Childbirth, a beautiful and awe-inspiring miracle, is often faced with its fair share of challenges.
Among them, lies the persistent occipito-posterior position, a formidable opponent in the realm of labor.
This formidable term refers to a malposition that can halt the smooth progression of childbirth, leaving both mother and baby at risk.
Stay with us as we dig deeper into the world of this intriguing predicament and explore the interventions that may be necessary to overcome it.
persistent occipitoposterior position
Persistent occipitoposterior position is a malposition in which the baby’s back is directed posteriorly during a vertex presentation.
It occurs in approximately 3% of cases and can lead to complications such as premature rupture of membranes, prolonged labor, obstructed labor, and increased incidence of instrumental and operative delivery.
Different methods can be used to manage persistent occipitoposterior position, including long internal rotation, spontaneous delivery, outlet forceps, vacuum extraction, manual rotation and extraction with forceps, and Caesarean section.
Vacuum extraction and Caesarean section are the commonly used methods in modern obstetrics for managing this position.
Craniotomy may be performed if the fetus is dead.
Key Points:
- Persistent occipitoposteior position is a malposition where the baby’s back is posterior during a vertex presentation.
- It occurs in approximately 3% of cases and can lead to complications such as premature rupture of membranes, prolonged labor, obstructed labor, and increased incidence of instrumental and operative delivery.
- Different methods can be used to manage it, including:
- Long internal rotation
- Spontaneous delivery
- Outlet forceps
- Vacuum extraction
- Manual rotation and extraction with forceps
- Caesarean section
- Vacuum extraction and Caesarean section are commonly used in modern obstetrics for managing this position.
- Craniotomy may be performed if the fetus is dead.
persistent occipitoposterior position – Watch Video
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Pro Tips:
1. Persistent occipitoposterior position, also known as OP position, occurs when the baby’s head is facing the mother’s abdomen instead of her back during childbirth.
2. The prevalence of persistent occipitoposterior position is estimated to be around 5-10% of all labors.
3. Babies in persistent occipitoposterior position may experience a longer and more challenging labor due to the increased pressure on the mother’s lower back and pelvis.
4. Research suggests that factors like a shallow pelvis, excessive amniotic fluid, and inadequate fetal rotation during labor can contribute to persistent occipitoposterior position.
5. Teaching the mother certain positions, such as rocking on all fours or using a birthing ball, can help encourage the baby to rotate and alleviate discomfort associated with persistent occipitoposterior position.
1. Occipito-Posterior Position: A Common Malposition In Labor
Occipito-posterior position, also known as OP position, is a malposition in which the baby’s back is directed posteriorly during a vertex presentation. This means that the baby’s head is positioned towards the mother’s spine rather than towards her abdomen.
Occipito-posterior position is not uncommon and occurs in approximately 10% of labors. It can present challenges during delivery due to the position of the baby’s head, which may result in a longer and more difficult labor. However, with appropriate management, the majority of cases can be managed without complications.
2. Left Vs. Right Occipito-Posterior Position: Which Is More Common?
When it comes to occipito-posterior position, right occipito-posterior (ROP) is more common than left occipito-posterior (LOP). This means that when facing the mother, the baby’s back is more likely to be positioned on her right side rather than her left side.
The reasons for this discrepancy between left and right occipito-posterior positions are not entirely clear. However, it may have to do with the shape and structure of the mother’s pelvis, as well as the positioning of other internal organs. Further research is needed to fully understand why ROP is more common than LOP.
3. Causes Of Occipito-Posterior Position: Pelvis Shape And Other Factors
There are several factors that can contribute to the occurrence of occipito-posterior position. One of the main causes is the shape of the mother’s pelvis. Anthropoid and android pelvises are commonly associated with occipito-posterior position.
Other factors that can contribute to occipito-posterior position include:
- Maternal kyphosis (abnormal curvature of the spine)
- Anterior insertion of the placenta
- Malpresentations such as placenta previa, pelvic tumors, pendulous abdomen, polyhydramnios, and multiple pregnancy
These factors can affect the positioning and movement of the baby during labor.
4. Diagnosing Occipito-Posterior Position During Pregnancy
Diagnosing occipito-posterior position during pregnancy can be done through various methods. The inspection, palpation, and auscultation are commonly used techniques.
During the physical examination, the healthcare provider will observe the position of the baby’s back and the mother’s abdomen. Through palpation, they will feel for the baby’s head and back and assess their position. Auscultation involves listening to the baby’s heart rate and identifying any deviations that may indicate an occipito-posterior position.
It is important to diagnose occipito-posterior position during pregnancy as it helps in developing an appropriate birthing plan and determining the potential risks and complications that may arise during labor.
– Diagnosing occipito-posterior position can be done through inspection, palpation, and auscultation.
– Physical examination involves observing the position of the baby’s back and the mother’s abdomen.
– Palpation allows the healthcare provider to feel for the baby’s head and back and assess their position.
– Auscultation helps in listening to the baby’s heart rate and identifying any deviations.
Note: Diagnosing occipito-posterior position during pregnancy is crucial for developing a birthing plan and assessing potential risks and complications.
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You may need to know these questions about persistent occipitoposterior position
What is the most common cause of persistent Occipito-posterior position?
The most common cause of persistent Occipito-posterior position is the shape of the pelvis. Anthropoid and android pelvises, characterized by a narrow fore-pelvis, often lead to this positioning. These pelvic shapes create a challenge for the baby to align correctly, resulting in the occiput facing the mother’s back. Additionally, maternal kyphosis, referring to the convexity of the fetal back aligning with the concavity of the lumbar kyphosis in the mother, can contribute to the persistence of this position. Both factors combined can increase the likelihood of the baby remaining occipito-posterior.
Can occipito-posterior position cause prolonged labor?
Yes, occipito-posterior position can cause prolonged labor. Research has shown that persistent occiput posterior position during labor is strongly associated with longer labor duration. This malposition can lead to difficulties in the descent and rotation of the baby’s head through the birth canal, thus potentially prolonging the labor process. The longer labor duration associated with OP position increases the risks of complications such as severe perineal tears and postpartum hemorrhage. Therefore, it is essential for healthcare providers to identify and manage occipito-posterior position promptly to optimize maternal and neonatal outcomes.
What is the common cause of Occipito-posterior position?
The primary cause of occipito-posterior position is the nulliparity, which refers to women who have never given birth. This is because the pelvic muscles and ligaments may be less flexible and not well-prepared for childbirth. Additionally, malnutrition combined with pelvic deformity can contribute to this fetal head position, making it more difficult for the baby to rotate into the optimal position. Adolescents with pelvic immaturity may also experience occipito-posterior position due to the underdevelopment of their pelvic structure. Furthermore, having an anterior placenta and receiving epidural analgesia during labor are both identified as risk factors for fetal malposition.
What increases the risk of persistent occiput posterior position?
Several factors have been identified as increasing the risk of a persistent occiput posterior position during delivery. These include nulliparity (having no previous births), obesity, advanced maternal age, sub-Saharan African origin, a prolonged gestational period, macrosomia (large baby size), an anterior placenta, and the use of epidural analgesia. Observational studies have consistently reported these risk factors for the persistence of posterior positions at delivery. These factors may influence the likelihood of the baby’s head facing the wrong way, making it more difficult for the baby to rotate into the optimal position for birth.
Reference source
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.13874
https://www.gfmer.ch/Obstetrics_simplified/malpresentations_and_malposition.htm
https://www.sciencedirect.com/science/article/pii/S2666577822000296
https://pubmed.ncbi.nlm.nih.gov/17923836/
