Persistent occipital posterior position, occipital transverse position
Introduction
Introduction to persistent posterior occipital position Abnormal fetal position is one of the common causes of dystocia. At the time of delivery, the anterior occipital position (normal fetal position) accounts for about 90%, while the abnormal fetal position accounts for about 10%. The abnormal position of the fetal head is mostly due to the rotation of the fetal head in the pelvic cavity. Persistent occipital transverse position, persistent posterior occipital position; face exposed due to poor fetal head flexion and extension of varying degrees, first exposed; high straight position, unequal tilting, etc. 6% to 7%. The abnormal breech presentation of fetal births accounts for about 3% to 4%, and the shoulders are rarely seen. There is also a composite first exposed. During the delivery process, the fetal head is connected by the posterior position of the pillow or the horizontal position of the occipital. During the descending process, most of the occipital part of the fetal head can be turned forward by 135° or 90° due to strong contractions, and converted into the anterior position of the occiput. Natural childbirth. If the fetal head occipital bone can not continue to turn to the front, until the rear of the maternal pelvis or the side of the maternal pelvis, causing difficulties in childbirth, known as persistent occipitoposteriorposition (persistentoccipitoposteriorposition) or persistent occipitotransverse position (persistentoccipitotransverseposition). basic knowledge Probability ratio: Susceptible people: good for women Mode of infection: non-infectious Complications: uterine contraction, postpartum hemorrhage, fetal distress, neonatal asphyxia
Cause
Persistent post-occipital and occipital transverse causes
1. Abnormal pelvis often occurs in male pelvis or apes-like pelvis. The characteristics of these two types of pelvis are that the front half of the entrance plane is narrow, not suitable for the connection of the fetal head occipital part, the latter half is wider, and the fetal head is easy to be in the posterior position. Or occipital transverse position, this type of pelvis is often accompanied by a middle pelvic stenosis, affecting the fetal head in the middle pelvis plane to rotate forward to become a continuous occipital posterior or continuous occipital transverse position.
2, if the fetal head flexion is connected with the posterior occipital position, the fetal spine is close to the mother's spine, which is not conducive to the fetal head flexion, the front of the fetal head becomes the lowest part of the fetal head drop, and the lowest point often turns to the front of the pelvis, currently When the squat is turned to the front or side, the occipital portion of the fetal head is turned to the rear or side to form a continuous posterior or occipital position.
3, other uterine contraction weakness affects fetal head flexion and internal rotation, easy to cause persistent posterior occipital or occipital transverse position, some scholars reported that the incidence of posterior occipital position of the anterior wall placenta is high.
The fetal head is often connected by the occipital transverse position. Even if the occipital posterior position is connected, during the delivery process, the strong contraction can make the fetal head occipital part turn 90°~135° forward, and turn into the anterior position of the occiput and naturally give birth. If you cannot convert to the anterior position of the occiput, there are two types of delivery mechanisms:
1. The left occipital part of the occipital left (right) posterior position reaches the middle pelvis and rotates 45° backwards, so that the sagittal suture is consistent with the anterior and posterior diameter of the pelvis. The occipital part of the fetus is oriented to the posterior position of the humerus. There are two ways of delivery. : 1 fetal head flexion is better: when the fetal head continues to descend until the anterior iliac crest reaches the pubic arch, the previous sputum is the fulcrum, the fetal head flexes and the top and the occipital part are delivered from the perineal anterior border, followed by the fetal head. The pubic symphysis is used to deliver the amount, nose, mouth, and sputum. This type of delivery is the most common way of vaginal delivery after the occipital position. 2 The fetal head is poorly bent: when the nasal root appears in the lower edge of the pubic symphysis, The nasal root is the fulcrum, the fetal head is flexed first, and the anterior iliac crest, the apex and the occipital part are delivered from the anterior perineal lining, and then the fetal head is extended, so that the nose, the mouth and the ankle are successively delivered by the pubic symphysis, because the fetal head is larger The circumference of the pillow is rotated, and the baby is more difficult to deliver.
2, the occipital transverse part of the pillow is located in the process of descent without internal rotation, or the occipital part of the posterior occipital position is only rotated 45° forward to become a continuous occipital transverse position, although the continuous occipital transverse position can be delivered through the vagina. However, most of them need to use the hand or the fetal head aspiration technique to transfer the fetal head into the front of the pillow.
