QuestionSBA
QuestionChoice
This describes a "footlong" breech presentation where the foetal foot is protruding from an undilated cervix. This is a contraindication to vaginal delivery.
49962
a
Transfer to theatre for an emergency caesarean section
QuestionChoice
Vaginal delivery is contraindicated in footlong breech, so the woman should not be encouraged to push.
49966
e
Advise the woman to push with each contraction to expedite delivery
QuestionChoice
Vaginal delivery is contraindicated in a footlong breech presentation.
49965
d
Reposition the cardiotocograph to obtain a reliable reading and proceed with vaginal delivery
QuestionChoice
This is management for cord prolapse. In this case, inflating the maternal bladder is unlikely to affect foetal descent, since the foetal foot has already breached the cervix.
49964
c
Inflate the maternal bladder with warm saline
QuestionChoice
Footlong breech presentation is a contraindication to vaginal delivery. Intravenous oxytocin would augment contractions in labour.
49963
b
Administer intravenous oxytocin
Concept
Chapter
# Summary

Fetal presentation refers to the part of the fetus that presents first at the pelvic inlet during delivery. The three main categories include cephalic, breech, and shoulder presentations. Key signs and symptoms vary according to the type of presentation. The main investigation tool is an ultrasound scan, which can accurately determine the type of fetal presentation. Management strategies are based on the type of presentation and may include vaginal birth, cesarean section, or external cephalic version (ECV).  


# Definition



Fetal presentation is the orientation of the fetus in the womb that determines which part of the fetus presents first at the pelvic inlet during childbirth. 


# Epidemiology



The most common type of fetal presentation is the cephalic presentation, specifically the vertex presentation, which occurs in approximately 95% of term pregnancies. Breech and shoulder presentations are less common, with breech presentations occurring in about 3-4% of term pregnancies and shoulder presentations being a rare occurrence.


# Aetiology



The cause of abnormal fetal presentations is often unclear but can be influenced by several factors such as prematurity, uterine abnormalities, placenta previa, multiple gestations, and previous cesarean sections.


# Signs and Symptoms



The signs and symptoms vary according to the type of presentation:

- Cephalic presentations: The most common sign is the baby's head being palpable at the base of the mother's abdomen.
- Breech presentations: The baby's buttocks or feet may be palpable at the base of the mother's abdomen instead of the head.
- Shoulder presentations: The baby's shoulder, arm, or trunk may be palpable at the base of the mother's abdomen.

[lightgallery]

[lightgallery1]

[lightgallery2]

# Investigations


The primary investigation for determining fetal presentation is an ultrasound scan. This imaging technique provides a clear view of the fetus's position in the womb and can identify the type of presentation accurately.

# Management


Management strategies for abnormal fetal presentations include:

- Vaginal birth: This is possible for some breech presentations, but it depends on the type of breech, the size of the baby, the size of the mother's pelvis, and the availability of a skilled practitioner.
- Cesarean section: This is often recommended for breech and always for shoulder presentations due to the high risk of complications.
- External cephalic version (ECV): This is a procedure where a healthcare provider manually turns the baby from a breech to a head-down position. It is usually attempted around 37 weeks of gestation. 

133
Picture
Complete breech presentation.
1013
Breech - complete.jpeg
images/qwnvjsd71665036171694.jpg
images/qwnvjsd71665036171694_256.jpg
images/qwnvjsd71665036171694_512.jpg
PAgGBgD3iGiXeKeHaHaIipaoAAAAAAA=
Picture
Footling breech presentation.
1009
Breech - footling.jpeg
images/qbe1vmbx1665036171694.jpg
images/qbe1vmbx1665036171694_256.jpg
images/qbe1vmbx1665036171694_512.jpg
PAgGBQD4d3aIyGd4h4eXmAAAAAAA
Picture
Frank breech presentation.
1006
Breech - frank.jpeg
images/y7x9m8uv1665036171694.jpg
images/y7x9m8uv1665036171694_256.jpg
images/y7x9m8uv1665036171694_512.jpg
OwgGBgD3iVeXeKeHWHeIioWoAAAAAAA=
133
Types of foetal presentation
Topic
38
Obstetrics
10029
A 34-year-old woman presents to accident and emergency with regular contractions at 38+5 weeks gestation.

She is transferred to the maternity department, where a midwife performs an examination. On examination, the abdomen is gravid, and the midwife cannot determine the foetal presentation. A cardiotocograph is difficult to obtain, but the foetal heart on auscultation is 145-160 beats per minute, with a variation of 10-15 beats per minute, and no decelerations. On vaginal examination, a foetal foot can be felt protruding from the cervix, which is approximately 6cm dilated. There is copious amounts of clear liquor draining from the vagina.

What is the most appropriate management?
a