types of compound presentation

Compound Presentations

• Author: Richard P Perkins, MD; Chief Editor: Carl V Smith, MD  more...
• Sections Compound Presentations
• Compound Presentations: Rare Obstetric Events

Compound presentations are rare obstetric events and often engender much anxiety in the care team. Such concerns are usually unjustified, but considering the unlikely possibility of a problem delivery is valuable. Although in an average delivery service of 2500 births annually such an event might be expected to occur only about once a year, providers should know strategies for managing this situation if intervention becomes necessary. [ 1 , 2 ]

Compound presentations may be observed more commonly after premature rupture of membranes, with preterm labor, with pelvic masses displacing the main fetal pole, or after inductions of labor involving floating presenting parts. Compound presentations are more likely with obstetric interventions than with spontaneous events. [ 3 , 4 , 5 ] This type of presentation involves the prolapse of an extremity along with the more traditional presenting part, almost always the fetal vertex. Usually, the misplaced part is a hand or arm. Less commonly, a foot can present with the vertex if the baby is extended at the knee and flexed at the hip, or a hand or arm may present along the side of the breech. Management of these individual events differs according to the finding and the circumstances. If intact membranes are found, leaving them intact while resolution of the compound presentation is attempted may be wise.

The discovery of a hand beside the head is the most common presentation irregularity and is the least worrisome of the possibilities. In general, if left unattended, the hand will retract or the arm will extend further as labor progresses. Although the presence of an extremity usually does not create prohibitive dystocia, its absence is preferable in principle; this avoids circulatory compromise that could occur if the extremity is in place too long. [ 6 ] Also, the bruising to which the limb is prone adds undue concern for the parents until it disappears. If the hand has not prolapsed beyond the presenting part, causing the hand to retract often is accomplished, if necessary. In contrast, if the hand or arm has prolapsed past the presenting part, abandoning vaginal delivery and proceeding to cesarean delivery is wise.

Resolution is best accomplished by the baby itself. Although people sometimes forget that unborn children have all their reflexes in utero, unborn babies are fully capable, within the limitations of the space available, of reacting as they would as newborns. The simplest approach, therefore, may be to apply a benign noxious stimulus, such as a gentle pinch to a fingertip of the advancing hand. By applying a benign noxious stimulus (between contractions, of course), the hand may withdraw and never appear in the undesired position again. Less often, gentle pressure upward also may displace it successfully. If these maneuvers do not succeed in solving the abnormal situation, it can be ignored as long as labor is progressing normally. Excessive force applied to the extremity can injure it, or it may displace the head and convert the benign situation into an undeliverable shoulder presentation with entrapment of the fetus. [ 7 ]

An intrusive foot beside the head is a more complicated event because it has more bulk than a hand and may retract less readily. Although it will not prolapse further, it may persist, increasing the diameter of the presenting part. Resolving this also involves trying a noxious stimulus, but this succeeds less often because of the complexity of the withdrawal response within available space. Forceful upward displacement also may not succeed if, for any reason, the knee does not readily bend or the hip does not flex further. An experienced operator may find that external manipulation of the leg may be achieved if it is the anterior one, but it is unreachable if it is the posterior limb. With fortuitous fetopelvic proportionality, delivery can still occur, but prudence precludes labor stimulation or difficult operative pelvic maneuvers. If vaginal birth is planned, it should occur spontaneously. Compound presentations preclude forceps applications orvacuum extraction.

Compound presentation with breech birth is less common, and management is less controversial. In general, unless readily resolved by benign maneuvers as described above, abdominal delivery is chosen even if it was not planned already for the breech presentation. An arm presenting with the breech may preclude descent of the breech into the pelvis, may add unduly to the increasing diameters presented as labor progresses, and may influence the baby to rotate into an arm or shoulder presentation. [ 8 ]

A case of a child with isolated lower brachial plexus palsy (Klumpke) and Horner syndrome who had a vertex compound arm presentation at birth has been reported. [ 9 ]  Cases of neonatal compartment syndrome associated with compound presentation have also been described. [ 10 , 11 ]

As suggested, in most cases, these events need not greatly influence the plans already made for the route of management of the birth process. Simple stimuli designed to get the child to withdraw the abnormal part may succeed. Management of labor and delivery after discovery of the intrusive part should be conservative and compatible with otherwise traditional obstetric principles.

Cunningham FG, MacDonald PC, Gant NF, et al, eds. Williams Obstetrics . 19th ed. Norwalk, Conn: Appleton & Lange; 1993. 507.

Goplerud J, Eastman NJ. Compound presentation; a survey of 65 cases. Obstet Gynecol . 1953 Jan. 1(1):59-66. [QxMD MEDLINE Link] .

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 Mar. 174(3):884-5. [QxMD MEDLINE Link] .

Vezina Y, Bujold E, Varin J. Cesarean delivery after successful external cephalic version of breech presentation at term: A comparative study. Am J Obstet Gynecol . 2004 Mar. 190(3):763-8. [QxMD MEDLINE Link] .

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 161 Summary: External Cephalic Version. Obstet Gynecol . 2016 Feb. 127 (2):412-3. [QxMD MEDLINE Link] .

Tebes CC, Mehta P, Calhoun DA, et al. Congenital ischemic forearm necrosis associated with a compound presentation. J Matern Fetal Med . 1999 Sep-Oct. 8(5):231-3. [QxMD MEDLINE Link] .

Hill MG, Cohen WR. Shoulder dystocia: prediction and management. Womens Health (Lond) . 2016. 12 (2):251-61. [QxMD MEDLINE Link] . [Full Text] .

Ojumah N, Ramdhan RC, Wilson C, Loukas M, Oskouian RJ, Tubbs RS. Neurological Neonatal Birth Injuries: A Literature Review. Cureus . 2017 Dec 12. 9 (12):e1938. [QxMD MEDLINE Link] . [Full Text] .

Buchanan EP, Richardson R, Tse R. Isolated lower brachial plexus (Klumpke) palsy with compound arm presentation: case report. J Hand Surg Am . 2013 Aug. 38(8):1567-70. [QxMD MEDLINE Link] .

Manini N, Unno H. Delayed onset of neonatal compartment syndrome associated with compound fetal presentation. BMC Pediatr . 2024 Apr 1. 24 (1):224. [QxMD MEDLINE Link] . [Full Text] .

Shen AH, Tevlin R, Kwan MD, Ho OH, Fox PM. Neonatal Compartment Syndrome and Compound Presentation at Birth. J Hand Surg Glob Online . 2020 May. 2 (3):166-70. [QxMD MEDLINE Link] . [Full Text] .

Contributor Information and Disclosures

Richard P Perkins, MD Perinatologist Richard P Perkins, MD is a member of the following medical societies: Central Association of Obstetricians and Gynecologists , Society for Maternal-Fetal Medicine , American College of Obstetricians and Gynecologists Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape.

Carl V Smith, MD The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists , American Institute of Ultrasound in Medicine , Association of Professors of Gynecology and Obstetrics , Central Association of Obstetricians and Gynecologists , Society for Maternal-Fetal Medicine , Council of University Chairs of Obstetrics and Gynecology , Nebraska Medical Association Disclosure: Nothing to disclose.

