Vertex position

The vertex position is an obstetric posture anomaly of the child in the womb; it represents the first degree of the deflexion position. In the vertex position, physiological flexion has not occurred. In the guide is the arrow suture between the large and small fontanels. In about 15% of the cases there is a dorso-anterior setting , ie the back is in front. The mechanically effective circumference (circumferentia frontooccipitalis) is 35 cm. The parting position is not mentioned in all textbooks.

root cause

The peculiarities of the child's head shape are mostly responsible for the formation of the apex position: often small, round heads that are not obliged to bend and so-called tower skulls . In addition, deformities (e.g. neck tumors) of the child and flexion disabilities such as "hand under chin" and the wrapping of the umbilical cord can be the cause. The apex position is also often observed in premature births, as well as in stillbirths , since there is no internal tension here.

Diagnosis

A clear diagnosis is difficult. During the internal examination, the arrow suture is located between the large and small fontanels; the child's eyebrows cannot be palpated, as otherwise it would be a forehead position . In the dorso-posterior setting, the arrow suture has the diagonal diameter opposite the back.

Course of birth

In the literature, on the one hand, a protracted course is described with vertex attitudes and, on the other hand, that if the cause is a small child, the births often proceed very quickly. The position of the back is certainly also decisive for the prognosis (dorso-anterior or dorso-posterior), but there is no information about this in the literature.

Since the perineum and rectum are loaded by the occiput to a greater extent and earlier than in the physiological anterior occipital position, the woman who gives birth feels a premature urge to press if the patient is positioned dorso-anterior.

The bracing point ( hypomochlion ) (in the dorso-anterior setting) at the exit of the head is the forehead-hair border. There is a flexion in which the occiput is born over the perineum, the face is then born facing the symphysis.

Therapy and Complications

An attempt should be made to position the woman on the side of the small fontanel or on the side of the child's back to change the vertex position through rotation and flexion into a proper occipital position. If the birth arrests, depending on the height of the child's head, either a vaginal surgical termination of labor ( suction cup or forceps ) or a caesarean section must be performed.

Because the child's head takes up more space, there is an increased risk of injury to the mother. Due to the delayed course, there is a risk of oxygen deficiency in the child.

literature

• Mändle, Opitz, Kreuter “The midwifery textbook of practical obstetrics” ISBN 3-7945-1765-2
• Pschyrembel "Practical Obstetrics"
• Martius "Midwife Textbook"

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !