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EMAK
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Joined: 26 Nov 2006
Posts: 572
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 Posted: Thu Dec 28, 2006 9:03 am Post subject: Cord prolapse |
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Incidence of cord prolapse increase with :
**circumvallete placentae,
** mentoposterior position.
I know it increase with occipitoposterior position, but mentoposterir?> |
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Nick Raine-Fenning
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Joined: 27 May 2006
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Location: Nottingham
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| Posted: Thu Dec 28, 2006 11:12 am Post subject: |
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Both are false.
Mentoposterior presentation means the presenting diameter is 9.5cm and so fits through the pelvic inlet with ease. My only worry about this one is that many mentoposteriors start off as brows and they are associated with an increased risk. This would be reading too much into the question again and on face value I would say false. |
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EMAK
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| Posted: Thu Dec 28, 2006 4:21 pm Post subject: |
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the presenting diameter in mento posterior is mento vertical=13 cm,,that is why in face presentation with persistant mento posterior position, CS is indicated....
the point is that it is one of the malpositions, and it is known that malepositions can lead to cord prolapse bec. of premature rupture of membrane, but in fact I can not find it till now,, only for occipitoposterior...
hope my gramer this time will setlle your hypertension. |
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bronwyn
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Joined: 19 Jul 2006
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Location: Alton, Hampshire
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| Posted: Thu Dec 28, 2006 10:25 pm Post subject: |
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No!
As Nick said before: the presenting diameter is submento-bregmatic, averaging 9.5 cm.
I would also say false to cord prolapse then (unless someone clever puts their hand in and tries to rotate or flex it....in which case you would probably cause a cord prolapse  )
B
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Bronwyn Bell
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EMAK
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| Posted: Thu Dec 28, 2006 10:57 pm Post subject: |
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If you mean face presentation, it will be submentopregmatic, but in persistant mentoposterior it is mentovertex....read before answer..  |
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bronwyn
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Location: Alton, Hampshire
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| Posted: Fri Dec 29, 2006 12:47 pm Post subject: |
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What is the difference between face and persistant mento-posterior? 
I thought mento-vertex was a brow presentation
" The diameters of the face are the normal biparietal (9.5cm) and the submento-bregmatic, which is the same as the occipito-frontal of a deflexed vertex (11.5cm)" from Turnbull's obstetrics
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Bronwyn Bell
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Fri Dec 29, 2006 2:06 pm Post subject: |
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Dear Dr
your Diameters is correct for Face presentation///mento-anterior which can deliver normally......but persistent mentoposterior is an absolute indication for CS.....believe me......
Regards and Happy 2007.. |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
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Location: Nottingham
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| Posted: Fri Dec 29, 2006 2:56 pm Post subject: |
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| EMAK wrote: | | If you mean face presentation, it will be submentopregmatic, but in persistant mentoposterior it is mentovertex....read before answer.. |
EMAK - please try to be less hostile - it is an attribute which will almost guarantee you a fail in the OSCE.
Furthermore I am afraid you are completely wrong. Bronwyn is spot on.
Mentoposterior is a position associated with a face presentation. They are associated with a sub-mento bregmatic diameter presenting to the pelvic inlet which is 9.5cm. This allows the presenting part to enter the pelvis with ease. The reason why mentoposterior face presentations do not deliver vaginally is that delivery requires upward flexion of the fetal head and neck and this is not posible as these structures are already hyperflexed. In contrast the mentoanterior face can deliver vaginally as the occiput and fetal back lie against the sacrum and the head and neck can flex upward - this is assisted with forceps.
The diameter of 13 cm you quote is for a mentovertical diameter which is associated with a brow presentation. These do not deliver vaginally obviously.
This discussion reminds me of a few good classic MCQs -
Brow presentation requires delivery by caesarean section?
Face presentation requires delivery by caesarean section?
A mentoposterior face presentation requires delivery by caesarean section?
A mentoanterior face presentation requires delivery by caesarean section?
What do you think? |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1862
Location: Nottingham
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| Posted: Fri Dec 29, 2006 2:58 pm Post subject: |
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| bronwyn wrote: | | ...unless someone clever puts their hand in and tries to rotate or flex it....in which case you would probably cause a cord prolapse ) |
Absolutely - all manouevres are contraindicated with a mentoposterior face. I have often wanted to try a Kjelland's rotation but logic has always prevailed. It just would not rotate safely. |
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EMAK
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Posts: 572
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| Posted: Fri Dec 29, 2006 8:12 pm Post subject: |
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60% of mentoposterior will rotate and deliver normally
40%of mentoposterior will persist
I think your explanation is accurate regarding dificulty of further extension..this is what I was willing to hear.
I don't think I was hostile with Browmwyn...I just want to explore the subject.
and regarding the OSCES..is this a worning for me??are you belong to the examination committee..because I will thanks the God I not appear by my original name.... |
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mridulaben
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Joined: 08 Nov 2006
Posts: 137
Location: Brunei
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| Posted: Mon Jan 01, 2007 10:07 am Post subject: |
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Brow presentation requires delivery by caesarean section? False
(If spontaneous labour is progressing without evidence of maternal or fetal compromise in a closely monitered fetus, no interference is needed initially as brow may progress to face or vertex. However if progress is slow, secondary arrest occurs or if brow persists in advanced labour then cs is performed.)
Face presentation requires delivery by caesarean section? False
A mentoposterior face presentation requires delivery by caesarean section? False
A mentoanterior face presentation requires delivery by caesarean section? False
(Face presentations can only deliver vaginally in mentoant positions but 20 - 30% of mentopost faces will rotate on reaching the pelvic floor. Therefore as long as labour is progressing smoothly, it is reasonable to wait and see if this occurs.) |
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Nick Raine-Fenning
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Joined: 27 May 2006
Posts: 1862
Location: Nottingham
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| Posted: Tue Jan 02, 2007 3:14 pm Post subject: |
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Well done mridulaben
All FALSE 
Many people make the mistake of saying true to all except the mentoanterior face. The trick is to realise they may all correct or change to more favourable presentations such as the brow becomming mentoanterior. The brow and mentoposterior would be true if the word 'persistent' was added |
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mridulaben
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Joined: 08 Nov 2006
Posts: 137
Location: Brunei
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| Posted: Wed Jan 03, 2007 12:12 pm Post subject: |
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| Thanks for ur time towards our doubts & guidance |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1862
Location: Nottingham
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| Posted: Wed Jan 03, 2007 5:52 pm Post subject: |
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My pleasure as always.
Just make sure you pass the exam! That would be the best reward. You can always come back and help the new members.
I think we will see the Forum go from strength to strength this year especially as we are just entering exam season again and will recruit / meet lots of new candidates.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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