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Management of Brow, Face, and Compound Malpresentations

Author: Meera Kesavan, MD

Mentor: Lisa Keder MD Editor: Daniel JS Martingano DO MBA PhD

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Fetal malpresentation, including brow, face, or compound presentations, complicates around 3-4% of all term births. Because these abnormal fetal presentations still are cephalic, many such cases result in vaginal deliveries, yet there are increased risks for adverse outcomes, including cesarean delivery resultant surgical complications, persistent malpresentation precluding vaginal delivery, and abnormal labor resulting in arrest of dilation or descent.

These fetal malpresentation are differentiated in the following ways:

• In face presentations, the presenting part is the mentum, which is further divided based on its position, including mentum posterior, mentum transverse or mentum anterior positions. This typically occurs because of hyperextension of the neck and the occiput touching the fetal back. Mentum anterior malpresentations can potentially achieve vaginal deliveries, whereas mentum posterior malpresentations cannot.
• In brow presentations, there is less extension of the fetal neck as in face presentations making the leading fetal part being the area between the anterior fontanelle and the orbital ridges. These presentations are uncommon and are managed similarly to face presentations. Brow presentation can be further described based on the position of the anterior fontanelle as frontal anterior, posterior, or transverse.
• Compound presentation is defined as the leading fetal part, including a fetal extremity, alongside a cephalic or breech presentation. Management of compound presentations is expected (and often incidentally noted following delivery) because the extremity will often either retract as the head descends or will feasibly allow for delivery in its current position, with manipulation attempts to reduce the compound presentation usually avoided.

Risk factors for brow and face presentations include fetal CNS malformations, congenital or chromosomal anomalies, advanced maternal age, low birthweight, abnormal maternal pelvic anatomy (e.g. contracted pelvis, cephalopelvic disporotion, platypelloid pelvis, etc.) and nulliparity. non-Hispanic White women have the highest risk for malpresentation, whereas non-Hispanic Black women have the lowest risk.

Diagnosis usually is made during the second stage of labor while performing routine vaingla examinations and involves palpation of the abnormal leading fetal part (forehead, orbital ridge, orbits, nose, etc.) Obstetric ultrasound can additionally provide complimentary information to support these diagnoses and distinguish from other fetal malpresentations or malpositions. In face presentation, the mentum (chin) and mouth are palpable.

Management considerations for face, brow, and compounds presentations are unique with compound presentations having higher rates of vaginal delivery and lower complications as compared to either brow or face presentations.

• For brow presentations, approximately 30-40% of brow presentations will convert to a face presentation, and about 20% will convert to a vertex presentation. Anterior positions have the possibility of vaginal deliveries and can be managed by usual labor management principles, whereas mentum posterior positions are indications for cesarean delivery.
• For face presentations, the likelihood of vaginal delivery depends on the orientation of the mentum, with mentum anterior being most suitable for vaginal delivery. If the fetus is mentum posterior, flexion of the neck is precluded and results in the inability of fetal descent.
• For compound presentations, management is expectant and manipulation of the leading extremities should be avoided. Most cases of compound presentation result in vaginal deliveries. For term deliveries, compound presentations with parts other than the hand are unlikely to result in safe vaginal delivery.

Labor management for brow and face presentation overall involves continuous fetal heart rate monitoring and repeat clinical assessments, given the increased potential of fetal complications as noted. Caution should be used with internal monitoring devices, which can cause ophthalmic injury or trauma to the presenting fetal parts, with the use of fetal scalp electrodes discouraged and intrauterine pressure catheters acceptable with appropriate clinical judgment and feasibility.

Midforceps, breech extraction, and manual manipulation are not recommended and increase the risk of maternal and neonatal morbidity. 

Neonatal outcomes for both face and brow presentations include facial edema, bruising, and soft tissue trauma. Complications of compound presentation specifically include umbilical cord prolapse and injury to the presenting limb. With appropriate management, neonatal and maternal morbidity for face, brow, and compound presentations are low.

Further Reading:

Bar-El L, Eliner Y, Grunebaum A, Lenchner E, et al. Race and ethnicity are among the predisposing factors for fetal malpresentation at term. Am J Obstet Gynecol MFM. 2021 Sep;3(5):100405. doi: 10.1016/j.ajogmf.2021.100405. Epub 2021 Jun 4. PMID: 34091061.

Bellussi F, Ghi T, Youssef A, et al. The use of intrapartum ultrasound to diagnose malpositions and cephalic malpresentations. Am J Obstet Gynecol. 2017 Dec;217(6):633-641. doi: 10.1016/j.ajog.2017.07.025. Epub 2017 Jul 22. PMID: 28743440 . 

Pilliod RA, Caughey AB. Fetal Malpresentation and Malposition: Diagnosis and Management. Obstet Gynecol Clin North Am. 2017 Dec;44(4):631-643. doi: 10.1016/j.ogc.2017.08.003. PMID: 29078945 .

Zayed F, Amarin Z, Obeidat B, et al. Face and brow presentation in northern Jordan, over a decade of experience. Arch Gynecol Obstet. 2008 Nov;278(5):427-30. doi: 10.1007/s00404-008-0600-0. Epub 2008 Feb 19. PMID: 18283473 . 

Initial Approval: August 2013; Revised: 11/2016; Revised July 2018; Reaffirmed January 2020; Revised September 2021. Revised July 2023.

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Chapter 27:  Compound Presentations

George Tawagi

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Prolapse of hand and arm or foot and leg.

• MANAGEMENT OF COMPOUND PRESENTATIONS
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A presentation is compound when there is prolapse of one or more of the limbs along with the head or the breech, both entering the pelvis at the same time. Footling breech or shoulder presentations are not included in this group. Associated prolapse of the umbilical cord occurs in 15 to 20 percent of cases.

Easily detectable compound presentations occur probably once in 500 to 1000 confinements. It is impossible to establish the exact incidence because:

Spontaneous correction occurs frequently, and examination late in labor cannot provide the diagnosis

Minor degrees of prolapse are detected only by early and careful vaginal examination

Classification of Compound Presentation

Upper limb (arm–hand), one or both

Lower limb (leg–foot), one or both

Arm and leg together

Breech presentation with prolapse of the hand or arm

By far the most frequent combination is that of the head with the hand ( Fig. 27-1 ) or arm. In contrast, the head–foot and breech–arm groups are uncommon, about equally so. Prolapse of both hand and foot alongside the head is rare. All combinations may be complicated by prolapse of the umbilical cord, which then becomes the major problem.

FIGURE 27-1.

Compound presentation: head and hand.

The etiology of compound presentation includes all conditions that prevent complete filling and occlusion of the pelvic inlet by the presenting part. The most common causal factor is prematurity. Others include high presenting part with ruptured membranes, polyhydramnios, multiparity, a contracted pelvis, pelvic masses, and twins. It is also more common with inductions of labor involving floating presenting parts. Another predisposing factor is external cephalic version. During the process of external version, a fetal limb (commonly the hand–arm, but occasionally the foot) can become “trapped” before the fetal head and thus become the presenting part when labor ensues.

