11 Questions
What is the result of incomplete rotation of occiput posterior to occiput anterior during labor?
Occipito-transverse position
How can impaired gas exchange be managed during labor?
Encouraging the mother to lie on her side
What does a persistent occiput transverse position during labor indicate?
Ineffective contractions or a flattened bony pelvis
Which nursing intervention is recommended to relieve back pain during labor?
Applying sacral counter-pressure with heel of hand
When should a cesarean section be considered during labor?
If there are signs of obstruction or abnormal fetal heart rate
What nursing management technique can assist in rotation of the fetus during labor?
Encouraging pelvic-rocking movements
What is the most ideal fetal position for vaginal birth?
Left occipito-anterior position
What is the main risk associated with an occipito-posterior position?
Arrested labor due to lack of rotation and/or descent of the fetal head
What is the maternal symptom associated with an occipito-posterior position?
Intense back pain during labor
What is the progression of fetal positioning in an occipito-posterior delivery?
(A) Fetus in cephalic presentation, LOP position, (B) Descent and flexion, (C) Internal rotation beginning, (D) Internal rotation complete, (E) Extension
What is the key difference between a normal left occipito-anterior (LOA) delivery and an occipito-posterior delivery?
The degree of fetal rotation
Study Notes
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 in obstetrics, including occipito-posterior and occipito-transverse positions. Understand the ideal Left Occipito-anterior position for vaginal birth and its assessment during labor.
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