Small pelvic outlet (particularly narrow subpubic arch)Įpidural anesthesia has been evaluated most extensively, in part because it is a modifiable risk factor.Įpidural anesthesia - Whether epidural anesthesia is a risk factor for OP position at birth is controversial. ![]() RISK FACTORS - Reported risk factors for OP position at birth include : In some cases, the OP position at birth results from malrotation from an OA or occiput transverse (OT) position early in labor spontaneous rotations are unlikely once the second stage has begun. Some persistent OP positions may be due to an android maternal pelvis, as the mechanical forces on the fetus during the cardinal movements of labor in this setting can inhibit rotation to the occiput anterior (OA) position. The large variation in prevalence before full dilation has been attributed to differences in the study investigator's definition and assessment of OP. At term, before labor and in early labor, studies have reported that 15 to 50 percent of fetuses in cephalic presentation are OP, but only 5 percent are OP at vaginal birth because most OP fetuses spontaneously rotate to an anterior position during labor, usually just before or during full cervical dilation. PREVALENCE AND PATHOGENESIS - The prevalence of OP position depends on how and when the diagnosis is made. (See "Labor: Overview of normal and abnormal progression".).(See "Overview of breech presentation" and "Delivery of the singleton fetus in breech presentation".). ![]() (See "Face and brow presentations in labor".).Other fetal malpositions, as well as diagnosis and management of labor abnormalities, are reviewed separately: This topic will review issues related to the occurrence, diagnosis, and management of OP position. It is important because it is associated with labor abnormalities that may lead to adverse maternal and neonatal consequences, particularly operative vaginal or cesarean birth. ![]() INTRODUCTION - Occiput posterior (OP) position is the most common fetal malposition.
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