Diagnosis is made by vaginal examination, and in many cases, the condition is not noted until labor is well advanced and the cervix is fully dilated.

The condition is suspected when:

There is delay of progress in the active phase of labor

Engagement fails to occur

The fetal head remains high and deviated from the midline during labor, especially after the membranes rupture

In the absence of complications and with conservative management, the results should be no worse than with other presentations.

Mechanism of Labor

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Uptodate Reference Title

Compound fetal presentation.

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 head [ 1 ]. This topic will review the pathogenesis, clinical manifestations, diagnosis, and management of this uncommon intrapartum scenario.

INCIDENCE  —  Compound presentation has been reported to occur in 1 in 250 to 1 in 1500 births [ 2-5 ]. This is a crude, wide estimate because transient cases are not consistently recognized, documented, or reported.

PATHOGENESIS AND RISK FACTORS  —  A variety of clinical settings can lead to compound presentation via different pathways. Compound presentation may occur when:

● The fetus does not fully occupy the pelvis, thus allowing a fetal extremity room to prolapse. Predisposing factors include early gestational age, multiple gestation, polyhydramnios, or a large maternal pelvis relative to fetal size [ 2,3 ].

● Membrane rupture occurs when the presenting part is still high, which allows flow of amniotic fluid to carry a fetal extremity, umbilical cord, or both toward the birth canal.

● During external version, a fetal limb (commonly the hand/arm, but occasionally the foot) becomes "trapped" below the fetal head and thus becomes the presenting part when labor ensues [ 6-8 ].

● The head of the first twin and an extremity of the second twin present together within the birth canal, but this is rare.

CONSEQUENCES  —  The large irregular presenting part of a compound presentation can result in:

● Dystocia.

● Cord prolapse, which was reported in 15 and 23 percent of patients in two series [ 2,9 ].

CLINICAL PRESENTATION

● Compound presentation may present as an incidental finding on ultrasound examination [ 10 ].

● Antepartum or intrapartum digital examination through a partially dilated or effaced cervix may detect an irregular shape beside or in advance of the head or breech.

● Intrapartum, the head may remain persistently unengaged after membrane rupture and deviated from the midline [ 9 ]. Active phase protraction or arrest of labor may occur. In the second stage, arrest of descent may be associated with a variant of compound presentation in which the fetal hand fills the space between the head and the maternal sacrum [ 11 ].

DIAGNOSIS  —  The diagnosis of compound presentation is based on identification of one or more fetal extremities presenting alongside or in front of the head or buttocks on physical or ultrasound examination [ 10 ].

On physical examination, a foot can be distinguished from a hand by its three bony protuberances (calcaneus, lateral and medial malleolus), the angle at the level of the calcaneus, and the toes, which are short and lie in the same line with no opposing thumb.

Differential diagnosis  —  When a fetal extremity is the presenting part on physical examination, differential diagnosis includes:

● Compound presentation

● Transverse lie with prolapse of an extremity

● Footling breech presentation

An accurate diagnosis is easily made by ultrasound examination or more thorough abdominal and vaginal examinations.

Antepartum management  —  Antepartum identification of compound presentation usually does not require any interventions or monitoring.

If noted on ultrasound examination immediately following an otherwise successful external cephalic version, the compound presentation will usually resolve spontaneously. In this setting, if a foot or hand is preventing the head from settling into the inlet, vibroacoustic stimulation can prompt fetal movement sufficient to resolve the problem.

If a compound presentation is identified on ultrasound examination in a patient with polyhydramnios, the patient should be counseled on the risks of a prolapsed umbilical cord and fetal extremity when membranes rupture. (See "Umbilical cord prolapse", section on 'Anticipation and prevention of cord prolapse' .)

Intrapartum management  —  Approaches to intrapartum management are based on patient-specific factors, clinical experience, and insights from case reports and small series, given the infrequent occurrence of this problem. High-quality data to guide management are not available.

For patients with normally progressing labor, we favor observation alone. Some authorities suggest attempting to gently reposition the fetal extremity, while others discourage this practice [ 3-5,9,12 ]. We favor expectant management because sometimes the presenting part will push the extremity aside or the fetus will retract the extremity as labor progresses, allowing a large majority of compound presentations to deliver vaginally. A compound presentation involving the arm is more likely to resolve than one involving the foot [ 4 ]. We choose to not pinch the presenting part in an attempt to provoke the fetus into withdrawing the presenting part, although this practice is not likely to be harmful.

If the compound presentation persists, descent of the presenting part in the second stage could slow or stop, unless the fetus is extremely small. Manipulation is reasonable in this setting. The author gently pushes the small part up into the uterine cavity with his dominant hand while simultaneously applying gentle fundal pressure to effect descent of the head with his other hand. If this gentle maneuver does not resolve the compound presentation and abnormal progress of labor, the author has a low threshold for proceeding to cesarean birth because of the increased risk for obstructed labor and an adverse outcome (see 'Outcome' below). Oxytocin augmentation should be avoided as it may lead to uterine rupture [ 2,7 ]. Forceps- or vacuum-assisted vaginal birth should also be avoided, with possible rare exceptions in which clinical judgment suggests this approach would be faster and safer than an urgent cesarean birth.

OUTCOME  —  In most cases managed by contemporary standards, labor results in an uncomplicated vaginal birth. Historically, however, high mortality rates were reported and were related to prolonged obstructed labor, internal podalic version and extraction, uterine rupture, prolapsed cord, and complications of preterm birth.

No large contemporary series of compound presentation have been published. The following case reports, and others, underscore the need for cesarean birth if the compound presentation does not resolve spontaneously or with gentle pressure in cases of protracted labor. However, it should be noted that only complicated cases prompt publication of a case report [ 13-15 ].

● One case report of a patient with a compound presentation and protracted labor described ischemic necrosis of the arm, which was attributed to entrapment of the fetal arm between the head and bony pelvis; limb amputation was required [ 13 ].

● Another case report described a similar occurrence with a dramatic appearance of limb ischemia ( picture 1 ), but recovery occurred without the need for amputation [ 15 ].

● A third case report described a vacuum-assisted birth in which an unrecognized compound presentation resulted in a maternal rectal laceration; the fetal hand was found to be protruding through the anus as the head was crowning [ 14 ].

If neonatal compartment syndrome occurs, some authorities recommend urgent fasciotomy, which may salvage the limb. (See "Pathophysiology, classification, and causes of acute extremity compartment syndrome", section on 'Birth injury' .)

SOCIETY GUIDELINE LINKS  —  Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Labor" .)

SUMMARY AND RECOMMENDATIONS

● Clinical findings and diagnosis – Compound presentation may be an incidental finding on an antepartum ultrasound examination or it may be palpated as an irregular shape beside or in advance of the vertex or breech during digital cervical examination. The diagnosis is based on identification of one or more fetal extremities presenting alongside or in front of the head or buttocks. (See 'Clinical presentation' above and 'Diagnosis' above.)

● Epidemiology – Persistent compound presentation is rare once active labor is established. Predisposing factors include preterm birth, multiple gestation, polyhydramnios, a large maternal pelvis, external cephalic version, and rupture of membranes at high station. (See 'Incidence' above and 'Pathogenesis and risk factors' above.)

