PRESENTED BY,

MS. NISHA
 MALPOSITION: Any position of the vertex other than flexed
occipito-anterior one.
 Occipito posterior: in a vertex presentation where the
occiput placed over the sacroiliac joint,sacrum, called
occipito-posterior position.
 SHAPE OF THE PELVIS:
◦ 50% in anthropoid or android pelvis.
 FETAL FACTORS:
◦ Marked deflexion of head
◦ Causes of deflexions are:
1. High up pelvis
2. Attachment of placenta in anterior wall of the uterus.
3. Primary brachycephaly
 UTERINE FACTORS:
◦ Abnormal uterine contraction
 ABDOMINAL EXAMINATION:
◦ INSPECTION: The abdomen looks flat, below the umbilicus.
◦ UMBILICAL GRIP:
 The head is not engaged.
 Cephalic prominance is not felt.
◦ AUSCULTATION:
 FHS heard on flank.
 VAGINAL EXAMINATION:
◦ Findings are:
1. Enlongated bag of membrane which likely to rupture during vaginal
examination.
2. The sagittal suture occupies any oblique diameters of pelvis.
3. Posterior fontanelle is felt near sacroiliac joint.
4. Posterior fontanelle felts more easily because of deflexion of the head.
 FETAL SITUATION:
◦ Lie: Longitudinally
◦ Attitute: Deflexion of head
◦ Presentation: Cephalic
◦ Presenting part: Vertex
◦ Denominator: Occiput
◦ Diameter : Occipito frontal (11.5 cm)
 IN FAVOURABLE CIRCUMSTANCES (90%):
Flexion
Internal rotation of the head
Extension
Restitution
External rotation of head
Lateral flexion of trunk
 IN UNFAVOURABLE CIRCUMSTANCES (10%):
Incomplete forward rotation
Non rotation
Malrotation
 Mechanism for face to pubis delivery:
Further descent
Flexion
Extension
Restitution
External rotation of head
 MECHANISM OF
LABOUR IN OCCIPITO
POSTERIOR

FAVOURABLE UNFAVOURABLE
CONDITION (90%) CONDITION (10%)

INCREASING
FLEXION WITH DELAYED ENGAGE
ENGAGEMENT

LONG INTERNAL
ROTATION OF DEFLEXION
OCCIPUT THROUGH PERSISTS
3/8th
OF A CIRCLE

SIMULTANEOUSLY DESCENT UPTO

2/8th ROTATION OF PELVIC FLOOR
SHOULDER
ANTERIORLY

CONTRACTED ANTHROPOID
SPONTANEOUS ANDROID PELVIS
PELVIS PELVIS
VAGINAL DELIVERY
BY NORMAL
MECHANISM
 ANDROID CONTRACTED ANTHROPOID
PELVIS PELVIS PELVIS

MILD MODERATE SEVERE

DEFLEXION DEFLEXION DEFLEXION
PERSISTS PERSISTS PERSISTS

ANTERIOR
POSTERIOR
ROTATION OF NO ROTATION
ROTATION OF
OCCIPUT 1/8th OF OCCIPUT
OCCIPUT
OF A CIRCLE

DEEP OBLIQUE OCCIPITO-

TRANSVERSE POSTERIOR SACRAL
ARREST ARREST POSITION

OCCIPITO-
FACE-PUBIS
SACRAL
DELIVERY
ARREST
 PRINCIPAL OF MANAGEMENT:
1) Early diagnosis
2) Strict observation & watchful expectancy
3) Judicious and timely interference
 First stage:
 Anticipating prolonged labor with interavenous fusion.
 Progress of labour is judge by:
 Progressive descent of head
 Rotation of back and the anterior shoulder towards the midline
 Increasing flexion
 Position of sagittal suture on vaginal examination.
 Cervical dilatation
 Weak pain,persistant of deflexion and non rotation of occiput:
 Oxytocin infusion for augmentation
 Indication of caeserian section:
 Arrest of labour/failure of rotation
 Incoordinate uterine action
 Fetal distress
 SECOND STAGE OF LABOR:
 Delivery can achieve spontaneously/ with the help of ventouse or forceps.
 In case of non/mal rotation:
◦ face to pubis delivery
◦ Caeserian section
 THIRD STAGE OF LABOR:
o Prophylactic analgesics and antibiotics
o Prophylactic ergometrium
 PER ABDOMINAL EXAMINATION:
Following conditions can be assessed:
 Big baby
 Engagement of head
 Amount of liquor
 FHS
 PER VAGINAL EXAMINATION:
following condition can be noted:
 Station of the head
 Position of sagittal suture & occiput
 Degree of deflexion of head
 Degree of moulding & caput formation
 Assessment of pelvis at or below the level of obstruction
 VENTOUSE (VACUUM EXTRACTION)
 ALTERNATIVE METHODS:

Manual rotation followed by forceps extraction

Forceps rotation & extraction
Caeserian section
Craniotomy
 If it is below the ischial spine forceps application followed
by extraction as face to pubis delivery.
 If remains above the ischial spine caeserian section is
preferable.
 The head is into deep cavity, sagittal suture is placed in transverse
bispinous diameter and there is no progress in descent of head even
after ½ -1 hour following full dilatation of cervix.
 CAUSES:
1. Faulty pelvis architecture
2. Deflexion of head
3. Weak uterine contraction
4. Laxity of pelvic floor muscles
 MANAGEMENT:
 In case of big baby/ inadequate pelvis caeserian section prefered
 If vaginal delivery safe:
1. Ventouse
2. Manual rotation and forceps application
3. Operative vaginal delivery for DTA.
 WHOLE HAND METHOD:
1. GRIPPING OF THE HAND
2. ROTATION OF THE HEAD
3. APPLICATION OF FORCEPS
 HALF HAND METHOD: