Posterior occiput
| Classification according to ICD-10 | |
|---|---|
| O64.0 | Obstacle to childbirth due to incomplete rotation of the child's head - Obstructed childbirth due to persistent child position: posterior occipital position |
| ICD-10 online (WHO version 2019) | |
The posterior occipital position is an obstetric adjustment anomaly of the child in the womb during birth (also known as the stargazer ). In spite of regular flexion, the occiput turns into the sacral sinus . The child's head has literally bowed and steps lower. In contrast to the normal birth mechanism, the occiput rotates towards the sacrum, the arrow suture rotates through the opposite diagonal diameter.
frequency
The posterior occipital position occurs in 0.5 to 1% of all births .
root cause
A b-position of the child's back is very often observed before birth, i.e. the back is left or right behind instead of right or left in front. There is no rotation by 135 degrees forwards to achieve the dorso-anterior setting, the head only rotates 45 degrees backwards.
A cause can also be an unfavorable head shape of the child (small, round head, long head, large head) or an unfavorable pelvis shape, especially the android pelvis.
The proper rotation can also be hindered by myomas in the small pelvis, the presence of arms and hands or by wrapping around the umbilical cord .
Diagnosis
The diagnosis is often only made during birth. On the external examination, the heart sounds can be heard noticeably far to the side of the midline. The child's back is difficult to palpate with the 2nd Leopold handgrip ; ultrasound diagnoses a b-position of the back.
During the internal examination, the small fontanel leads, the arrow suture has the opposite diagonal diameter during the birth process.
therapy
Position the woman in labor on the side of the small fontanel in order to achieve rotation and stepping forward. In the case of protracted expulsion periods, it may also be necessary for multiparous women to terminate labor using a suction cup or forceps .
literature
- Mändle, Opitz, Kreuter “The midwifery textbook of practical obstetrics” ISBN 3-7945-1765-2