● Management

• Antepartum – Antepartum identification of compound presentation usually does not require any interventions or monitoring other than patient education about the finding. (See 'Antepartum management' above.)

• Intrapartum – For compound presentations with normal progress of labor, we suggest expectant management rather than intervention ( Grade 2C ). Most cases will resolve spontaneously or will have vaginal births even without resolution. (See 'Intrapartum management' above.)

A persistent compound presentation can result in dystocia. If descent of the presenting part in the second stage becomes protracted or arrests, we gently push the small part up into the uterine cavity with the dominant hand while simultaneously applying fundal pressure with the other hand to effect descent of the vertex. If the compound presentation and labor abnormality do not resolve after this gentle maneuver, we have a low threshold for proceeding to cesarean birth. Oxytocin augmentation should be avoided as it may lead to uterine rupture. (See 'Intrapartum management' above.)

ACKNOWLEDGMENTS  —  The UpToDate editorial staff acknowledges Edward R Yeomans, MD, and Clint M Cormier, MD, who contributed to earlier versions of this topic review.

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• QUINLIVAN WL. Compound presentation. Can Med Assoc J 1957; 76:633.
• 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.
• Ang LT. Compound presentation following external version. Aust N Z J Obstet Gynaecol 1978; 18:213.
• KING JM, MITCHELL AP. Compound presentation of the foetus following external version. J Obstet Gynaecol Br Emp 1953; 60:555.
• CHAN DP. A study of 65 cases of compound presentation. Br Med J 1961; 2:560.
• Dall'Asta A, Volpe N, Galli L, et al. Intrapartum Sonographic Diagnosis of Compound Hand-Cephalic Presentation. Ultraschall Med 2017; 38:558.
• Vacca A. The 'sacral hand wedge': a cause of arrest of descent of the fetal head during vacuum assisted delivery. BJOG 2002; 109:1063.
• SWEENEY WJ 3rd, KNAPP RC. Compound presentations. Obstet Gynecol 1961; 17:333.
• Tebes CC, Mehta P, Calhoun DA, Richards DS. Congenital ischemic forearm necrosis associated with a compound presentation. J Matern Fetal Med 1999; 8:231.
• Byrne H, Sleight S, Gordon A, et al. Unusual rectal trauma due to compound fetal presentation. J Obstet Gynaecol 2006; 26:174.
• Kwok CS, Judkins CL, Sherratt M. Forearm Injury Associated with Compound Presentation and Prolonged Labour. J Neonatal Surg 2015; 4:40.

1 : Obstetric malpresentations: twenty years' experience.

2 : Compound presentation; a survey of 65 cases.

3 : Compound presentation: a survey of 131 patients.

4 : Compound presentation of the fetus.

5 : Compound presentation.

6 : Compound presentation resulting from the forward-roll technique of external cephalic version: a possible mechanism.

7 : Compound presentation following external version.

8 : Compound presentation of the foetus following external version.

9 : A study of 65 cases of compound presentation.

10 : Intrapartum Sonographic Diagnosis of Compound Hand-Cephalic Presentation.

11 : The 'sacral hand wedge': a cause of arrest of descent of the fetal head during vacuum assisted delivery.

12 : Compound presentations.

13 : Congenital ischemic forearm necrosis associated with a compound presentation.

14 : Unusual rectal trauma due to compound fetal presentation.

15 : Forearm Injury Associated with Compound Presentation and Prolonged Labour.

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Compound Presentations- Causes, Effects on Labor, Complications, and Management

Compound presentation occurs when one extremity emerges concurrently with the part of the fetus closest to the birth canal.

Dr. Ankita Balar

Medically reviewed by

Dr. Richa Agarwal

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What Are Compound Presentations?

Compound presentations are rare obstetric occurrences that frequently cause the care team to become quite anxious. A prenatal presentation known as a compound presentation occurs when one extremity develops concurrently with the part of the fetus closest to the birth canal. A fetal hand or arm typically presents with the head during compound fetal presentations.

A fetal presentation is considered compound when one or more limbs prolapse together with the head or breech, both of which enter the pelvis simultaneously. This group excludes footling breech or shoulder presentations. In 15 to 20 percent of instances, the umbilical cord prolapses along with the condition.

Compound Presentations Are Classified As,

• Cephalic presentation is also called fetal presentation of the baby. Cephalic presentation is classified into vertex, face, and bow presentation. Vertex baby presentation is the common form of cephalic presentation in which the baby is in a down position toward the spine, and the baby's chin is tucked into the chest. Vertex baby presentation is when the head comes first in the birth canal. Face presentation baby is the presentation in which the fetus's head is extended, and it goes first into the face of the pelvis. A baby with a face presentation can be delivered through the vagina. However, in some cases, C-section is indicated. Cephalic presentation is with prolapse of,

One or both upper limbs (arm and hand).

One or both lower limbs (leg and foot).

Arms together with legs.

2. Breech presentation is when the fetus's buttocks and feet pass through the cervix first. It is accompanied by an arm or hand prolapse.

The combination of the head with the hand or arm is by far the most common. On the other hand, the head-foot and breech-arm groups are relatively infrequent. It is unusual for a hand or foot to prolapse alongside the head. The prolapse of the umbilical cord might complicate any combination, which makes it the main issue.

What Causes Compound Presentations?

Different mechanisms can result in compound fetal presentation from several clinical contexts. The causes of compound presentations include any circumstances that prevent the presenting component from filling and occluding the pelvic entrance.

Instances of compound presentation include,

Due to early gestational age, multiple gestations , polyhydramnios (excessive amniotic fluid accumulation), or a large maternal pelvis in comparison to fetal size, the fetus does not fully occupy the pelvis, which leaves an opportunity for a fetal extremity to prolapse.

When the presenting part is still high, the membranes rupture, allowing the amniotic fluid to flow and carry a fetal extremity, the umbilical cord, or both to the birth canal.

Preterm labor (when the baby is born too early or before six weeks of the due date).

External Cephalic Version (ECV) - A fetal limb (often the hand or arm, but occasionally the foot) may become "trapped" before the fetal head during the external version process and end up being the component that gives birth when labor starts.

How Are Compound Presentations Diagnosed?

A vaginal examination is used to make the diagnosis, and in many cases, the problem is not discovered until labor has progressed significantly and the cervix is fully dilated.

One suspects the condition when,

The active phase of labor is moving more slowly than it should.

Engagement does not take place - In any situation where the fetal head does not engage during labor. Still, there is no cephalo-pelvic disproportion (when the baby's head is too large and does not fit into the mother's pelvis), so the compound presentation diagnosis should be considered.

Even after the membranes have ruptured, the fetal head continues to be elevated and off-center during labor.

What Is the Effect of Compound Presentation on Labor?

The size of the fetus and the mother's pelvis affect compound presentation during labor.

There are three possible perspectives on this,

The fetal head may not enter the pelvic brim in cases where the fetus is large, and the pelvis is narrow due to a compound presentation. If it is not fixed, it will cause obstructed labor.

