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Y4R2 - Obstetrics I 🤰 > L5: Malpresentation & Malposition (OP) > Flashcards

L5: Malpresentation & Malposition (OP) Flashcards

1
Q

Def of Occipito-Posterior Position

A
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2
Q

Incidence of Occipito-Posterior Position

A

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

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3
Q

Positions of Occipito-Posterior Position

A
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4
Q

Types of Occipito-Posterior Position

A
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5
Q

Etiology of Occipito-Posterior Position

A
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6
Q

Mechanism of Labor in Occipito-Posterior Position

A
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7
Q

Deflexion in Occipito-Posterior Position is due to ……

A
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8
Q

Degrees of deflexion in Occipito-Posterior Position

A
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9
Q

Descent in Occipito-Posterior Position

A

Delayed

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10
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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11
Q

Internal Rotation in Occipito-Posterior Position

A
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12
Q

Internal Rotation in Occipito-Posterior Position

  • Depends on …..
A
  • degree of deflexion
  • efficiency of uterine contractions
  • pelvic configuration.
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13
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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14
Q

Internal Rotation in Occipito-Posterior Position

  • Normal Mechanism (long anterior Rotation)
A
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15
Q

Internal Rotation in Occipito-Posterior Position

  • Abnormal Mechansim (Short anterior Rotation)
A
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16
Q

Internal Rotation in Occipito-Posterior Position

  • Abnormal mechanism (No Rotation)
A
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17
Q

Internal Rotation in Occipito-Posterior Position

  • Abnormal Mechanism (Posterior Rotation)
A
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18
Q

Factors Favoring Long anterior Rotation

(Good Omens of OP)

A
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19
Q

Factors Favoring Long anterior Rotation

(Good Omens of OP)

  • Power
A
  • Good efficient uterine contractions
20
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)
21
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
22
Q

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

23
Q

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

  • Power
A

Weak uterine contractions

24
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
25
Q

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

  • Passengers
A
  • Persistent marked deflexion of head (commonest cause)
  • Anterior shoulder is far away from midline.
  • Early ROM
  • Delayed engagement
26
Q

Course of Labor in Occipito-Posterior Position

27
Q

Read Dx of Occipito-Posterior Position

28
Q

Managment of Occipito-Posterior Position

A
  • During Pregnancy
  • During Labor
29
Q

Managment of Occipito-Posterior Position

  • During Pregnancy
A

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

30
Q

Managment of Occipito-Posterior Position

  • During Labor
A
  • 1st Stage
  • 2nd Stage
  • 3rd Stage
31
Q

Managment of Occipito-Posterior Position

  • 1st Stage
A

As Normal Labor

32
Q

Managment of Occipito-Posterior Position

  • 2nd Stage
A
  • Wait for 2 hours + observe mother & fetus + give oxytocin drip to correct inertia (if there are no contraindications).
  • Then According to position
33
Q

Managment of Occipito-Posterior Position

  • Long Anterior Rotation
A

The rest of management is as OA.

34
Q

Managment of Occipito-Posterior Position

  • Posterior Rotation (Face to Pubis)
A
  1. Spontaneous vaginal delivery + deep episiotomy.
  2. Outlet forceps extraction + deep episiotomy.
35
Q

Managment of Occipito-Posterior Position

  • DTA
  • Persistent oblique OP
A

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
36
Q

Managment of DTA & Persistent oblique OP

  • Manual Rotation & Forceps Extraction
37
Q

Managment of DTA & Persistent oblique OP

  • Forceps Rotation & Extraction
38
Q

Managment of DTA & Persistent oblique OP

  • Vaccum Extraction & deep Episiotomy
39
Q

Managment of DTA & Persistent oblique OP

  • CS
40
Q

Managment of DTA & Persistent oblique OP

  • Craniotomy
A

If fetus is dead (not done now).

41
Q

Managment of Occipito-Posterior Position

  • 3rd Stage
A

As Normal Labor

42
Q

Complications of Occipito-Posterior Position

43
Q

Complications of Occipito-Posterior Position

  • Prolonged Labor
A

Due to long anterior rotation & abnormal uterine action.

44
Q

Complications of Occipito-Posterior Position

  • PROM
A

Due to ovoid plane of engagement of fetal head.

45
Q

Complications of Occipito-Posterior Position

  • Pernineal & Vaginal Lacerations & tears

Y4R2 - Obstetrics I 🤰 (59 decks)

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