In obstetrics

Obstetrics

Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...

, the presentation of a fetus

Fetus

A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

 about to be born

Childbirth

Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

 refers to which anatomical part

Human anatomy

Human anatomy is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy is the study of anatomical structures that can be seen by the naked eye...

 of the fetus is leading, that is, is closest to the pelvic inlet of the birth canal. According to the leading part, this is identified as a cephalic

Cephalic presentation

A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput is the leading part...

, breech, or shoulder

Shoulder presentation

A shoulder presentation refers to a malpresentation at childbirth where the baby is in a transverse lie , thus the leading part is an arm, shoulder, or the trunk...

 presentation. A malpresentation is any other presentation than a vertex presentation (with the top of the head first).

Classification

Thus the various presentations are:

• cephalic presentation
  Cephalic presentation
  A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput is the leading part...
  
   (head first):
  • vertex (crown
    Crown (anatomy)
    A crown is the top of the head.The following birds and other animals are said to have a crown on their head:* Cranes** Grey-crowned Crane** Red-crowned Crane** Black-crowned Crane* Crowned eagle* Gray-crowned Rosy Finch* Yellow-crowned Gonolek...
    
    ) — the commonest and associated with the fewest complications
  • sinciput
    Sinciput
    Sinciput is the front of the skull including the forehead and some part above it.In Terminologia Anatomica, "sinciput" is given as the Latin equivalent to "forehead"....
    
     (forehead)
  • brow (eyebrows)
  • face
  • chin
• breech presentation (buttocks or feet first):
  • complete breech
  • footling breech
  • frank breech
• shoulder presentation
  Shoulder presentation
  A shoulder presentation refers to a malpresentation at childbirth where the baby is in a transverse lie , thus the leading part is an arm, shoulder, or the trunk...
  
  :
  • arm
  • shoulder
  • trunk

Attitude

• Definition: Relationship of fetal head to spine:
  • flexed, (this is the normal situation)
  • neutral (“military”),
  • extende.

Position

• Definition: Relationship of presenting part to maternal pelvis: and based on presentation:
  • Cephalic presentation
    Cephalic presentation
    A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput is the leading part...
    
    
    • Vertex presentation with longitudinal lie:
      • Left occipitoanterior (LOA)—the occiput
        Occiput
        The occiput is the anatomical term for the posterior portion of the head, in insects the posterior part of those head capsule.-Clinical significance:Trauma to the occiput can cause a basilar skull fracture....
        
         is close to the vagina (hence known as vertex presentation) faces anteriorly (forward with mother standing) and towards left. This is the most common position and lie.
      • Right occipitoanterior (ROA)—the occiput faces anteriorly and towards right. Less common than LOA, but not associated with labor complications.
      • Left occipitoposterior (LOP)—the occiput faces posteriorly (behind) and towards left.
      • Right occipitoposterior (ROP)—the occiput faces posteriorly and towards right.
      • Occipitoanterior —the occiput faces anteriorly (absolutely straight without any turning to any of the sides)
      • Occipitoposterior—the occiput faces posteriorly (absolutely straight without any turning to any of the sides)
    • Face presentation
  • Breech presentation with longitudinal lie:
    • Left sacrum
      Sacrum
      In vertebrate anatomy the sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx...
      
       anterior (LSA)—the buttocks, as against the occiput of the vertex presentation, like close to the vagina (hence known as breech presentation), which like anteriorly and towards the left.
    • Right sacrum anterior (RSA)—the buttocks face anteriorly and towards the right.
    • Left sacrum posterior (LSP)—the buttocks face posteriorly and towards the left.
    • Right sacrum posterior (RSP)—the buttocks face posteriorly and towards right.
    • Sacrum anterior(SA)—the buttocks face anteriorly.
    • Sacrum posterior (SP)—the buttocks face posteriorly.
  • Shoulder presentation
    Shoulder presentation
    A shoulder presentation refers to a malpresentation at childbirth where the baby is in a transverse lie , thus the leading part is an arm, shoulder, or the trunk...
    
     with transverse lie are classified into four types, based on the location of the scapula
    Scapula
    In anatomy, the scapula , omo, or shoulder blade, is the bone that connects the humerus with the clavicle ....
    
     (shoulderblade); note: this presentation needs to be delivered by cesarean section.
    • Left scapula-anterior (LSA)
    • Right scapula-anterior (RSA)
    • Left scapula-posterior (LSP)
    • Right scapula-posterior (RSP)

Lie

• Definition: Relationship between the longitudinal axis of fetus and mother:
  • longitudinal, (resulting in either cephalic or breech presentation)
  • oblique, (unstable, will eventually become either transverse or longitudinal)
  • transverse (resulting in shoulder presentation).

See also

• Child birth
• Fetal relations
• Position
  Position (Obstetrics)
  In obstetrics, position is the orientation of the fetus in the womb, identified by the location of the presenting part of the fetus relative to the pelvis of the mother...
  
  
• Eucharius Rösslin
  Eucharius Rösslin
  Eucharius Rösslin , sometimes known as Eucharius Rhodion, was a German physician who authored a book about childbirth called Der Rosengarten in 1513, which became a standard medical text for midwives.He was an apothecary at Freiburg before being elected physician to the city of Frankfurt on Main...
  
  

External links

• http://www.who.int/reproductive-health/impac/Symptoms/Malpositions__malpresetations_S69_S81.htmlMalpresentations and malpositions: A guide for midwives and doctors by the WHO
  Who
  Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
  
  ]
• Normal Labor and Delivery from Management of Labor and Delivery provided by Google books