A complex presentation will delay the second stage of labor when the fetus and the pelvis are of average size. This delay results from the prolapsed limb interfering with the fetal head's normal internal and external flexion and rotation mechanisms. Correction is frequently required.

A complex presentation will not change the course of labor if the fetus is small and the pelvis is large; the baby will still be born with the hand prolapsed.

What Is the Treatment of Compound Presentation?

The fetal presentation and position determine how the fetus is positioned in the womb during the delivery. As in all cases of fetal presentation and position, such as a baby in the vertex or face presentation, the first essential is to determine whether the pelvis is large enough to allow vaginal delivery. The baby in vertex position is delivered through the vagina and the doctor will say to the woman to push the baby until the head comes out. Face presentation baby can be delivered through the vagina and in more complicated cases, C-section is indicated. A cesarean section will have to be performed if there is a mechanical obstruction.

If there is no obstruction, a vaginal delivery will be possible following one of the undermentioned methods,

Treatment of the presentation of an arm aims at preventing its prolapse into the vagina when the membranes rupture. Initially, the patient is placed in the genu pectoral or high Trendelenburg position for 30 minutes. This allows the limb, aided by gravity, to slip back above the head. The patient is then placed in the dorsal position. The fetal head is pushed into the pelvic brim by abdominal palpation, and an abdominal binder is applied. This method is not always successful. A vaginal examination should be performed as soon as the membranes rupture.

The prolapse of an arm or foot is best treated by replacing the limb above the head. The head is then pressed down by pressure on the abdomen. It is advisable not to remove the hand from the vagina until the head has been pushed into the pelvis.

When a prolapsed arm is discovered during the second stage of labor, it is sometimes possible to deliver by forceps without replacing the arm. During the application of the forceps, care must be taken not to include the arm within the forceps blades.

The internal version is now rarely used because of the dangers involved. The method may cause separation of the placenta and death of the features, rupture of the uterus, and probable death of the mother.

This method should only be used in the following cases,

An arm prolapses again after replacement.

A foot resists all attempts at replacement.

Occasionally, the compound presentation is complicated by the prolapse of the cord.

Prolapse of the cord necessitates rapid treatment if the fetus is to be saved. In the first stage of labor, a cesarean section is the treatment of choice. During the second stage of labor, forceps delivery is indicated, preferably if conditions permit, without replacement of the limb. The internal version is indicated solely when these procedures are not practical because of a lack of equipment.

What Are the Complications of Compound Presentation?

The two complications likely to occur are prolapse of the umbilical cord and uterine inertia.

They are as follows,

Prolapse of the Umbilical Cord - The same factors that lead to limb prolapse can cause cord prolapse. Most of the time, it will call for immediate delivery.

Inertia - Inertia may complicate any malpresentation. Its exact cause is unknown, but it may be due to the malposition of the fetus interfering with the normal mechanism of labor. The uterus reacts to this interference by diminishing its action. Treatment of inertia usually necessitates replacement of the prolapsed limb, except early in the first stage, when it is sometimes better to treat inertia by recognized methods and later replace the limb.

Conclusion:

In the majority of situations, compound presentation events need not significantly alter the arrangements already made for the method of managing the birth process. Simple stimuli that are intended to encourage the baby to reject the abnormal component may be successful. Following the identification of the invasive portion, labor, and delivery should be managed conservatively and following other established obstetrical standards.

Frequently Asked Questions

How is compound presentation treated, how is compound breech clinically seen, what does icd code 10 in compound presentation represent, is compound presentation normal/vertex, what is meant by cephalic presentation, and is it considered good, how are compound presentation patients delivered, is a cephalic presentation considered ideal in cases of c section, what are the complications of breech position, and can patients with the same have a normal delivery.

Management of Brow, Face, and Compound Malpresentations

https://exxcellence.org/list-of-pearls/management-of-brow-face-and-compound-malpresentations/

Fetus papyraceous disguised as compound presentation: A case report

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486711/

Compound presentation following external version

https://pubmed.ncbi.nlm.nih.gov/283786/

Obstetrics and Gynecology

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Simple, Compound, and Complex Sentences PowerPoint

Updated:  16 May 2023

A 23-slide editable PowerPoint template that introduces simple, compound, and complex sentences.

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CCSS.ELA-LITERACY.L.2.1.F

Produce, expand, and rearrange complete simple and compound sentences (e.g., The boy watched the movie; The little boy watched the movie; The action movie was watched by the little boy).

CCSS.ELA-LITERACY.L.3.1.H

Use coordinating and subordinating conjunctions.

CCSS.ELA-LITERACY.L.3.1.I

Produce simple, compound, and complex sentences.

CCSS.ELA-LITERACY.L.4.2.C

Use a comma before a coordinating conjunction in a compound sentence.

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Explain the function of conjunctions, prepositions, and interjections in general and their function in particular sentences.

ELAR 2.11(D)

Edit drafts using standard English conventions, including:

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Complete sentences with subject-verb agreement;

ELAR 2.11(D)(viii)

Coordinating conjunctions to form compound subjects and predicates;

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Elar 3.11(d)(i).

Complete simple and compound sentences with subject-verb agreement;

ELAR 3.11(D)(viii)

Coordinating conjunctions to form compound subjects, predicates, and sentences;

ELAR 4.11(D)

Elar 4.11(d)(viii), elar 4.11(d)(x).

Punctuation marks, including apostrophes in possessives, commas in compound sentences, and quotation marks in dialogue; and

ELAR 5.11(D)(x)

Punctuation marks, including commas in compound and complex sentences, quotation marks in dialogue, and italics and underlining for titles and emphasis; and

Use this teaching presentation to introduce simple, compound, and complex sentences to your students.

The presentation explains all three sentence types in detail. Links to student activities are also included in the presentation.

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Types of Compounds

Oct 24, 2014

860 likes | 1.39k Views

Types of Compounds. There are two types of compounds Ionic Compounds These are compounds where electrons are transferred from one atom to another to give each atom full outer shells.

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• covalently bonded
• methane ch 4
• 2 atoms covalently bonded

Presentation Transcript

Types of Compounds • There are two types of compounds • Ionic Compounds • These are compounds where electrons are transferred from one atom to another to give each atom full outer shells. • This forms a (+) ion and a (-) ion. These oppositely charged ions are attracted to each other to form an ionic bond • Eg Na = 2,8,1 Now Na+ is formed • Cl = 2,8,7 Now Cl- is formed • The Na+ and Cl- come together to form NaCl (now we don’t write the charges) The Na electron is transferred to the Cl atom

Ionic compounds are always between a metal and a non metal eg Na (metal) Cl (non metal) make NaCl In year 11 you will be given a table of ions – you don’t have to remember them. But you must know how to write balanced formula for ionic compounds using these ions

Task : write the chemical formula for sodium oxide in your book Step one: Write out the two ions from the chart with their charges ie Na+ and O2- Step two : Make the two charges balance (in other words are there the same number of (+) as (-) ) Na = +1 and O = -2 no they don’t balance. Now the seesaw doesn’t balance Step three: You must add an extra Na+ ion to make the (+) and (-) balance which ion do you think you will need to add to the seesaw?

