Dear Marilyn I also cared for a woman recently with a brow presentation, 2nd baby normal labour but I thought it was a a bit slow and really noisy behaviour. Her husband assured me this is how she was first time around and wasn't bothered. i actually called her GP as she was obvoiusly fully and just not progressing. He asked me to check dilation which I did and we encouraged her to push, suddenly there was head on view, but it didn't look right (I work in the dark). The GP thought it looked breech and called the obstetrician, who promptly diagnosed the brow, called for the vaccum,pushed baby's head back slightly, then used the vacuum to rotate baby's head, rapid birth with a generous epis and all well. On checking my books later I discovered that the brow will not be discovered on VE unless there is a high index of suspicion, ie you go looking for it. Mum very happy to have avoided a section.
Hope this helps Sandra ----- Original Message ----- From: "Marilyn Kleidon" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, December 17, 2003 1:37 AM Subject: [ozmidwifery] Brow presentations > What do you all know about brow presentations? I was with a lovely woman > yesterday who wanted a natural birth and so i spent the morning with her and > her partner on the floor, in the shower and she dilated to fully within 4 > hrs, just lovely and I am sure (so sure) I palped a posterior fontanelle > such that baby was direct OA, but almost military poition; I was trying so > hard to follow her through a physiological 2nd stage but after an hour and a > half with no sign of baby's head I did another VE and she had pushed down a > small anterior lip, which obligingly slipped back but now there was a > central anterior fontanelle with caput just inferior to the fontanelle, so > consultant called in and an emergency c/s due to brow presentation(not > emergent emergent, baby was just fine and mum was exhausted but not > physiologically compromised). Baby had great apgars, which is good as I had > not identified any fetal distress, I just want to know if there is anything > we could have done differently. Mum spent most of her labour and 2nd stage > on all fours on the floor over a bean bag, with regular partner dancing, > pelvic rocking ie very active and effective first stage after 4cm. She had > had a prolonged early first stage with a significant hind leak and > intermittent contractions for almost 24 hrs before presenting to to birth > suite yesterday for IOL and antibiotics. She was then 4cm dilated and ARM of > forwaters to induce baby ROL at this time (this happened before my shift > thankfully as I have a hard time supporting ARM and just hate that > compromised feeling). Anyway she moved rapidly into an effective active > first stage as described above. > > I am wondering if anyone thinks preserving those forewaters might had > avoided the malpresentation. Also should I have re-examined her earlier? Do > you think I mistook the posterior fontanelle for the anterior one on my > first 2nd stage VE? I was so convinced, I mean it felt like a text book > palp.I just hate to think I encouraged this woman to work so hard for one > and half hours when I could have saved her that exhaustion. And I don't mean > "saved" in any metaphysical sense, just can't think of a better word. I know > hindsight is often 20/20 and am not beating myself up, just trying to > understand. There was some veiled criticism from the ob regarding not having > "effective analgesia" on board: however it was realised when the woman > elected to have a GA that having an epidural or narcotics was never part of > her plan. > > I have looked up all of my texts and am pretty satisfied that a c/s for > brow presentation is the best alternative, but would welcome other ideas. > > thanks > marilyn > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
