High straight position

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Classification according to ICD-10
O64.0 Obstacle to birth due to incomplete rotation of the child's head
ICD-10 online (WHO version 2019)

The high straight position is an obstetric anomaly of the attitude of the child in the womb. An irregularity in the setting refers to the relationship of the preceding part to the birth canal. The arrow suture , the longest axis of the child's head, which is physiologically transverse at the entrance to the pelvis , has a straight diameter, the smaller diameter of the elliptically shaped pelvis, when it is straight. The shape adaptation to the transversely oval pelvic entrance, which is normally carried out by the head with the transverse diameter, has not taken place here or there are causes that prevent a shape adaptation. The cervix is open at least 8–10 cm, the amniotic sac is open and the woman giving birth has strong contractions , before that one speaks of a tendency to stand tall .

Classification

  • Dorso-anterior high straight position (2/3 of the cases): anterior high straight position. The child's back is directed forward towards the mother's stomach. The head is placed on the pelvis, the arrow suture is straight in diameter, the small fontanelle is directed towards the symphysis.
  • Dorsoposterior high straight position (1/3 of the cases): posterior high straight position. The child's back is directed backwards, the small fontanel is directed towards the sacrum.

frequency

A tendency towards a high straight position, i.e. a straight arrow seam during the opening period, is evident in approx. 2-3% of all births. Usually it is a temporary adjustment anomaly, because about two thirds of these children turn spontaneously during the birth and then literally step into the pelvis. The maladjustment persists in approx. 0.5% of all births. The child remains in the pelvic entrance with a straight arrow seam until it is fully opened. Only now does one speak of a really high straight position.

root cause

  • Maternal cause: The most common cause seem to be spastic changes in the area of ​​the pelvic entrance, for example a spasm in the lower uterine segment or tense maternal lumbar muscles. A long, flat or generally narrowed bony pelvis is less common. Other causes can be deep-seated myomas or a form of placenta previa .
  • Child-related cause: The cause here can be a head that is too large, for example hydrocephalus (water head), or the presence of small parts (e.g. hand), which can lead to an impairment of rotation.

A high level of straightness can also occur in combination with other irregularities when the point is that the head is temporarily trying to achieve the most favorable shape adaptation to the pelvic entrance. The cause often remains unclear.

Diagnosis

  • Early indications are an upstanding infantile head infantile spinal is right behind (IIb-position), instead of the left or right front (Ia or IIa-position), a protracted course, premature rupture of membranes, ineffective contractions
  • With the 3rd Leopold handle , the head feels noticeably narrow
  • The Zangemeister handle is positive, the head hand is the same as or higher than the symphysis hand.
  • The child's heart tones can be heard most clearly in the midline (front, high straight position) or to the side (rear, high straight position).
  • The vaginal examination reveals a high head that does not go deeper despite the opening of the cervix. The arrow seam is straight. As long as the head is not bent, both fontanelles feel at the same level.
  • After the rupture of the bladder , the scalp swells up to a caput succedaneum (birth tumor) during vigorous labor. Many women now feel the urge to press, despite their high heads.

course

The opening period is protracted because the head does not go lower and therefore does not press on the cervix. Some children also bend their straight head maximally in the pelvic entrance, in the sense of a Roederer head position . This enables the head circumference to be reduced. The head can enter the pool. A dorsoposterior high straight position then changes into a posterior occipital position , but can also be established as a regular anterior occipital position . If the patient remains in a straight position for 2 hours without the birth progress, the birth must be ended with a caesarean section , depending on the intensity of the labor because of the risk of a uterine rupture .

therapy

  • Change of the birthing position, especially alternating position (swing position)
  • Epidural anesthesia to achieve maximum relaxation for the mother and to relieve pain
  • Warmth, massage, aromatherapy , also to relax the mother
  • Knee-head or knee-elbow positioning so that the head slips away from the symphysis and can readjust itself
  • Ball handle according to Liepmann
  • Caesarean section (caesarean section)

See also

literature

  • Mändle, Opitz, Kreuter “The midwifery textbook of practical obstetrics” ISBN 3-7945-1765-2
  • U.Harder "High straightness of the head" in The Midwife 4-2008