UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Compound fetal presentation

Author
William H Barth, Jr, MD
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Compound presentation is a fetal presentation in which an extremity presents alongside the part of the fetus closest to the birth canal. The majority of compound presentations consist of a fetal hand or arm presenting with the vertex [1]. This topic will review the pathogenesis, clinical manifestations, diagnosis, and management of this uncommon intrapartum problem.

INCIDENCE

Compound presentation complicates from 1 in 268 to 1 in 1000 deliveries [2,3].

PATHOGENESIS AND RISK FACTORS

A variety of clinical settings can lead to compound presentation via different pathways.

A fetal extremity has room to descend when the fetus does not fully occupy the pelvis because of prematurity, multiple gestation, polyhydramnios, or a large maternal pelvis relative to fetal size [2,3].

Flow of amniotic fluid after rupture of membranes when the presenting part is still high can carry a fetal extremity, umbilical cord, or both toward the birth canal.

        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Nov 29 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Cruikshank DP, White CA. Obstetric malpresentations: twenty years' experience. Am J Obstet Gynecol 1973; 116:1097.
  2. GOPLERUD J, EASTMAN NJ. Compound presentation; a survey of 65 cases. Obstet Gynecol 1953; 1:59.
  3. Breen JL, Wiesmeier E. Compound presentation: a survey of 131 patients. Obstet Gynecol 1968; 32:419.
  4. Brost BC, Calhoun BC, Van Dorsten JP. Compound presentation resulting from the forward-roll technique of external cephalic version: a possible mechanism. Am J Obstet Gynecol 1996; 174:884.
  5. Ang LT. Compound presentation following external version. Aust N Z J Obstet Gynaecol 1978; 18:213.
  6. KING JM, MITCHELL AP. Compound presentation of the foetus following external version. J Obstet Gynaecol Br Emp 1953; 60:555.
  7. Vacca A. The 'sacral hand wedge': a cause of arrest of descent of the fetal head during vacuum assisted delivery. BJOG 2002; 109:1063.
  8. SWEENEY WJ 3rd, KNAPP RC. Compound presentations. Obstet Gynecol 1961; 17:333.
  9. CHAN DP. A study of 65 cases of compound presentation. Br Med J 1961; 2:560.
  10. Weissberg SM, O'Leary JA. Compound presentation of the fetus. Obstet Gynecol 1973; 41:60.
  11. QUINLIVAN WL. Compound presentation. Can Med Assoc J 1957; 76:633.
  12. Tebes CC, Mehta P, Calhoun DA, Richards DS. Congenital ischemic forearm necrosis associated with a compound presentation. J Matern Fetal Med 1999; 8:231.
  13. Byrne H, Sleight S, Gordon A, et al. Unusual rectal trauma due to compound fetal presentation. J Obstet Gynaecol 2006; 26:174.
  14. Kwok CS, Judkins CL, Sherratt M. Forearm Injury Associated with Compound Presentation and Prolonged Labour. J Neonatal Surg 2015; 4:40.