INTRODUCTION

Compound presentation is defined as presentation of a fetal extremity alongside the

presenting part. It may involve one or more extremities (eg, hand, arm, foot) with the vertex
or the breech. The majority of compound presentations are represented by the fetal hand or
arm presenting with the vertex [1].
INCIDENCE AND ETIOLOGY
Compound presentation complicates from 1 in 700 to 1 in 1000 deliveries [2,3]. It is more
likely to occur when the pelvis is not fully occupied by the fetus because of low birth weight,
multiple gestation, polyhydramnios, or a large pelvis [2,4]. Rupture of membranes when the
presenting part is still high also increases the risk of compound presentation, cord prolapse,
or both. Another predisposing factor is external cephalic version [4,5]. During the process of
external version, a fetal limb (commonly the hand/arm, but occasionally the foot) can
become "trapped" below the fetal head and thus become the presenting part when labor
ensues. In multiple gestations, a possible scenario involves the head of the first twin and an
extremity of the second twin within the birth canal.
DIAGNOSIS
Compound presentation may be noted on an antepartum obstetrical ultrasound examination
or palpated during a cervical examination, typically during early labor. The examiner will feel
an irregular shape beside or in advance of the vertex or breech. Compound presentation
may not be diagnosed on admission to the labor unit if the cervix is long or closed, but will
be discovered as labor progresses and the cervix becomes more dilated. The clinician
should consider this condition when the head remains high or unengaged after rupture of
membranes or when there is a delay in the active phase.
LABOR MANAGEMENT
The management of compound presentation is debatable. Some experts recommend
attempting to reposition the fetal extremity, while others discourage this practice [6]. There is
consensus that oxytocin should be avoided.
For women with normal progressing labor, we favor observation alone. Occasionally, the
presenting part will simply push the extremity aside or the fetus will retract the extremity as
labor progresses.