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Occipital presentation of the fetus: low transverse position of the head
Last reviewed: 04.07.2025
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Low transverse position of the head occurs during labor in cases where the head, presenting the occiput, moves toward the exit from the pelvis without making an internal rotation and remaining a sagittal suture in the transverse size. This deviation occurs in 0.5 - 1% of all births. Its causes: flat pelvis, funnel-shaped pelvis, wide gas, small head of the fetus (weakness of labor). The most common cause is a flat pelvis with a narrowed direct size of the exit.
With a small fetus and good labor activity, sooner or later the internal rotation of the fetus occurs or the head emerges from the vagina, remaining in the transverse size of the outlet from the small pelvis. With an average size fetus, the head lingers for a long time near the outlet from the pelvis, weakness of labor activity occurs, labor is often complicated by infection, fetal distress.
It is important to recognize such a deviation in the birth mechanism in a timely manner. Low transverse position of the head can be suspected if, with occipital insertion and good labor activity, the head stands in the small pelvis without movement.
[ How to recognize low transverse position of the head?
The diagnosis is clarified by vaginal examination: the head fills the cavity of the small pelvis, is low, its sagittal suture is in the transverse size of the pelvis. In case of formation of a birth tumor, recognition is difficult, since sometimes a large fontanelle in the area of the pubic symphysis is taken for a small one. To avoid such a mistake, an ear should be found near this fontanelle in the area of the pubic symphysis. This sign indicates a low transverse position of the head. With a low transverse position of the head, labor should be carried out expectantly, if possible. In itself, this deviation from the normal mechanism of labor with occipital insertion should not serve as an indication for operative delivery.
Childbirth with low transverse position of the head
In the case of prolonged standing of the head at the exit of the small pelvis, the classic manual of obstetrics allowed the possibility of using combined rotation of the head with two hands. To do this, two fingers of the right hand are inserted through the vagina behind the posterior parietal bone and pushed forward; at the same time, the body of the fetus is moved with the outer hand. The fetus should be moved so that the small fontanel moves toward the womb, otherwise the fetus may end up in a posterior position, which is less advantageous for its advancement. Such assistance causes discussions among many obstetricians.
If there are indications for emergency delivery, then it is possible to pull the child out by applying atypical obstetric forceps or performing vacuum extraction of the fetus. In case of intrapartum fetal death, craniotomy is indicated. For many years, there has been controversy about the advantages of applying obstetric forceps or vacuum extraction of the fetus.
A significant advantage of using a vacuum extractor is the lack of need for additional increase in the volume of the presenting part, which occurs when using obstetric forceps.
Nowadays, a large number of works devoted to vacuum extraction of the fetus have been published. At the same time, according to the opinion of most authors, vacuum extraction of the fetus is most acceptable when the internal rotation of the fetal head has not occurred, and the sagittal suture is in the transverse size,