Forehead position
| Classification according to ICD-10 | |
|---|---|
| O64.3 | Obstacle to birth due to position of the forehead |
| ICD-10 online (WHO version 2019) | |
The forehead position is an obstetric posture anomaly in the child in the womb. The physiological flexion of the child's head has not taken place and has turned into an extension, the forehead has taken the lead. One also speaks of an extension or deflection position. Because a maximum extension to the face position has not been achieved, some authors speak of an imperfect face position . The forehead position is the most unfavorable of the deflection positions, since the obstetrically largest head circumference is 37–39 cm. If the forehead has already taken the lead in the pelvic entrance , then, according to the exact definition, there is an anomaly in attitude ; one speaks of a forehead position .
frequency
The frequency of the forehead position is given as 1: 2000 to 3000 births.
root cause
Child causes can be an unfavorable head shape (long head) or child malformations (e.g. anencephaly ). The obstruction of the stretching in an obstetrically more favorable facial position can z. B. be caused by a pronounced birth tumor, the occiput getting caught on the promontory or by an umbilical cord looping.
Diagnosis
The external examination reveals a b-position of the child's back during the second Leopold manipulation (back is left or right behind, instead of left or right in front). With the third and fourth Leopold manipulations, the occiput should be palpated from the side.
The internal examination reveals an irregular, comparatively "angular" preceding part. The root of the nose, the eyebrows and possibly the mouth are palpable. If the nose is not attainable and definitely the head stretched, is a leading main location before. If the chin is palpable, it is a face position. The internal examination should be carried out very carefully and gently if a posture anomaly is suspected, there is a risk of eye and eye socket injuries in the child.
Course of birth
When the head is in the forehead position, the head has usually already been stretched at the pelvic entrance. In the course of the birth it can still adjust to the face position. In the vaginal examination , the forehead suture (runs from the large fontanel towards the nose) corresponds to the orientation , corresponding to the arrow suture in the anterior occipital position . This forehead suture runs in the opposite diagonal diameter as the child tries to assume a dorsoposterior position. On the pelvic floor , the forehead adjusts to an approximately oblique diameter. The hypomochlion , when the head emerges, is the zygomatic bone , whereby the face uses more space under the pubic arch than the upper jaw, which is also used as a clamping point. The head bends until the occiput can be born over the perineum . An extension takes place, the rest of the face is born under the symphysis. In the case of perineum protection , the Ritgen rear perimeter handle can be used to facilitate flexion and extension .
Complications
The birth is very delayed, often resulting in labor disorders and birth arrest . Attempting to terminate labor vaginally with forceps can injure the mother. Since the face does not seal properly, a rupture of the bladder can lead to an umbilical cord prolapse . Cerebral haemorrhage , tentorial tears and a lack of oxygen can occur in the child .
particularities
The forehead position is very rarely observed, mainly because the forehead position usually changes into a face position. A spontaneous delivery is theoretically possible. In modern obstetrics, however, due to the high morbidity and mortality rate of the child (around 33%), there is an absolute indication for caesarean section .
literature
- Mändle, Opitz, Kreuter: The midwifery textbook of practical obstetrics . ISBN 3-7945-1765-2 .
