What is persistent occiput posterior position?

Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Its diagnosis by physical examination is challenging but is improved with bedside ultrasonography. Occiput posterior discovered in the active phase or early second stage of labor usually resolves spontaneously.

What is an Occipito posterior position?

The occipitoposterior position in the main is caused by the adaptation of the head to a pelvis having a narrow fore pelvis and an ample anteroposterior diameter and therefore may be considered “physiologic.” A true posterior position is one in which the occiput is at or posterior to the sacroiliac synchondrosis.

What are the outcomes of Occipito posterior position?

The primary outcome will be operative delivery (defined as vacuum, forceps and/or caesarean section deliveries). Secondary outcomes will be caesarean section, significant maternal mortality/morbidity and significant perinatal mortality/morbidity.

What increases the risk of persistent occiput posterior position?

Conclusion: Epidural use, AROM, African-American ethnicity, nulliparity, and birth weight >4000 g are associated with persistent OP position at delivery, with higher rates of operative deliveries and obstetric complications.

How is Occipito posterior position diagnosed?

Fetal head position during the entire labor. Diagnosis made by transabdominal ultrasound during the first stage, by transperineal ultrasound during the second stage, by clinical assessment at time of delivery.

Why is occiput posterior bad?

The posterior position at birth is associated with a higher risk of short-term complications for the baby, such as lower five-minute Apgar scores, a greater likelihood of needing to be admitted to the neonatal intensive care unit (NICU), and a longer hospital stay.

When does persistent occipito posterior position ( pop ) occur?

Persistent occipito-posterior position (POP) is found in about 1% of labors, and its management is still controversial. A study group of 319 patients with POP deliveries were screened and analyzed for prepartum, intrapartum and postpartum parameters. A control group of the same size was matched for …

Which is the external rotation of the occipito?

Restitution – The head moves 1/8th of a circle in the opposite direction of internal rotation. External rotation – The occiput further rotates to the same direction of restitution to 1/8th of a circle, now the face directs towards the left thigh in ROP and the right thigh in LOP.

How are persistent posteriors determined at the beginning of Labor?

One study using ultrasound to determine the position at the beginning of labor found that only one-third of persistent posteriors begin labor as posteriors and fail to rotate; the other two-thirds develop through a malrotation during labor from an initially occipito-anterior (face down) position (Gardberg et al).

Where does the sagittal suture lie in the occipito?

Incomplete forward rotation (Deep transverse arrest) – The occiput rotates through 1/8th of a circle anteriorly and the sagittal suture comes to lie in the bispinous diameter in the pelvic outlet (small diameter in the outlet). Thus further anterior rotation is not possible and arrests in this position.