Compound Fetal Presentation

COMPOUND PRESENTATION

DEFINITION

When a cephalic presentation is complicated by the presence of a hand or a foot or both alongside the head or presence of one or both hands by the side of the breech, it is called compound presentation.

ETIOLOGY

• Prematurity
• Contracted pelvis
• Pelvic tumours
• Multiple pregnancy
• Macerated fetus
• High head with premature or early rupture of the membranes
• Hydraminos

DIAGNOSIS

   The diagnosis is not difficult whent the cervical os is sufficiently dilated to feel the limbby the side of the presenting part, specially after rupture of the membranes. Premature orearlyrupture of the membranes occurs in about one-third of the cases. Cord prolapse is to be excluded because of its frequent association-10 to 15%.

MANAGEMENT

Factors to be considered are:-

• Stege of labour
• Matrity of the fetus
• Singleton or twins
• Pelvic adequacy
• Associated cord prolapse

Indication of caesarean section:-

• Mature singleton fetus associated with contraceted pelvis or cord prolapse eith the fetus alive.

Expectant treatment:-

            In uncomplicated cases, an attitude of wait and watch policy is preferable. Elevation of the prolapsed limb with descent of the presenting part usually takes place spontaneously. Slight elevation of the prolapsed limb during uterine contraction is a favourable sign. Temptation to replace the limbs early is not only necessary but carries increased maternal and fetal risks.