What is the back of the head transverse position

Persistent occipital dystocia

introduction

Introduction to Persistent Occipital Dystocia

The continuous occipital position is due to the connection of the fetal head with the transverse occipital position during delivery. During the descending process, when twice the top diameter of the fetal head reaches or approaches the mid-pelvic plane, most of the internal rotation can be completed and turned into one Pillow can be converted. Natural birth. 5% to 10% by the end of the birth, the back of the head of the fetus cannot rotate further forward, nor behind the pelvis or to the side of the mother.

Basic knowledge

The proportion of the disease: the incidence rate of pregnant women is about 0.01% -0.05%

Vulnerable people: good for pregnant women

Type of infection: not contagious

Complications: postpartum bleeding, hemorrhagic shock

Pathogen

Persistent occipital dystocia

(1) causes of disease

The occurrence of a persistent occipital transverse position is influenced by several factors as well as a persistent posterior occipital position.

1. Abnormal pelvis morphology and size: Shallow and male pelvis are prone to persistent transverse occipital positions. According to the survey, the two make up 43.23%, of which the shallow pool makes up 23.88%. The reason the sustained occipital position is good is flat. The type and male pelvis are due to the short anterior and posterior diameters of the shallow pelvis and the narrowing of the anterior half of the male pelvic inlet so that the anterior and posterior diameters of the entrance can be shortened. The shallow pelvis has a range of transverse diameters and the anteroposterior diameter is reduced. Therefore, the fetal head moves to the occipital position to the pelvic floor, which is called the lower transverse position of the fetal head, while the male pelvis must be converted to the front position before reaching the middle pelvis. Otherwise, the transverse diameter of the pelvis in the male pelvis will be short and the fetal head will not be able to rotate forward in this plane.

2. The size of the pillow is not mentioned: it prevents the pillow from rotating.

3. Poor flexion of the fetal head: The transverse occipital position can still be caused by poor flexion of the fetal head, which increases the diameter of the fetal head through the birth canal and hinders rotation of the fetal head.

4. Weak uterine contractions: natural or anesthetic uterine contractions can affect the rotation and retraction of the fetal head.

(two) pathogenesis

The occipital transverse position is divided into the left transverse position and the right transverse position of the pillow. No internal rotation occurs during the partial lowering of the pedestal, or the occipital part of the occipital position is only rotated forward 45 ° to form a continuous transverse occipital position. Although the transverse occipital position can be delivered through the vagina, most of them will have to use the hand or the fetal head aspiration technique to transfer the fetal head to the anterior occipital position.

prevention

Prevention of Persistent Occipital Dystocia

The persistent occipital position has the highest incidence in the abnormal position of the fetal head and also represents the smallest abnormal position of the fetal head. The degree of dystocia is the smallest among the abnormalities of the position of the fetal head. However, the operation rate is high. Although the caesarean section rate is lower than the persistent occipital position, the vaginal relief rate is higher than the persistent occipital position. Since it is the slightest abnormality in the fetal position, the position of the fetal head is low and is often not taken seriously, eventually leading to serious complications for both mother and child. The cause of the formation is similar to the persistence of the posterior occipital position. Vaginal exam, B-ultrasound can confirm the diagnosis. In addition to the obvious countertop basin, which is not mentioned, a trial can be made. Maintain good productivity during the work process and closely watch the expansion of the cervix and the decline of the fetal head. If the head of the fetus fails to bandage after a full test production, or if the cervix cannot fully expand, the caesarean section will terminate the pregnancy. When the occipital transverse head reaches 2 or less, it can be used for vaginal surgery. Surgical midwives should be productive and be careful about the illusion that the fetal head is deforming and that the tumor is causing the fetal head to be in a lower position.

1. Inadequate or extensive use of antipsychotics or central nervous system stimulants can lead to tics of tics or tics.

2, reasonable arrangements for children's daily working hours and activities, in order to avoid excessive tension and fatigue, can participate in rhythmic sports activities.

complication

Persistent occipital transverse dystocia complicationsComplications postpartum hemorrhagic shocks

Postpartum Bleeding: Clinical manifestations are mainly vaginal bleeding, hemorrhagic shock, and secondary anemia when excessive blood loss can be complicated by diffuse intravascular coagulation. The severity of symptoms differs depending on the amount of blood loss, the rate, and the combination of anemia. In the short term, bleeding can occur quickly. It should be noted that in the early stages of the shock, due to the compensatory mechanism in the body, vital functions such as pulse and blood pressure may be in the normal range, but strict monitoring, the early detection of common risk factors, the assessment of blood loss and active treatment are still required. . In clinical practice, with a certain degree of decompensation, such as increased heart rate and drop in blood pressure, attention is paid to the loss of blood, so that the best time for treatment is lost. If the mother has already suffered from anemia, shock can occur and correction is difficult. Therefore, every woman must be carefully observed and analyzed to avoid delays in the rescue.

symptom

Persistent occipital lateral dystocia symptoms CommonSymptoms Fatigue Male pelvis after childbirth Poor flexion Fatigue Cervical edema Soft birth canal Abnormal occipital transverse position in the pelvis Head pelvis is not called anus bulge defect

symptom

(1) After delivery, the fetal head is connected late, which can lead to weak uterine contractions, slow expansion of the cervix, and stagnation of the fetal head.

(2) Maternal conscious angulation and bowel movements are early.

(3) mother's fatigue: related to the mother not opening the mouth of the palace, is not aware of the hand.

(4) cervical edema, labor progression is slow.

