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Occiput Posterior
Aka: Occiput Posterior, Occipitoposterior Malpresentation, OP Presentation
- See Also
- Fetal Position
- Fetal Malpresentation
- Fetal Presentation
- Fetal Lie
- Twin Gestation
- Occiput Posterior
- Breech Presentation
- Face Presentation
- Brow Presentation
- Definition
- Abnormal Fetal Position with occiput at maternal Sacrum
- Fetal face towards maternal Symphysis Pubis
- Epidemiology
- Represents 10% of Fetal Positions
- Physiology
- Less favorable fetal head diameter for delivery
- Deflexion of fetal head
- Posterior presentation
- Usually corrects spontaneously
- Rotates to Occiput Anterior position in 90% of cases
- Symptoms
- Back labor
- Prolonged labor
- Nulliparous: Additional two hours
- Multiparous: Additional one hour
- Signs: Digital cervical exam
- Asymmetric cervical dilation
- Persistant anterior lip
- Palpation of fetal head
- Fetal anterior Fontanel most palpable
- Follow sagittal Suture to posterior Fontanel
- Posterior Fontanel, lambdoid Suture with be posterior
- Complications
- Failure to Progress
- Extended episiotomy or perineal Laceration
- Management
- Spontaneous Delivery (anticipate in 45% of cases)
- Maternal position changes (unclear efficacy)
- Any position in which mother curls forward from hips
- Hands and knees
- Squatting
- Manual rotation during vaginal exam
- See Manual Rotation in Occipitoposterior Presentation
- Vacuum Delivery
- Place vacuum cup as posterior as possible
- Inproves flexion of fetal head
- Do not use vacuum to rotate fetal head
- Results in Scalp Laceration
- Forceps Delivery
- Forceps Rotation (skilled clinician only)
- Techniques: Scanzoni or Kielland
- Requires immediate Ceserean back-up
- Rarely performed in U.S. now