Yes you are correct you need to add one Na+ to the left hand side of the seesaw Now you write the formula for sodium oxide as Na2O This tells us in each particle of sodium oxide (Na2O) There are two Na+ ions and one O2- ion

Task : Find the formula for aluminium oxide Step one Write out the ions from your table ie Al 3+ and O 2- Step two : Make the two charges balance (in other words are there the same number of (+) as (-) ) Al = +3 and O = -2 no they don’t balance. Step three: Add ions to both sides until the charges balance Al 3+ O 2- Al 3+ O 2- O 2- Al2O3 Aluminium oxide

You try this one write out each step : Find the formula for magnesium nitrate Step one Write out the ions from your table ie Mg2+ and NO3- Step two : Make the two charges balance (in other words are there the same number of (+) as (-) ) Mg = +2 and NO3- = -1no they don’t balance. Step three: Add ions to both sides until the charges balance NO3- Mg 2+ Then write formula NO3- Mg(NO3)2

Starter Task : Write the chemical formula for Calcium hydroxide in your book Step one: Write out the two ions from the chart with their charges Step two : Make the two charges balance by adding ions Step three: Write the finished formula without the charges

You can quietly read the following 6 slides or you can copy them down

Types of Compounds 2. Covalently bonded Compounds Covalent bonds involve atoms sharing electrons to form molecules. Molecules can be compounds made of two or more different atoms eg CO2, H2O, C6H12O6 etc Molecules can also be elements where 2 identical atoms are covalently bonded together eg H2, N2, O2, Cl2 etc

Remember covalent bonds involve the sharing of electrons This is how both carbon and hydrogen achieve full valence (or outer) shells in CH4. When atoms form covalent bonds they form molecules.

How to draw the bonding structure of a covalent molecule First draw both atoms with their valence electrons

Task: Making Molecules 1. In pairs use the model atoms to make a methane (CH4) molecule C atoms are black H atoms are white Use the long grey bonds to join them 2. Then make an H2O molecule H = white O = red 3. Then make a SO2 molecule S = yellow O = red 4. Then make an H2 molecule Show me when you have finished each one

Task: Making Molecules Then make a carbon dioxide (CO2) molecule Then make a glucose (C6H12O6) molecule (hint make a ring of 6 carbons) Show me when you have finished each one

Covalent bonding in methane (CH4) From the carbon atomic number we find: 6 carbon has an electron arrangement of 2, 4 This means carbon has 4 electrons in its valence (or outer) shell C 12 We can draw the 4 valence electrons of carbon like this: How many electrons does carbon need in its valence (or outer) shell? Ans: 8 electrons

From the hydrogen atomic number we find: 1 hydrogen has an electron arrangement of 1 This means hydrogen has 1 electron in its valence (or outer) shell H 1 We can draw the valence electron of hydrogen like this: How many electrons does hydrogen need in its valence (or outer) shell? Ans: 2 electrons

Place 4 hydrogen atoms around the C atom so that each H shares an electron with a C electron This sharing of electrons between H and C also means the C atom has a full valence shell of 8 electrons Each H atom shares one electron with one C electron to give each H a full valence shell of 2 electrons Can you see that both H and C atoms have full valence shells by sharing their electrons?

Ions and Molecules Ions Write down the following filling in the gaps. Ions are atoms that have g_____ or l_____ electrons to form p_______ or n________ ions 3 examples of ions are _________ion symbol ( ) , ________ ion symbol ( ) and _________ ion symbol ( ). Choose from : smallest, neutrons, covalent, electrons, gained, loss, negative, positive, valence, outer, protons, water, hydrogen gas, H2, CO2, H2O

Atoms, Ions and Molecules Atoms Write down the following filling in the gaps. Atoms are the s________ particles that make up all things. They consist of ________ and _________ in the nucleus with e________ in shells around the nucleus. 3 examples of atoms are _________ symbol ( ) , ________ symbol ( ) and _________ symbol ( ). Choose from : smallest, neutrons, covalent, electrons, gained, loss, negative, positive, valence, outer, protons, water, hydrogen gas, H2, CO2, H2O

Atoms, Ions and Molecules Molecules Write down the following filling in the gaps. Molecules are where two or more atoms share electrons in a c________ bond to give both atoms full v______ or o______ shells. 3 examples of molecules are w_______ formula ( ) , c________ d_______ formula ( ) and h______ g___ formula ( ). Choose from : smallest, neutrons, covalent, electrons, gained, loss, negative, positive, valence, outer, protons, water, hydrogen gas, H2, CO2, H2O

What is an ion? • An anion is an atom that has gained electron(s) to form a (-) ion e.g Cl- (Chloride) S2- (Sulfide) or a cation is an atom that has lost electron(s) to form a (+) ion e.g Na+ (Sodium) Fe2+ (iron (ll) ion) (aka Ferric ion) Fe3+ (iron(lll) ion ) (Ferrous)

Compounds can be two types – Copy this neatly into your book 1. Compounds can be Ionic Ionic compounds form when atoms lose and gain electrons to form charged (+) and (-) . These oppositely charged ions are attracted together to form an ionic bond. Ionic bonds always occur between a metal and non metal. Eg Na (+) and Cl (-) come together to form NaCl

Compounds can be two types – Copy this neatly into your book 2. Compounds can be Covalent These atoms share electrons so that each atom has a full outer shell. This sharing of electrons is called a covalent bond. Covalently bonded atoms form molecules. Molecules are always between non metal atoms. Examples of molecules are CH4 methane, H2O water, CO2 carbon dioxide

Atoms and elements A substance made of one type of atom is called an element e.g. a piece of Aluminium (symbol Al) consists of only aluminium atoms bonded together and is called an element.

Molecules • Some elements are unstable as single atoms and only exist as 2 atoms covalentlybonded together to form a molecule. These are usually gases e.g H2 , N2, Cl2, O2

Compounds and Molecules Some compounds are molecules that contain 2 or more different atoms covalently bonded together. Some common molecular compounds are: • CO2 (carbon dioxide) • H2O (water) • CH4 (methane) • C6H12 O6 (glucose)

Mg + O2 Zn + HCl Fe + Cl2 NaOH + HCl CH4 + O2 Ca + H2O NaOH + H2SO4 CH3OH + O2 MgO ZnCl2 + H2 FeCl3 NaCl + H2O CO2 + H2O Ca(OH)2 + H2 Na2SO4 + H2O CO2 + H2O Balancing Reactions 2 2 2 2 2 4 2 2 2 3 2 2 2 2 3

Simple formulae to learn H2O CO2 NH3 H2 O2 N2 SO2 Water Carbon dioxide Ammonia Hydrogen Oxygen Nitrogen Sulphur dioxide NaCl CaCl2 MgO HCl H2SO4 HNO3 NaOH Ca(OH)2 CaCO3 Al2O3 Fe2O3 Sodium chloride Calcium chloride Magnesium oxide Hydrochloric acid Sulphuric acid Nitric acid Sodium hydroxide Calcium hydroxide Calcium carbonate Aluminium oxide Iron oxide

