Occipito-posterior position

Occipito-posterior position is an abnormal poison of vertex presentation, and the occiput pointed posteriorly to the scrum of maternal pelvis.This is the most common malposition where the head initially engages normally, but then the occiput rotates posteriorly rather than anteriorly. Approximately 10% of labours begin this way, but many correct in labour.

The occipito-posterior position results from a poorly flexed vertex. The anterior fontanelle (four radiating sutures) is felt anteriorly. The posterior fontanelle (three radiating sutures) may also be palpable posteriorly.

Causes:

• Attitude of the fetus.
• Contracted pelvis.

Complications:

• Obstructed labour unless rotated.
• Fistula.
• Fetal distress or death.

Management:

• Early detection and referral