L5: Malpresentation & Malposition (OP)

Question 1

Def of Occipito-Posterior Position

Answer 1

Question 2

Incidence of Occipito-Posterior Position

Answer 2

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

Question 3

Positions of Occipito-Posterior Position

Answer 3

Question 4

Types of Occipito-Posterior Position

Answer 4

Question 5

Etiology of Occipito-Posterior Position

Answer 5

Question 6

Mechanism of Labor in Occipito-Posterior Position

Answer 6

Question 7

Deflexion in Occipito-Posterior Position is due to ……

Answer 7

Question 8

Degrees of deflexion in Occipito-Posterior Position

Answer 8

Question 9

Descent in Occipito-Posterior Position

Answer 9

Delayed

Question 10

Engagement in Occipito-Posterior Position

Answer 10

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).

Question 11

Internal Rotation in Occipito-Posterior Position

Answer 11

Question 12

Internal Rotation in Occipito-Posterior Position

• Depends on …..

Answer 12

• degree of deflexion
• efficiency of uterine contractions
• pelvic configuration.

Question 13

Internal Rotation in Occipito-Posterior Position

• Mechanisms

Answer 13

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

Question 14

Internal Rotation in Occipito-Posterior Position

• Normal Mechanism (long anterior Rotation)

Answer 14

Question 15

Internal Rotation in Occipito-Posterior Position

• Abnormal Mechansim (Short anterior Rotation)

Answer 15

Question 16

Internal Rotation in Occipito-Posterior Position

• Abnormal mechanism (No Rotation)

Answer 16

Question 17

Internal Rotation in Occipito-Posterior Position

• Abnormal Mechanism (Posterior Rotation)

Answer 17

Question 18

Factors Favoring Long anterior Rotation

(Good Omens of OP)

Answer 18

Question 19

Factors Favoring Long anterior Rotation

(Good Omens of OP)

• Power

Answer 19

• Good efficient uterine contractions

Question 20

Factors Favoring Long anterior Rotation

(Good Omens of OP)

• Passages

Answer 20

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

Question 21

Factors Favoring Long anterior Rotation

(Good Omens of OP)

• Passengers

Answer 21

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

Question 22

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

Answer 22

Question 23

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

• Power

Answer 23

Weak uterine contractions

Question 24

Factors Unfavoring Long anterior Rotation

(Bad Omens of OP)

• Passages

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

Question 27

Read Dx of **Occipito-Posterior Position**

Answer 27

Question 28

Managment of **Occipito-Posterior Position**

Answer 28

- During Pregnancy - During Labor

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

As Normal Labor

Question 32

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

Answer 32

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

Question 33

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

Answer 33

The rest of management is as OA.

Question 34

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

Answer 34

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

Question 35

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

Answer 35

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

Question 36

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

Answer 36

Question 37

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

Answer 37

Question 38

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

Answer 38

Question 39

Managment of DTA & Persistent oblique OP - CS

Answer 39

Question 40

Managment of DTA & Persistent oblique OP - Craniotomy

Answer 40

If fetus is dead (not done now).

Question 41

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

Answer 41

As Normal Labor

Question 42

Complications of **Occipito-Posterior Position**

Answer 42

Question 43

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

Answer 43

Due to long anterior rotation & abnormal uterine action.

Question 44

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

Answer 44

Due to ovoid plane of engagement of fetal head.

Question 45

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

Answer 45

No b