Acids Acids release hydrogen ions (H+) in water to give acidic solutions Common Lab Acids are: Sulfuric acid (formula H2SO4 ) Nitric acid (formula HNO3) Hydrochloric acid (formula HCl) These are strong acids because they form a lot of H+ ions in water EgHCl (l) H+ (aq) + Cl- (aq) Eg H2SO4 (l) 2H+ (aq) + SO42- (aq)

Acids Other Acids found around the home are: ethanoic acid (formula CH3COOH ) this is the acid found in vinegar. Tartaric acid (formula C4H6O6)used in cooking Citric acid ( formula C6H8O7) this is the acid found in oranges and other fruits. ascorbic acid is another acid known as vitamin C. These acids are called weak acids because they form a small number of H+ ions in water

Bases • Bases are substances that release hydroxide ions (OH-) in water. • Eg NaOH (s) Na+ (aq) + OH- (aq) • Eg KOH (s) K+ (aq) + OH- (aq) Strong bases give off lots of OH- ions and weak base give off less OH- ions Common strong bases are: • Sodium hydroxide (NaOH) • Potassium hydroxide (KOH) • Ammonium hydroxide (NH4OH) Many cleaning agents are bases eg oven cleaners, window cleaners

The pH Scale The amount of H+ ions given off by an acid are measured by the pH scale 1 on the pH scale means there are a lot of H+ ions in the water and the solution is said to be acidic 14 on the pH scale means there are very few H+ ions in the water but a lot of OH- ions creating a basic solution

Draw the pH scale below your book Neutral Eg water acid base The colours below are the colours for the different pH numbers with universal indicator this indicates how acidic or basic a solution is Task – gently shade your pH scale these colours

acid neutral basic Anything less than 7 on the pH scale is called an acid neutral Strong acid Weakacid

acid neutral basic Indicators can also tell us how many OH- ions a base will give off and this gives us an indication of how basic a solution is. neutral Strong base Weak base

Litmus paper is another indicator Beaker 1 Blue litmus Beaker 2 Red litmus Which beaker contains the acid and which one contains the base? Remember blue litmus paper tests for acids Red litmus tests for bases Acid Base (H+) (OH-) Which beaker has more OH- ions? Which beaker has more H+ ions?

Litmus paper can also tell us Whether we Have an Acid or a base. Litmus paper can be red or blue Acids turn blue litmus paper red Bases turn red litmus paper blue

Neutralisation hydroxide (OH-) ions are the opposite to H+ When there are equal amounts of H+ and OH- ions in a solution they will react to form pure water (H2O) in a neutralisation reaction – the neutralisation reaction is below H+ + OH- H2O (water is neutral and has a pH of 7) From acid From base So bases eg NaOH, KOH can neutralise acids! and acids eg HCl,H2SO4 can neutralise bases!

Gas tests All carbonates eg _______ react with any acid to from CO2 (carbon dioxide) gas. CaCO3 Give a balanced equation for an acid/carbonate reaction CaCO3 + 2HCl CaCl2 + CO2 + H2O How do you test for CO2? The limewater test bubbled CO2 through limewater CO2 + Ca(OH)2 CaCO3 + 2H2O

How do you test for O2? (Oxygen) The glowing splint test KMnO4 MnO2 + O2

Finally how do you test for H2 (hydrogen)? The pop test Give a balanced reaction for the magnesium and hydrochloric acid reaction Mg + 2HCl MgCl2 + H2 Give a balanced reaction for the combustion of the hydrogen

Physical Properties of metals

Metal Structure • A metal consists of a regular arrangement of positive ions held together by a 'sea' of electrons.

Metal structure Starter Metals consist of p______ metal ions surrounded by n______ electrons. The attraction of the e_______ for the p_____ ions acts like a glue that holds metals atoms together

Activity On the periodic table in your book colour the metals red and nonmetals blue leave the metalliods (these are elements found on the border line between the metals and non metals) white. Give names to the following metal symbols: Al - Zn - Ag - Ni - Ca - Cu – Fe - Li - Mg – Pb - Na - Au - Aluminium Zinc Silver Copper Nickel Calcium Iron Lithium Magnesium Lead Sodium Gold

Metal Structure • A metal consists of positive ions held together by a 'sea' of electrons. • The electrons account for the lustrous appearance of metals • Because the electrons can move freely they conduct electricity, however the positive ions can only vibrate in the one spot. This means metals also conduct heat as well Note This type of metal bonding between positive ions and electrons in metals is strong giving metals high melting points.

Why metals conduct heat The word particle in this passage refers to the metal ions. Demo by heating spatula with paper clips attached by vasoline

Why most metals can be bent or shaped As the metallic bonds do not act in a particular direction, the rows of positive ions can slide over one another easily. This allows the metal to be bent or shaped. This structure allows metals to be bent (malleable) or made into wires (ductile)

Isotopes • An isotope is an atom with a different number of neutrons • The above are all naturally occurring isotopes of hydrogen

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Chapter 5 Types of Compounds - PowerPoint PPT Presentation

Chapter 5 Types of Compounds

Chapter 5 types of compounds ionic compounds covalent compounds lectureplus timberlake * more practice naming binary ionic compounds-p __ of i.n. kf caf2 al2o3 ... – powerpoint ppt presentation.