Prevention
Persistent posterior occipital position
Pregnant women should not sit for a long time, and should increase the gentle activities such as walking, belly, waist and so on.
Avoid cold and flatulent foods, such as: watermelon, hawthorn, beans, milk and so on.
The stool should be unblocked, and it is best to have a bowel movement every day.
Need to remind all expectant mothers, if the above therapy can help you to change the abnormal fetal position is very good, if you can not turn it, you do not have to be nervous, you need to be hospitalized 1 to 2 weeks before the expected date of delivery, the doctor decides the mode of delivery according to the specific conditions of the pregnant woman. .
Complication
Persistent posterior occipital and occipital transverse complications Complications, uterine contraction, postpartum hemorrhage, fetal distress, neonatal asphyxia
After the delivery, the fetal head is connected late and the flexion is poor. Because the posterior part of the occipital post is not easy to adhere to the cervix and the lower uterus, it often leads to coordinated uterine contraction and slow cervical dilation, because the occipital bone continues to be located behind the pelvis and compresses the rectum. Maternal conscious self-expansion and defecation, resulting in the uterus has not been fully open, premature use of abdominal pressure, easily lead to anterior lip edema of the cervix and maternal fatigue, affecting the progress of labor.
Impact on the mother: Abnormal fetal position leads to secondary uterine weakness, prolonged labor, often requires surgical midwifery, prone to soft birth canal injury, increased postpartum hemorrhage and infection, if the fetal head compresses the soft birth canal for a long time, can occur Ischemic necrosis falls off and forms genital warts.
Impact on the fetus: Due to the prolongation of the second stage of labor and increased chances of surgical midwifery, it often causes fetal distress and neonatal asphyxia, resulting in increased perinatal mortality.
Symptom
Persistent post-occipital position, occipital transverse position symptoms Common symptoms Defecation feeling After delivery, fetal head joints are later, anal bulge, fatigue, anterior lip edema fatigue
After the delivery, the fetal head is connected late and the flexion is poor. Because the posterior part of the occipital post is not easy to adhere to the cervix and the lower uterus, it often leads to coordinated uterine contraction and slow cervical dilation, because the occipital bone continues to be located behind the pelvis and compresses the rectum. Maternal conscious swell and defecation, resulting in the uterus has not been fully open, premature use of abdominal pressure, easily lead to anterior lip edema of the cervix and maternal fatigue, affecting the progress of labor, continuous post-occipital position often leads to the extension of the second stage of labor, if Although the fetal hair has been seen in the vaginal opening, but after many times of contractions, but the breath is not seen, the fetal head continues to decline smoothly, it should be thought that it may be a persistent posterior position.
Examine
Persistent post-occipital and occipital lateral examination
1, abdominal examination
At the bottom of the palace, the fetal hip is touched, and the fetal back is biased to the rear or side of the mother. On the opposite side, the fetal limb can be clearly touched. If the fetal head is connected, sometimes the fetal genital ridge can be reached above the pubic symphysis of the fetal limb. The outer side of the umbilicus is most loudly heard. When the back of the pillow is straight, the front chest is close to the abdominal wall of the mother, and it can also be heard on the chest of the fetus.
2, anal examination or vaginal examination
When the anal examination of the cervix is partially expanded or opened, if it is the posterior occipital position, the pelvic cavity is emptied, and the sagittal suture of the fetal head is located on the pelvic slanting path. The anterior iliac crest is in the right front of the pelvis, and the posterior condyle (occipital) is The left posterior pelvis is the left posterior position of the pillow, and the right posterior position of the pillow. The sagittal suture of the fetal head is located on the transverse diameter of the pelvis. The posterior iliac crest is on the left side of the pelvis, which is the left lateral position of the pillow. If there is fetal head edema, the skull overlaps, the cardia is unclear, and a vaginal examination is required to determine the fetal position by the position and direction of the fetal auricle and the tragus. If the auricle is facing the back of the pelvis, it can be diagnosed as the posterior position; The profile faces the side of the pelvis and is the occipital position.
3, B-mode ultrasound examination
According to the position of the face and the occiput of the fetal head, the position of the fetal head can be accurately detected to confirm the diagnosis.
Diagnosis
Diagnosis and identification of persistent posterior occipital and occipital transverse position
According to the position of the face and the occiput of the fetal head, the position of the fetal head can be accurately detected to confirm the diagnosis. Generally, the diagnosis is not diagnosed, but the difference should be the posterior position of the pillow or the transverse position of the pillow.
