The fetal presentation is the part of your baby that is down near your cervix at the time of labor and delivery. Cephalic presentation or head first is the normal presentation. However, for various reasons, your baby’s position could be breech, transverse, compound or shoulder presentation. A breech presentation means that your baby’s butt, foot or feet are coming out first. A transverse lie means your baby is lying sideways in the uterus. A compound presentation means that your baby’s hand is being delivered with your baby’s head and a shoulder presentation is when your baby’s shoulder is trying to deliver first.
A breech presentation could be a frank breech, footling breech or complete breech position. In a frank breech presentation your baby’s butt is the presenting part with his or her legs up along your baby’s stomach and chest and the feet next to the face. In a footling breech position one of your baby’s feet (single footing) or both feet (double footling) is coming out first. This is also sometimes called an incomplete breech position. In a complete breech presentation, your baby’s thighs are flexed along your baby’s belly, but the lower legs and feet are tucked under the legs. Some breech babies can be safely delivered vaginally but not without an increased risk of damage to nerves, organs, bones or fetal head entrapment. In addition, there is a much higher risk of umbilical cord prolapse (UCP) that can significantly cut off much needed blood and oxygen to your baby leading tohypoxic ischemic encephalopathy (HIE) or even fetal death. For these reasons, many breech babies are delivered by cesarean section (C-section).
If your baby is in a transverse lie he or she cannot be delivered vaginally because the entire body would not be able to fit through the birth canal sideways. If labor is allowed to continue with a transverse lie it could lead to a uterine rupture and a lack of blood and oxygen to your baby. Just as in a breech presentation, an umbilical cord prolapse could also occur in a transverse lie because your baby’s head is not able to block it from dropping down or out.
In a compound presentation your baby’s hand is coming out with the head during labor and delivery. If this happens there is a higher risk of damage to the arm including brachial plexus injury, Erb’s palsy, fractures or other nerve injuries. Also, since the size of the presenting part (head and arm) increased it could lead to 3rd or 4th degree tears or perineal lacerations (also called perineal tears, which may be caused by medical malpractice). Sometimes, the baby can be encouraged to pull the hand back up into the birth canal and allow the head to engage for delivery. At times, if your baby’s head and arm are small enough they may be able to be delivered together without any birth injury or difficulties. However, if your baby’s arm and head are relatively large, compared to your pelvis, a cesarean section should be performed.
In a shoulder presentation, your baby’s shoulder is trying to be delivered first. This presentation is considered an advanced form of transverse lie and cannot be delivered vaginally. A C-section will need to be performed.
With each of these presentations an umbilical cord prolapse can occur since your baby’s head is not blocking the cord from dropping down. Pregnant women who are carrying a baby in the breech or transverse lie must be informed of additional important labor instructions. Because the lowermost presenting parts of the baby are not completely filling in all the space in the birth canal, that usually occurs when the head engages, once the water bag breaks or amniotic fluid leaks the umbilical cord can drop down first. If that happens it could cut off the blood supply to the baby and he or she will need to immediately be delivered by cesarean section.
If you developed an umbilical cord prolapse during labor and delivery and it led to oxygen deprivation, a brain injury, neurological damage, cerebral palsy (CP) or death to your newborn you may be eligible for compensation. Babies that were subjected to prolonged stress or who were deprived of vital oxygen during the prenatal (pregnancy) period or labor are going to have lifelong medical problems and expenses. The legendary Beasley Philadelphia Birth Injury Firm has an unparalleled record of success investigating and litigating obstetrical malpractice cases with documented results. Our experienced birth injury team is made up of doctors and nurses that have collectively worked over 25 years in the hospital, in the labor and delivery and neonatal intensive care units.
Our collective knowledge assisted in obtaining two of the largest medical negligence verdicts in Pennsylvania history, $100 million and $55 million, as well as countless other multimillion dollar judgments and settlements that amount to over $2 billion awarded. Please feel free to contact one of our experienced lawyers, doctors or nurses for a strictly confidential and free consultation.
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