: Jul 05, 2018 Author: Gerard G Nahum, MD, FACOG, FACS; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Uterine Rupture in Pregnancy Overview Overview Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. Numerous factors are known to increase the risk of uterine rupture, but even in high-risk subgroups, the overall incidence (...) clinically significant fetal morbidity becomes inevitable. Fetal morbidity occurs as a result of catastrophic hemorrhage, fetal anoxia, or both. The premonitory signs and symptoms of uterine rupture are inconsistent, and the short time for instituting definitive therapeutic action makes uterine rupture in pregnancy a much feared event for medical practitioners. Definition Uterine rupture during pregnancy is a rare event and frequently results in life-threatening maternal and fetal compromise. It can

2014 eMedicine.com

153. Umbilical Cord Complications (Treatment)

the cervix into the vagina is significant. Occult prolapse occurs when the cord lies alongside the presenting part. Cord prolapse occurs in 0.6% of deliveries. The risk is increased with fetal malpresentations, especially when the presenting part does not fill the lower uterine segment, as is the case with incomplete breech presentations (5-10%), premature infants, and multiparous women. [ ] Causes include abnormal presentation, a long umbilical cord, polyhydramnios, prematurity, and an unengaged (...) Complications Updated: Jun 01, 2018 Author: Marie Helen Beall, MD; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Umbilical Cord Complications Overview Overview Umbilical cord abnormalities are numerous, ranging from false knots, which have no clinical significance, to vasa previa, which often leads to fetal death. As prenatal ultrasonography becomes increasingly sophisticated, many of these conditions are being diagnosed in utero. However, many are not apparent before

2014 eMedicine.com

154. Premature Rupture of Membranes (Overview)

hours, expectant management and waiting for spontaneous labor may be considered in selected patients for the first 12-24 hours if a patient desires expectant management. The use of expectant management after the first 24 hours is questionable. Digital vaginal examinations should be avoided until labor is initiated; however, fetal presentation should be documented to avoid discovering malpresentation of the fetus long after admission for ROM. All patients with ROM should be asked to come (...) to the hospital to ensure fetal well being. The neonatal risks of expectant management of PROM include infection, placental abruption, fetal distress, fetal restriction deformities and pulmonary hypoplasia, and fetal/neonatal death. Fetal death does occur in approximately 1% of patients with PROM after viability who have been expectantly managed [ ] and in about 1:1000 term PROM. [ ] The primary determinant of neonatal morbidity and mortality is gestational age at delivery, again stressing the importance

2014 eMedicine.com

155. Surgical Management of Mullerian Duct Anomalies (Overview)

outcomes are generally poor in this group. Unicornuate uterus is associated with the poorest fetal survival among all müllerian anomalies. [ ] Cesarean delivery rates are high. Common obstetrical complications include malpresentation, intrauterine growth retardation, and preterm birth. [ , ] A review of compiled data from several studies of uterine anomalies and pregnancy outcomes revealed that the unicornuate uterus had the poorest overall reproductive outcomes of all the uterine anomalies. Problems

2014 eMedicine.com

156. Cervical Ripening (Overview)

with an "unfavorable" or unripened cervix. Previous Next: Contraindications to Cervical Ripening Contraindications to cervical ripening include, but are not limited to, the following: Active herpes Fetal malpresentation Nonreassuring fetal surveillance History of prior traumatic delivery Regular contractions Unexplained vaginal bleeding Placenta previa Vasa previa Prior uterine myomectomy involving the endometrial cavity or classical cesarean delivery Previously, a history of a prior low transverse cesarean (...) in response to uterine contractions, allowing the cervix to easily pass over the presenting fetal part during labor. In late pregnancy, hyaluronic acid content increases in the cervix. This leads to an increase in water molecules that intercalate among the collagen fibers. The amount of dermatan sulfate decreases, leading to reduced bridging among the collagen fibers and a corresponding decrease in cervical firmness. Chondroitin sulfate also decreases. Cervical ripening is associated with decreased

2014 eMedicine.com

157. Uterine Rupture in Pregnancy (Overview)

=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2FydGljbGUvMjc1ODU0LW92ZXJ2aWV3 processing > Uterine Rupture in Pregnancy Updated: Jul 05, 2018 Author: Gerard G Nahum, MD, FACOG, FACS; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Uterine Rupture in Pregnancy Overview Overview Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. Numerous factors are known to increase the risk of uterine rupture, but even in high-risk subgroups, the overall incidence (...) clinically significant fetal morbidity becomes inevitable. Fetal morbidity occurs as a result of catastrophic hemorrhage, fetal anoxia, or both. The premonitory signs and symptoms of uterine rupture are inconsistent, and the short time for instituting definitive therapeutic action makes uterine rupture in pregnancy a much feared event for medical practitioners. Definition Uterine rupture during pregnancy is a rare event and frequently results in life-threatening maternal and fetal compromise. It can

2014 eMedicine.com

158. Cesarean Delivery (Overview)

clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. The most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the primary cesarean delivery rate will require different approaches for these indications, as well as others. Increasing (...) . [ ] The emerging consensus is that a randomized prospective study is required to address this issue. [ ] Fetal indications Fetal indications for cesarean delivery include the following: Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma Malpresentations Certain congenital malformations or skeletal disorders Infection Prolonged acidemia A fetus in a nonvertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation

2014 eMedicine.com

159. Vesicovaginal Fistula (Overview)

. Previous Next: Etiology Developing countries Numerous factors contribute to the development of VVF in developing countries. Commonly, these are areas where the culture encourages marriage and conception at a young age, often before full pelvic growth has been achieved. Chronic malnutrition further limits pelvic dimensions, increasing the risk of cephalopelvic disproportion and malpresentation. In addition, few women are attended by qualified health care professionals or have access to medical (...) facilities during childbirth; their obstructed labor may be protracted for days or weeks. [ , ] The effect of prolonged impaction of the fetal presenting part in the pelvis is one of widespread tissue edema, hypoxia, necrosis, and sloughing resulting from prolonged pressure on the soft tissues of the vagina, bladder base, and urethra. Typically in these countries, the UGF is large and involves the bladder, urethra, bladder trigone, and the anterior cervix. Complex neuropathic bladder dysfunction

2014 eMedicine.com

160. Umbilical Cord Complications (Overview)

the cervix into the vagina is significant. Occult prolapse occurs when the cord lies alongside the presenting part. Cord prolapse occurs in 0.6% of deliveries. The risk is increased with fetal malpresentations, especially when the presenting part does not fill the lower uterine segment, as is the case with incomplete breech presentations (5-10%), premature infants, and multiparous women. [ ] Causes include abnormal presentation, a long umbilical cord, polyhydramnios, prematurity, and an unengaged (...) Complications Updated: Jun 01, 2018 Author: Marie Helen Beall, MD; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Umbilical Cord Complications Overview Overview Umbilical cord abnormalities are numerous, ranging from false knots, which have no clinical significance, to vasa previa, which often leads to fetal death. As prenatal ultrasonography becomes increasingly sophisticated, many of these conditions are being diagnosed in utero. However, many are not apparent before

2014 eMedicine.com

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