occipito posterior

8/16/2019 Occipito Posterior

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MAL POSITIONS / MALMAL POSITIONS / MAL

PRESENTATIONSPRESENTATIONS• Occiptio-posterior position 1 in 5 deliveriesOcciptio-posterior position 1 in 5 deliveries

• Face presentation 1 in 5 deliveriesFace presentation 1 in 5 deliveries

• !ro" presentation 1 in 1 deliveries!ro" presentation 1 in 1 deliveries

• !reec# presentation 1-$ in 5 deliveries!reec# presentation 1-$ in 5 deliveries

• S#o%lder presentation 1 in $ deliveriesS#o%lder presentation 1 in $ deliveries

• &nsta'le lie 1 in (5 deliveries&nsta'le lie 1 in (5 deliveries


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Occipito – posterior position..Occipito – posterior position..

In a verte) presentation "#en t#e occip%t isIn a verte) presentation "#en t#e occip%t is

placed posteriorl* over t#e sacr%+ / sacro ,placed posteriorl* over t#e sacr%+ / sacro ,

iliac oint. it is called an occipito , posterioriliac oint. it is called an occipito , posterior

positionposition

ROP , Occip%t on ri0#t sacro - iliac ointLOP , Occip%t on let sacro , iliac oint2irect occipito , posterior , occip%t points to"ards sacr%+


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LOP


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Occipito , posterior is an a'nor+al position o t#eOccipito , posterior is an a'nor+al position o t#everte) rat#er t#an an a'nor+al presentation 3In +ostverte) rat#er t#an an a'nor+al presentation 3In +ost

o cases 346 anterior rotation o occip%t occ%rs6o cases 346 anterior rotation o occip%t occ%rs6!%t as t#e posterior position +a* 0ive rise to!%t as t#e posterior position +a* 0ive rise to2*stocia 3a'nor+al la'o%r 7 deliver*6. it is2*stocia 3a'nor+al la'o%r 7 deliver*6. it isassociated "it# +al presentationassociated "it# +al presentation


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Incidence , %pto 1( o all verte) presentationIncidence , %pto 1( o all verte) presentation

ROP is ( ti+es +ore co++on t#an LOPROP is ( ti+es +ore co++on t#an LOP

89: ;;89: ;;

--Dextro-rotation of the uterus favoursDextro-rotation of the uterus favoursoccipito-posterior than right occipito-occipito-posterior than right occipito-anterior positionanterior position

-The right oblique diameter is slightly longer-The right oblique diameter is slightly longerthan the left onethan the left one

-The left oblique diameter is reduced by the-The left oblique diameter is reduced by thepresence of sigmoid colonpresence of sigmoid colon


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2ia0nosis= ,2ia0nosis= ,

Inspection =-Inspection =-

- A'do+en loo?s lat 'elo" t#e %+'ilic%s A'do+en loo?s lat 'elo" t#e %+'ilic%s

Palpation =-Palpation =-

F%ndal #ei0#t =- corresponds "it# period o a+enorr#oeaF%ndal #ei0#t =- corresponds "it# period o a+enorr#oea

F%ndal 0rip =- 'reec#F%ndal 0rip =- 'reec#Lateral 0rip =-Foetal 'ac? is elt on rt Flan? o +ot#er in inLateral 0rip =-Foetal 'ac? is elt on rt Flan? o +ot#er in in

ROP 7 in let lan? in LOPROP 7 in let lan? in LOP

Fetal li+'s are elt easil* as ?no' li?e str%ct%re anteriorl*Fetal li+'s are elt easil* as ?no' li?e str%ct%re anteriorl*

Pelvic 0rip =-9ead is not en0a0edPelvic 0rip =-9ead is not en0a0ed

-


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-A%sc%ltation =--A%sc%ltation =-

F9S is 'est #eard in lan? in direct occipito , posterior / ROP '%tF9S is 'est #eard in lan? in direct occipito , posterior / ROP '%tdiic%lt in LOPdiic%lt in LOP

@a0inal e)a+ination =-@a0inal e)a+ination =-

11 Findin0 depends %pon de0ree o le)ion o #eadFindin0 depends %pon de0ree o le)ion o #ead

$$


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Mec#anis+ o la'o%r ,Mec#anis+ o la'o%r ,

11 9ead en0a0es t#ro%0# t#e ri0#t o'li%e dia+eter in ROP 79ead en0a0es t#ro%0# t#e ri0#t o'li%e dia+eter in ROP 7Let o'li%e dia+eter in LOP !eca%se o delectionLet o'li%e dia+eter in LOP !eca%se o delectionen0a0e+ent is dela*eden0a0e+ent is dela*ed

$$ In +ost o t#e cases 346 ,In +ost o t#e cases 346 ,

a le)ion , d%e to 0ood %terine contraction t#ere is le)ion oa le)ion , d%e to 0ood %terine contraction t#ere is le)ion o#ead#ead

