L5: Malpresentation & Malposition (OP) Flashcards by Ahmed Farag

Q

Def of Occipito-Posterior Position

A

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Q

Incidence of Occipito-Posterior Position

A

30-40% during last weeks of pregnancy & 20% at onset of labor

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Q

Positions of Occipito-Posterior Position

A

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Q

Types of Occipito-Posterior Position

A

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Q

Etiology of Occipito-Posterior Position

A

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Q

Mechanism of Labor in Occipito-Posterior Position

A

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Q

Deflexion in Occipito-Posterior Position is due to ……

A

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Q

Degrees of deflexion in Occipito-Posterior Position

A

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Q

Descent in Occipito-Posterior Position

A

Delayed

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Q

Engagement in Occipito-Posterior Position

A

Delayed

Engaging longitudinal diameter is SOF (10 cm) or OF (11.5 cm). ~ Sob needs full fex
BPD (9.5 cm) enters pelvis in sacrocotyloid diameter (9.5 cm).

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Q

Internal Rotation in Occipito-Posterior Position

A

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Q

Internal Rotation in Occipito-Posterior Position

Depends on …..

A

degree of deflexion
efficiency of uterine contractions
pelvic configuration.

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Q

Internal Rotation in Occipito-Posterior Position

Mechanisms

A

Normal mechanism long anterior rotation (90%)
Abnormal mechanisms (failed long anterior rotation (10%)

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Q

Internal Rotation in Occipito-Posterior Position

Normal Mechanism (long anterior Rotation)

A

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Q

Internal Rotation in Occipito-Posterior Position

Abnormal Mechansim (Short anterior Rotation)

A

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Q

Internal Rotation in Occipito-Posterior Position

Abnormal mechanism (No Rotation)

A

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Q

Internal Rotation in Occipito-Posterior Position

Abnormal Mechanism (Posterior Rotation)

A

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Q

Factors Favoring Long anterior Rotation

(Good Omens of OP)

A

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Q

Factors Favoring Long anterior Rotation

(Good Omens of OP)

Power

A

Good efficient uterine contractions

Q

Factors Favoring Long anterior Rotation

(Good Omens of OP)

Passages

A

Roomy pelvis & no cavity or outlet contraction
Good pelvic floor è proper tonicity (neither rigid nor weak)

Q

Factors Favoring Long anterior Rotation

(Good Omens of OP)

Passengers

A

Well flexed average sized head
Anterior shoulder isn’t far away from midline.
No PROM
Early engagement

Q

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

A

Q

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

Power

A

Weak uterine contractions

Q

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

Passages

A

Abnormal shape of pelvic brim & narrow transverse diameter of outlet
Relaxed or weak pelvic floor
Full bladder & rectum, placenta previa & pelvic tumors

Factors Unfavoring Long anterior Rotation (Bad Omens of OP) - Passengers

- **Persistent marked deflexion of head (commonest cause)** - Anterior shoulder is far away from midline. - Early ROM - Delayed engagement

Course of Labor in **Occipito-Posterior Position**

Read Dx of **Occipito-Posterior Position**

Managment of **Occipito-Posterior Position**

- During Pregnancy - During Labor

Managment of **Occipito-Posterior Position** - During Pregnancy

Exaggerated It lateral position hoping for correction into OA (of little value).

Managment of **Occipito-Posterior Position** - During Labor

- 1st Stage - 2nd Stage - 3rd Stage

Managment of **Occipito-Posterior Position** - 1st Stage

As Normal Labor

Managment of **Occipito-Posterior Position** - 2nd Stage

- Wait for 2 hours + observe mother & fetus + give oxytocin drip to correct inertia (if there are no contraindications). - Then According to position

Managment of **Occipito-Posterior Position** - Long Anterior Rotation

The rest of management is as OA.

Managment of **Occipito-Posterior Position** - Posterior Rotation (Face to Pubis)

1. Spontaneous vaginal delivery + deep episiotomy. 2. Outlet forceps extraction + deep episiotomy.

Managment of **Occipito-Posterior Position** - DTA - Persistent oblique OP

Head can't be delivered spontaneously & they can be dealt e by one of the Vip following methods depending on fetal size, pelvic configuration, general condition of mother & fetus & skills of obstetrician: - Manual rotation& forceps extraction - Forceps Rotation & Extraction - Vacuum Extraction & Deep Episiotomy - CS - Craniotomy

Managment of DTA & Persistent oblique OP - Manual Rotation & Forceps Extraction

Managment of DTA & Persistent oblique OP - Forceps Rotation & Extraction

Managment of DTA & Persistent oblique OP - Vaccum Extraction & deep Episiotomy

Managment of DTA & Persistent oblique OP - CS

Managment of DTA & Persistent oblique OP - Craniotomy

If fetus is dead (not done now).

Managment of **Occipito-Posterior Position** - 3rd Stage

As Normal Labor

Complications of **Occipito-Posterior Position**

Complications of **Occipito-Posterior Position** - Prolonged Labor

Due to long anterior rotation & abnormal uterine action.

Complications of **Occipito-Posterior Position** - PROM

Due to ovoid plane of engagement of fetal head.

Complications of **Occipito-Posterior Position** - Pernineal & Vaginal Lacerations & tears

No b