Occipito-posterior position
Malposition is referring to any position of the vertex other than a flexed occipito anterior position. Occipito-posterior is an abnormal position of the vertex (Malposition).
There are 3 malpositions-
When occiput is placed posteriorly over the sacroiliac joint is the right occipito-posterior (ROP), 3rd position of the vertex and when placed over the left sacroiliac joint, is left occipito-posterior (LOP), 4th position and when it points towards the sacrum, is the direct occipito-posterior.
The factors responsible are-
Lie – Longitudinal
Presentation – Cephalic
Presenting part – Vertex
Attitude – Deflexion
Denominator – Occiput
Position – Right / Left Occipito-posterior
Mechanism of Labour-
In favourable circumstances (90%)–
In unfavourable circumstances / Malrotation / Non-rotation (10%) –
When occiput fails to rotate because of deflexion of the head, weak uterine contraction, the shape of the pelvis, big baby. The 3 condition occurs-
– In favourable circumstances with an average size baby, good uterine contractions and an adequate pelvis like anthropoid or gynaecoid delivery may occur as “face to pubis”. The steps are –
-Descent – Until the root of the nose comes under the symphysis pubis.
-Flexion – The brow, vertex, and occiput stretched perineum and the face is born by the movement of extension.
Restitution – The head moves 1/8th of a circle in the opposite direction of internal rotation.
External rotation – The occiput further rotates to the same direction of restitution to 1/8th of a circle, now the face directs towards the left thigh in ROP and the right thigh in LOP.
And in unfavourable Persistent occipito-posterior arrest may occur in occipito-sacral arrest.
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