2nd character

(1) Examination of the abdomen: At the lower end of the palace, the fetal hip is touched and the fetal back is biased backwards or to the side of the mother. The anterior abdominal wall lightly touches the fetal limb. When the fetal head is connected, the fetal ankle on the side of the fetal limb above the pubic symphysis can sometimes be touched. On the face, the heart sound of the fetus is most clearly heard on the lower side of the navel, as the fetal back is biased backwards or to the mother's side, i.e. H. The part near the fetal back is most clearly heard.

(2) Anal examination: the anal examination of the pelvic cavity is empty, the sagittal suture of the fetal head is on the pelvic slope or on the anteroposterior diameter, the sulcus sacralis anterior and posterior is on both sides of the pelvis, and the sagittal suture of the fetal head is on the transverse pelvic diameter. The upper and lower ribs are on the left side of the pelvis, the left lateral position of the pillow, and vice versa (Fig. 1).

(3) Vaginal Examination: If the cervix is ​​open, there is fetal head edema, and if the skull is overlapped, the vaginal examination is feasible, the position of the fetus is determined according to the direction of the auricle and tragus, and the auricle is to the side of the pelvis aligned pillow horizontal position.

Investigate

Continuous occipital dystocia examination

The accuracy of the ultrasound examination can reach more than 90%. Ultrasound examination can be used to understand the changes in the lateral position of the occipital and timely treatment.

diagnosis

Diagnosis and identification of persistent occipital dystocia

Diagnostic criteria

1. Pelvic Examination: In the shallow and male pelvis, the fetus's head should be made aware of the possibility of a sustained transverse occipital position in the pelvis with the occipital position.

2. If the working curve is abnormal and the occiput position has dystocia performance, the working curve shown in the working curve is abnormal and roughly corresponds to the sustained posterior position.

3. Characteristics of the lateral position of the pillow:

(1) Abdominal Examination: Half of the mother's abdomen is occupied by the fetal limbs, the other half by the back of the fetus, the upper part of the shame is touched further than the front of the occipital position, and the occipital transverse head is not bent and the fetal head is occupied The side is the two ends of the occipital forehead, the average is 11.3 cm, which may be a little less depending on the degree of flexion. The crest of the skull of shame is not the same and the side of the fetal occipital bone is higher than the frontal bone. The side, such as the left lateral position of the pillow, can be combined with the upper left iliac crest and the occipital part (round, hard) on the left side of the lower abdomen; the occiput is 3 fingers high on the pubic symphysis while the right Side of the forehead can only be one finger. High, like the right lateral position of the pillow, the direction is opposite, the follow-up of the fetal head should be based on the occipital side by default, if the left lateral position of the occipital is always in the left lower abdomen of the mother, then the height of the occipital part should be be touched. To touch the first part of the forehead is just ashamed, and the misunderstanding that the head of the fetus has fallen off by 2 fingers. On the opposite side of the fetal occipital area, the crotch below the forehead can be touched, but it's too biased. The lateral side is not as easy to reach as the back position of the pillow, and the fetal heart is loudest on the side of the lower abdomen on the same side of the back of the head.

(2) Anal and vaginal examination: the sagittal suture of the fetal head is on the transverse diameter of the pelvis. When childbirth is not in use, or when the head pelvis is not called, the fetal head can be bent laterally and reduced to the diameter of the pelvis. All of them are poured into the pelvis so that the back top enters the pelvis first, and the sacral curvature is used to pull back to slide the front top down from the shame to form an even slope, and then to fall so that the sagittal seam of the fetal head goes forward and close to the shame first. Union, and then back to the pelvis in the middle of the transverse diameter, is the normal birthing machine if the transverse occipital position to take the anterior uneven slope into the pelvis (pre-uniform immersion) for abnormal childbirth is discussed in the next chapter, pillow on the right In this position, the front crouch is on the left side of the pelvis and the crouch is on the right. With the left side of the pillow in the horizontal position, the front squat is on the right side of the pelvis and the squat is on the left.

Differential diagnosis

1. The unequal position of the occiput and the head pelvis are not mentioned: the occiput transverse position cannot be diagnosed as the unequal unequal position, and the unequal position after the occiput transverse position is accompanied by the head pelvis. According to the identification, the uneven head tilt combined with the head pelvis does not mean that the fetal head cannot be connected and lowered, the sagittal suture of the fetal head is in front of the transverse diameter of the pelvis, and the rear uneven tilt of the left occipital lateral position is the fetal head edema On the left parietal bone, when the transverse position of the right occiput is unevenly inclined, the fetal head edema is located, on the right parietal bone, which can be distinguished from the anterior uneven inclination.

2. The horizontal position of the occipital position: the common point is that the sagittal suture of the fetal head coincides with the transverse diameter of the pelvis, the difference is that the uneven insertion of the fetal head into the pelvis before the occipital transverse position is more difficult than the horizontal one Position of the occipital The vaginal examination of the sagittal suture is not located in the middle of the pelvic plane and is mostly paralyzed. Most of the anterior inferior tilt position is difficult to move through the vagina. The edema of the parietal bone in the postpartum may help with identification.

3. The anterior position of the cushion, the posterior position of the cushion: the anterior anterior and posterior iliac crests move backward when the anterior is inclined unevenly. When the left lateral occipital position is inclined unevenly into the pelvis, the anterior crouch is at 7 a.m. to 8 a.m. Position, easy to mistakenly think that the occipital left position, the posterior iliac crest at 4 to 5 o'clock position, easy to mistakenly think that the occiput left position, the key to diagnosis is to find out the sagittal direction of the seam, parallel to the transverse diameter of the pelvis, transverse radial transfer into the anterior uneven inclination position and finally observing the fetal head edema site, the previous uneven inclination position is more difficult due to the vaginal delivery, vaginal delivery is prone to soft birth canal tears.