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Occipital presentation of the fetus: low transverse position of the head
Last reviewed: 23.04.2024
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Low transverse position of the head occurs during childbirth in those cases when the prepulsive head moves towards the exit from the pelvis, without performing an internal rotation and remaining an arrow-shaped suture in the transverse dimension. This deviation occurs in 0.5 - 1% of cases of all genera. Its causes: a flat basin, funnel-shaped pelvis, wide gas, a small head of the fetus (weakness of labor). The most frequent cause is a flat pelvis with a narrowed straight outlet.
With a small fetus and good labor, sooner or later an internal turn of the fetus takes place or the head is erupted from the vagina, remaining in the transverse dimension of the exit from the pelvis. With the average size of the fetus, the head lingers for a long time near the outlet from the pelvis, there comes a weakness in labor activity, often the birth is complicated by infection, distress of the fetus.
This deviation in the mechanism of birth is important to recognize in a timely manner. A low transverse position of the head can be suspected if, in the occipital insertion, good generic activity, the head stands in the small pelvis without movement.
[How to recognize the low transverse position of the head?
The diagnosis is refined by vaginal examination: the head fills the cavity of the small pelvis, it is low, its sagittal seam is in the transverse dimension of the pelvis. In the case of the formation of a birth tumor, recognition is difficult, because sometimes a large fontanel in the region of the pubic symphysis is taken as small. To prevent such a mistake, you should find near the fontanel in the region of the pubic symphysis to find the ear. This sign indicates a low transverse position of the head. At a low transverse standing of the head, the birth should be kept expectantly, if possible. In itself, this deviation from the normal delivery mechanism with occipital insertion should not serve as an indication for surgical delivery.
Childbirth with a low transverse head
In the case of a long head at the exit from the pelvis, the classic manual on obstetrics allowed the use of combined rotation of the head with two hands. For this, two fingers of the right hand are inserted through the vagina behind the posterior parietal bone and push it forward; At the same time, the fetal body is displaced by the external hand. The fetus should be promoted so that the small fontanel goes to the bosom, otherwise the fruit may appear in the rear view, less favorable for its advancement. Such help causes discussions among many midwives.
If there were indications for emergency delivery, it is possible to stretch the child by imposing atypical obstetric forceps or vacuum extraction of the fetus. With intranatal fetal death, craniotomy is indicated. For many years there has been controversy about the advantages of applying obstetrical forceps or vacuum extraction of the fetus.
A significant advantage of using a vacuum extractor is the absence of the need for an additional increase in the volume of the presenting part, which occurs when using obstetric forceps.
Nowadays a large number of works devoted to the vacuum extraction of the fetus have been published. In this case, according to most authors, vacuum extraction of the fetus is most acceptable when the internal rotation of the fetal head is not carried out, and the sagittal suture is in the transverse dimension,