Attitude anomaly
| Classification according to ICD-10 | |
|---|---|
| O64 | Obstruction of birth due to positional, postural and adjustment anomalies of the fetus |
| ICD-10 online (WHO version 2019) | |
When setting anomaly is called an irregular setting of the fetus (to gebärendes child) in the pelvis , the complications of normal birth path may lead.
In preparation for childbirth, the fetus ready for birth normally takes a position that favors the course of the birth or makes it possible in the first place. This consists of a "high transverse head position" (the child's head is aligned across the transverse oval pelvic entrance of the mother's pelvis) and a "high transverse shoulder position".
Anomalies
- high straight position : the head is in or above the pelvic entrance with the arrow suture in a straight diameter. A distinction is made between the front high straight position (the back of the child's head isdirected towardsthe pubic bone ) and the rear high straight position (the back of the head isdirected towardsthe sacrum ). The front high straight stand occurs about 2 to 3 times as often as the rear high straight stand. The cause is usually a pelvic anomaly in the woman giving birth, e.g. B. a long, narrow or flat pelvis. If this positionpersistseven afterthe mother has been given pain medication , relaxed and changed position, a caesarean section may benecessary.
-
Parietal bones adjustment (asynclitism): here the head is positioned across the pelvic entrance, but tilted forwards or backwards.
- The anterior parietal bone adjustment (transverse arrow seam deviates in the sacral direction = "nails obliquity" ) is prognostically more favorable, spontaneous delivery possible.
- The posterior parietal bones adjustment (transverse arrow suture deviates ventrally = "Litzmann obliquity" ) is considered to be pathological, and birth is usually not possible spontaneously.
- Note: front setting: "vörderlich"; rear setting: "obstructive".
- Low transverse position of the head : This is the most common anomaly of adjustment, here the natural rotation of the head by 90 ° in the birth canal is missing . An attempt is made to support a rotation by changing the position of the nut. If it does not occur, a vaginal-operative delivery may be necessary (forceps, suction cup ).
- Posterior occipital position : here the child's face does not point towards the mother's back as it normally does, but towards the stomach ( stargazing ), whereby the child's head with its largest diameter has to slide through the mother's pelvis. Often there is a delayed birth or a birth arrest, which has to be treated with a vaginal-surgical delivery.
The positional anomalies must be distinguished from this :
- Transverse or oblique position - the child lies transversely or obliquely in the uterus - a position that is impossible to give birth and requires intervention (turning, caesarean section).
Pole alignment anomaly: Breech position - the rump of the child appears as the preceding part (VT). Different forms: perfect breech position (most favorable in obstetrics), perfect breech-toe position, imperfect breech-toe position, perfect knee position, imperfect knee position, perfect foot position, imperfect foot position. Spontaneous partus possible under certain conditions (usually only considered in the case of a perfect breech position).
literature
- Pschyrembel Clinical Dictionary. Founded by Willibald Pschyrembel . Edited by the publisher's dictionary editor under the direction of Helmut Hildebrandt. 261st edition. De Gruyter, Berlin 2007, ISBN 978-3-11-018534-8 .
- W. Pschyrembel , JW Dudenhausen: Practical obstetrics. 17th edition. Walter de Gruyter, Berlin 1991, ISBN 3-11-012881-0 , p. 294 ff.