' internal rotation o t#e #ead , occip%t rotates to 1(5 de0rees' internal rotation o t#e #ead , occip%t rotates to 1(5 de0reesanteriorl* to lie 'e#ind t#e s*+p#*sis p%'is. s#o%lder rotatesanteriorl* to lie 'e#ind t#e s*+p#*sis p%'is. s#o%lder rotatesto occ%p* ri0#t o'li%e dia+eterto occ%p* ri0#t o'li%e dia+eter

( F%rt#er descent 7 deliver* o t#e #ead occ%rs li?e occipito ,( F%rt#er descent 7 deliver* o t#e #ead occ%rs li?e occipito ,anterior positionanterior position

> !irt# o s#o%lders 7 tr%n? , is t#e sa+e as t#at o occipito> !irt# o s#o%lders 7 tr%n? , is t#e sa+e as t#at o occipitoanterioranterior


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Fate o OPPFate o OPPOPP

En0a0in0 dia+eter =- occipito-rontal

115c+ or s%'-occipitorontal 1c+

Favora'le 346&navora'le 316

(/Bt# rotation

occipit co+es %nder

s*+p#*sis p%'is 3rt/lt

occipito anterior6

Nor+al va0inal deliver*

Mild dele)ion Moderate dele)ion Severe dele)ion

Occip%t rotate '*

1/Bt# circle

2eep

transverse

arrest

Non-rotation

O'li%e

posteriorarrest

Occip%t rotate

posteriorl* '* 1/Bt#

POPP/ occipito-sacral position

Face to p%'is deliver* Arrest


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Factors avo%rin0 lon0 anterior rotation

316 8ell le)ed #ead

3$6 Cood %terine contractions

3(6 Roo+* pelvis

3>6 Cood pelvic loor

356 No pre+at%re r%pt%re o +e+'ranes


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Mana0e+entMana0e+ent

2%rin0 12%rin0 1stst sta0e=-sta0e=-

11 Earl* dia0nosisEarl* dia0nosis

$$ Fetal. +aternal condition and pelvicFetal. +aternal condition and pelvicassess+ent s#o%ld 'e doneassess+ent s#o%ld 'e done

(( Prevent r%pt%re o +e+'rane '* 'edPrevent r%pt%re o +e+'rane '* 'ed

rest in lt lateral positionrest in lt lateral position

>> Parto0rap# to 'e strictl* +aintainParto0rap# to 'e strictl* +aintain

55 Earl* c/s in contracted pelvisEarl* c/s in contracted pelvis


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Second sta0eSecond sta0e$nd sta0e

p/v e)a+=- To see level o presentin0 part.

de0ree o le)ion. position. cap%t. +o%ldin0. c)

Favora'le 346&navora'le 316

Ant (/Bt# rotation

occipit co+es %nder

s*+p#*sis p%'is 3rt/lt

occipito anterior6

Nor+al va0inal deliver*

Mild dele)ion Moderate dele)ion Severe dele)ion

Occip%t ant

rotate '* 1/Bt#

circle

2eep

transverse

arrest

Non-rotation

O'li%e

posterior

arrest

Occip%t rotate

posteriorl* '* 1/Bt#

POPP/ occipito-

sacral position


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Mana0e+ent o 2TAMana0e+ent o 2TA2TA or o'li%e

posterior arrest

Assisted deliver*

Pelvis ade%ate Inade%ate pelvis

-Man%al rotation o occip%t to

anterior position ollo"ed '*

orceps e)traction

- vac%%+ deliver*

- orceps rotation

2ead 'a'*


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Man%al rotation and e)traction '* orceps=

&nder 0eneral anaest#esia t#e ollo"in0 steps are done=

1-2isi+paction= t#e #ead is 0rasped 'ite+porall* and p%s#ed sli0#tl*

%p"ards

$-Fle)ion o t#e #ead

(-Rotation o t#e occip%t anteriorl* '* t#e ri0#t #and va0inall* aided '*.- Rotation o t#e anterior s#o%lder a'do+inall* to"ards t#e +iddle line '*

t#e let #and or an assistant

>-- Fi) t#e #ead a'do+inall* '* an assistant. appl* orceps and e)tract it


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POPPPOPPPOPP

Spontaneo%s ace to

p%'is deliver*

Arrest

9ead a'ove t#e isc#ial

spine / 'i0 'a'*


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Pro0nosis ,Pro0nosis ,

Increased +aternal +or'idit* d%e to pronlon0ed la'o%rIncreased +aternal +or'idit* d%e to pronlon0ed la'o%r

7 increased incidence o operative deliver*7 increased incidence o operative deliver*

occipito posterior

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