Obstetrics: Problems with Fetal Passenger

Fetal Malposition

• Fetal malposition refers to positions other than occipito-anterior position during labor
• Malpositions include occipito-posterior and occipito-transverse positions of the fetal head in relation to the maternal pelvis
• Fetal malpositions are more common in multipara or those with lax abdominal wall
• Fetal malpositions are assessed during labor

Occipito-Anterior Position

• The most ideal position for vaginal birth
• The fetus rotates 90 degrees from this position during labor

Occipito-Posterior Position

• Can cause arrested labor, perineal tears, or extension of an episiotomy
• Maternal risks include prolonged labor, potential for operative delivery, extension of episiotomy, and 3rd or 4th degree laceration of the perineum
• Maternal symptoms include intense back pain in labor, dysfunctional labor pattern, prolonged active phase, secondary arrest of dilation, and arrest of descent
• The fetus rotates 135 degrees from this position during labor

Occipito-Transverse Position

• Incomplete rotation of OP to OA results in the fetal head being in a horizontal or transverse position
• Persistent occiput transverse position occurs as a result of ineffective contractions or a flattened bony pelvis
• Diagnosis involves abdominal examination and vaginal examination
• Ultrasound can be used to confirm diagnosis

Nursing Management

• Impaired gas exchange: encourage the mother to lie on her side, use knee-chest position, and pelvic-rocking to facilitate rotation
• Pain: encourage relaxation with contractions, apply sacral counter-pressure, and provide comfortable environment
• Fatigue: assess psychological and physical factors, monitor physical response, and monitor fetal heart beat and contractions
• Anxiety: keep client and family informed, provide support, and identify client's perception of threat

Medical Management

• If there are signs of obstruction or abnormal fetal heart rate, deliver by cesarean section
• If membranes are intact, rupture them with an amniotic hook or a Kocher clamp
• If cervix is not fully dilated and there are no signs of obstruction, augment labor with oxytocin
• If cervix is fully dilated but there is no descent in the expulsive phase, assess for signs of obstruction

Learn about fetal malpositions such as occipito-posterior and occipito-transverse, and the ideal left occipito-anterior position for vaginal birth. This lesson covers assessments during labor and the significance of LOA position in cephalic presentation.