Fore-head position

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The frontal position is an obstetric postural abnormality of the child in the womb. The frontal position represents the second degree of the deflection posture. In contrast to the indifferent posture in the apex position , an extension has occurred in the frontal position. The large fontanel is in the lead , the occiput rotates towards the sacrum, the child's back is behind (dorsoposterior). The dorso-anterior position of the head (back) is described as a very rare phenomenon in the literature. The mechanically effective circumference ( circumferentia frontooccipitalis ) is 35 cm.

frequency

The frequency of the frontal position is given as 0.9%.

root cause

Characteristics of the child's head shape are usually responsible for the development of the forehead position: often small, round heads and so-called tower skulls , and deformities in the child can also be the cause. Second twins , small immature children, and stillbirths are often born in the frontal position.

A severe rigidity of the pelvic floor and spasms in the lower uterine segment are given as maternal causes .

Diagnosis

During the internal examination, the large fontanel is in the lead and the child's eyebrows can be palpated. The arrow seam goes the diagonal diameter opposite the back.

Course of birth

As with all posture anomalies, especially the expulsion period , it is very likely that it will be delayed. Since the perineum and the rectum are loaded by the occiput to a greater extent and earlier than in the physiological anterior occipital position, the woman in labor feels a premature urge to press. The point where the head emerges ( hypomochlion ) is the forehead-hair border. There is a flexion in which the forehead, then the vertex and occiput, are born over the perineum, with the subsequent stretching the forehead and face are born looking towards 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 forecapital position by rotation and flexion into a proper occipital position. If the head does not go deeper when the labor is good, the woman in labor must be positioned on the side of the large fontanel to allow passage through the pelvis. Eventually, the fore-head position becomes a rear 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"