• Ionic Compounds
• Covalent Compounds
• Def The strength with which an atom in a bond pulls on e-s.
• Nonmetals have high electronegativity values
• Electrons are shared
• single bond shares 1 pair electrons
• double bond shares 2 pairs electrons
• triple bond shares 3 pairs electrons
• Two nonmetal atoms form a covalent bond because they have less energy (are more stable!) after they bonded
• H? ?H H H H?H H2 hydrogen molecule
• Indicate whether a bond between the following would be 1) Ionic 2) covalent
• ____ A. sodium oxygen
• ____ B. nitrogen oxygen
• ____ C. phosphorus chlorine
• ____ D. calcium sulfur
• ____ E. chlorine bromine
• 1 A. sodium and oxygen
• 2 B. nitrogen and oxygen
• 2 C. phosphorus and chlorine
• 1 D. calcium and sulfur
• 2 E. chlorine and bromine
• Elements that form diatomic molecules
• Binary covalent compounds
• Organic compounds/ Hydrocarbon
• Acids Bases
• (Common v. Formal Names)
• Elements that exist as diatomic molecules
• are H2, F2, N2, O2, Cl2, Br2, I2
• ? ? ? ? ? ? ? ?
• ? N ? ? N ? ?? NN
• triple bond
• Use the name of the element to name a diatomic molecules.
• H2 hydrogen
• N2 nitrogen
• Cl2 _______________
• O2 _______________
• I2 _______________
• Use the name of the element to name the following diatomic molecules.
• Cl2 chlorine
• Two nonmetals (def of binary covalent)
• Name each element
• End the last element in -ide
• Add prefixes to show how many atoms of each
• (except when theres only 1 atom of the 1st element listed)
• Prefixes-(see Table 5.5, p 168 of text)
• mon 1 penta 5
• di 2 hexa 6
• tri 3 hepta 7
• tetra 4 octa 8
• Fill in the blanks to complete the following names of covalent compounds.
• CO carbon ______oxide
• CO2 carbon _______________
• PCl3 phosphorus _______chloride
• CCl4 carbon ________chloride
• N2O _____nitrogen _____oxide
• CO carbon monoxide
• CO2 carbon dioxide
• PCl3 phosphorus trichloride
• CCl4 carbon tetrachloride
• N2O dinitrogen monoxide
• A. P2O5 1) phosphorus oxide
• 2) phosphorus pentoxide
• 3) diphosphorus pentoxide
• B. Cl2O7 1) dichlorine heptoxide
• 2) dichlorine oxide
• 3) chlorine heptoxide
• C. Cl2 1) chlorine
• 2) dichlorine
• 3) dichloride
• A. P2O5 3) diphosphorus pentoxide
• Def organic compounds contain __ atoms hooked together.
• (Why do you think this element can hook up with many other atoms, including itself?)
• Def hydrocarbons are made of ___ ___
• They are named by the number of Carbon atoms a molecule contains.
• See Table 5.8, p 183
• CH4 methane
• C2H6 ethane
• C3H8 propane
• C4H10 butane
• C5H12 pentane
• C6H14 hexane
• C7H16 heptane
• C8H18 octane
• C9H20 nonane
• C10H22 decane
• Formal Names follow the rules we have learned for naming compounds.
• Common Names are ones that dont follow these rules.
• Ammonia NH3
• Common Acids Bases
• (Table 5.7, p 182)
• Formula Name
• HCl hydrochloric acid
• H2SO4 sulfuric acid
• H3PO4 phosphoric acid
• HNO3 nitric acid
• HC2H3O2 acetic acid (vinegar)
• NaOH sodium hydroxide
• KOH potassium hydroxide
• NH3 ammonia
• Bonding pairs
• Lone pair of electrons
• Def molecules of the same element that differ in structure
• Ex Carbongraphite, charcoal, Buckminsterfullerin e (bucky ball)
• - see Fig ___ on p ___ of text
• Ex2 O2 (oxygen) and O3 (ozone)
• A Atoms of the same elements can combine in different ratios.
• 1. Identify it as a covalent containing only nonmetals.
• 2. Determine what type of covalent it is
• diatomic element binary
• hydrocarbon (ends in ane) acid/base
• 3. Reverse the naming process.
• Binary Ionic
• Ionic Compounds contain-ing Polyatomic Ions.
• Ionic Cpds containing Transition Metals
• IF YOU ARE UNABLE TO IDENTIFY IONIC COVALENT COMPOUNDS, YOU WILL BE LOST!!!
• PLEASE SEE ME IMMEDIATELY TO GET CAUGHT UP.
• Nonmetals have high ENs.
• Metals have low ENs.
• Bonds between a metal a nonmetal involve transfers of e-s b/c of the big difference in EN!
• Binary 2 elements
• Ionic 1 metal 1 nonmetal
• 1. Identify name the 2 elements in the compound.
• 2. Name the cation, which is the given the name of the element.
• 3. Name the anion, which is given the name of the element, w/the ending changed to ide.
• 2. Na sodium
• 3. Cl chloride
• (full name is sodium chloride)
• ________ ______ ______
• (cation (anion (cation name) (anion name) symbol) symbol)
• DEF Charged particles containing more than 1 type of atom. Ex SO42-
• Identify the cation the anion. (Draw a line between the 2 ions)
• Name the cation, then the anion (find polyatomics on Table 5.3, p 159 of text). Thats it!
• Most polyatomic ions are anions.
• Important Exception 1 there are 2 cations that contain NO METALS
• NH4 (ammonium)
• H3O (hydronium)
• (this can be tricky b/c we have always identified ionic compounds because they start with a metal cation.)
• Important Exception 2 Some anions contain metals.
• Ex MnO4- permanganate
• Cr2O72- dichromate
• (this can be tricky b/c anions are usually a nonmetal)
• Determine the total of negative charges in a unit of the compound
• Ex O2- O2- 4 total - charges
• 2. Determine the charge on the cation that will give you 4 total charges Ex Ni4
• 3. Write the cation anion names. Write cation with the oxidation written as a Roman numeral in parentheses
• Ex nickel (IV) oxide
• 1. Identify the ionic charge (oxidation number) on the cation anion.
• ELEMENT OXIDATION
• Group 14 4 or 4-
• Group 15 3-
• Group 16 2-
• Group 17 1-
• 2. A compound has NO CHARGE on it, so a formula unit (the smallest ratio of cations to anions) must have equal numbers of - charges. (use the LCM)
• You can use this to write formulas.
• Take the charge on the cation and use it as the subscript on the anion
• Take the charge on the anion and use it as the subscript on the cation
• Reduce the subscripts, if necessary
• Determine the cation anion
• Determine the oxidation on each ion. (oxidation s for polyatomics are found on Table 5.2)
• Write a balanced formula
• If there is more than 1 of an ion, use parentheses, then a subscript
• Ex see Practice Problems, p 162
• 3. Write the formula for the compound formed from the following pairs of ions
• a) ammonium sulfite ions
• IONS NH4 SO3 2-
• FORMULA (NH4)2SO3
• QUESTION What was strange about the e- configurations of transition metals?
• The d sublevel e-s are so close to the actual valence e-s, they sometimes act like valence e-s!
• See Table 5.4 on p 164 of text Common Ions of Select Transition Metals
• Ex Fe 2 Fe 3
• Write the e- configuration
• 1s22s22p63s23p64s23d6
• Valence e-s4s2
• BUT, some 3d e-s can be lost too!
• 1. Identify the cation anion
• 2. Determine the oxidation s on the cation anion
• The oxidation of the cation is given in the name ex Nickel (IV) Ni4
• The Roman numeral is the oxidation
• 3. Write a formula w/ 0 charge.
• Def process of separating ionic covalent compounds by heating them till the covalent compound evaporates.
• The ionic compound remains in the flask
• The covalent compound can be cooled collected in a separate container.
• This process is called distillation
• Match each set with the correct name
• A. Na2CO3 1) magnesium sulfite
• MgSO3 2) magnesium sulfate
• MgSO4 3) sodium carbonate
• B. Ca(HCO3)2 1) calcium carbonate
• CaCO3 2) calcium phosphate
• Ca3(PO4)2 3) calcium bicarbonate
• A. Na2CO3 3) sodium carbonate
• MgSO3 1) magnesium sulfite
• MgSO4 2) magnesium sulfate
• B. Ca(HCO3)2 3) calcium bicarbonate
• CaCO3 1) calcium carbonate
• Ca3(PO4)2 2) calcium phosphate
• A. aluminum nitrate
• 1) AlNO3 2) Al(NO)3 3) Al(NO3)3
• B. copper(II) nitrate
• 1) CuNO3 2) Cu(NO3)2 3) Cu2(NO3)
• C. Iron (III) hydroxide
• 1) FeOH 2) Fe3OH 3) Fe(OH)3
• D. Tin(IV) hydroxide
• 1) Sn(OH)4 2) Sn(OH)2 3) Sn4(OH)
• 3) Al(NO3)3
• 2) Cu(NO3)2

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