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Occipital presentation of the fetus: high upright standing of the head
Last reviewed: 23.04.2024
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The position of the fetus, that is, the ratio of its back to the wall of the uterus, is correct when the back is turned to the side. Deeply incorrect position, in which the back is facing straight ahead or right back. In these cases, complications may occur during childbirth, since the head with its largest size (straight) is inserted into the smallest size of the entrance to the small pelvis - into the direct entry size, into the true conjugate.
Depending on where the back and occiput are facing - towards the symphysis or back to the cape - there are two types of high standing: the front, positio occipitalis pubica s. Anterior, and posterior, positio occipitalis sacralis s. Posterior.
The flexed back of the fetus is more easily reduced in front, respectively, protrusion of the uterine wall and abdominal wall than behind, where there is protuberance due to physiological lordosis of the mother's spine. This is why the front view is more often seen from the posterior. Characteristic for these anomalies of insertion is the finding of a swept suture in the direct size of the entrance to the pelvis. Thus, the high direct standing of the head is usually designated as such when it is in a state of flexion and stands at the entrance to the pelvis with a swept suture in the direct size of the pelvis.
The reasons for the high direct standing of the head are varied. It occurs in different forms of the head and in various forms of the pelvis, both in normal and flat, transversely depressed, funnel-shaped, generally uniformly depressed.
[How to recognize a high direct head stand?
Before the outflow of water, a high direct stance of the head is often not diagnosed, and since it is rare, the possibility of its occurrence can simply be forgotten. However, even before the outflow of water it is possible to suspect such a deviation: above the entrance to the small pelvis an unusually narrow head, hanging over the pubic symphysis, is determined, which is shifted by hands across. During childbirth, the sagittal stitch remains in a straight line throughout the entire length of the birth canal, except for temporary deviations to the side. The period of exile is prolonged, because for a successful expulsion a strong skull configuration is necessary.
Childbirth with a high straight head stand?
The result of childbirth with high direct standing of the head depends on many factors: the nature of the birth forces, the correspondence between the mother's pelvis and the size of the fetal head, and the ability of the head to be configured.
With good generic activity, the head can move, the swept suture is inserted into one of the oblique sizes and the birth ends in the type of occipital insertions. If such a shift does not occur, the high direct stance of the head passes into a high direct insertion and the delivery takes a pronounced pathological character: contractions intensify, become sharply painful, prolonged.
The forward view of a high direct insertion of the head is more favorable in comparison with the posterior one, since with it one can more often expect spontaneous delivery. However, they do not occur in more than half the cases. A small head can pass through the entire birth canal without an internal rotation. The first movement of the delivery mechanism is flexion, with the suboccipital region resting on the symphysis, along the headland there is a region of a large fontanel and forehead; then comes the second turn - extension, and the head rolls out from under the pubic symphysis. External rotation of the head is carried out in the same way as with occipital insertions.
At the parturient with a full-term pregnancy, with an average fetal size, the insertion of the head in the direct size of the pelvis is difficult, since there is a non-correspondence between the pelvic dimensions and the size of the fetus. The difficulty of passing the head is that the direct size of the entrance to the small pelvis is 11 cm, and the direct size of the head it is inserted is 12 cm, and the head in this size is not very capable of configuration. Therefore, often there are insurmountable obstacles, secondary generic weakness develops, childbirth is ensured. Intrauterine asphyxia and fetal death occur
Prolonged compression of the soft tissues of the birth canal with a head is accompanied by the formation of vesicovaginal fistulas, and without timely assistance, a rupture of the uterus may occur. Duration of labor can be from 17 to 63 hours.
Particularly difficult to flow genera in the back view of a high direct insertion of the head. However, sooner or later, a shift of the head with an arrow-shaped suture in the oblique pelvic size can occur and the head falls into a small pelvis. Then the inner turn of the head continues, until the arrow-like suture is set in the direct exit size, and the suboccipitary fossa approaches the pubic symphysis.
If the arrow sweep does not occur, the position of the mother and fetus day becomes extremely dangerous and is aggravated by severe complications - infection, rupture of the uterus, etc.
It is important to recognize the high direct stance of the head at the onset of labor, when the fetal mobility is maintained, and perform the caesarean section. It is advisable not to postpone surgery in order to avoid intrauterine fetal asphyxia. With prolonged labor complicated by the weakness of labor and intrauterine fetal asphyxia, caesarean section should be carried out with great caution, since it is possible to extract a non-viable child with cerebral hemorrhages. With a dead fetus, craniotomy should be done.
In classical obstetrics, in this situation, an allowance was allowed - a head shift by the type of a bowl ball or an external-internal rotation of the fetus on the leg followed by extraction of the fetus. To facilitate the insertion of the head into the small pelvis for 20-30 min, the woman is recommended to take the Walcher position.
The high direct insertion of the head is deservedly recognized by all obstetricians as a severe obstetric pathology. Spontaneous deliveries without obstetric benefits and surgeries are possible only in 13.1% of cases, with the front view - 2 times more often than with the posterior.