Persistent occipital-transverse dystocia
Introduction
Introduction to persistent occipital dystocia The continuous occipital position is due to the connection of the fetal head to the occipital transverse position during the delivery. During the descending process, when the double top diameter of the fetal head reaches or approaches the middle pelvis plane, most of the internal rotation can be completed and converted into a pillow. Natural birth. 5% to 10% until the end of childbirth, the occipital portion of the fetal head can not continue to turn to the front, still behind the mother's pelvis or lateral. basic knowledge The proportion of the disease: the incidence rate of pregnant women is about 0.01%-0.05% Susceptible people: good for pregnant women Mode of infection: non-infectious Complications: postpartum hemorrhage, hemorrhagic shock
Cause
Persistent occipital dystocia
(1) Causes of the disease
The occurrence of persistent occipital transverse position is affected by multiple factors as well as persistent posterior occipital position.
1. Abnormal pelvic morphology and size: flat and male pelvis are prone to persistent occipital transverse position. According to the survey, the two account for 43.23%, of which the flat pelvis accounts for 23.88%. The reason why the persistent occipital position is good is flat. The type and male pelvis are due to the short anterior and posterior diameter of the flat pelvis, and the narrowing of the front half of the male pelvis inlet, so that the anterior and posterior diameters of the entrance can be shortened. Therefore, in these two types of pelvis, the fetal head is often taken into the basin. The flat pelvis has a series of transverse diameters, and the anteroposterior diameter is reduced. Therefore, the fetal head continues to the occipital position to the pelvic floor, which is called the lower transverse position of the fetal head, while the male pelvis must be converted into the anterior position before reaching the middle pelvis. Otherwise, the transverse diameter of the pelvis in the male pelvis is short, and the fetal head cannot rotate forward in this plane.
2. The size of the head basin is not called: it hinders the rotation of the head of the pillow.
3. Poor fetal head flexion: The occipital transverse position can still be caused by poor fetal head flexion, increasing the diameter of the fetal head through the birth canal, hindering the rotation of the fetal head.
4. Weak uterine contractions: Natural or uterine contractions caused by anesthesia can affect the rotation and decline of the fetal head.
(two) pathogenesis
The occipital transverse position is divided into the left lateral position and the right lateral position of the pillow. There is no internal rotation during the partial pedestal lowering, or the occipital portion of the occipital position is only rotated forward by 45° to form a continuous occipital transverse position. Although the occipital transverse position can be delivered through the vagina, most of them need to use the hand or the fetal head aspiration technique to transfer the fetal head into the anterior occipital position.
Prevention
Persistent occipital dystocia prevention
The persistent occipital position has the highest incidence in the abnormal position of the fetal head, and is also the slightest abnormal position of the fetal head. The degree of dystocia is the lightest among the abnormalities of the fetal head position. However, the surgical rate is high. Although the cesarean section rate is lower than the persistent occipital position, the vaginal assist rate is higher than the persistent occipital position. Because it is the slightest abnormality of the fetal position, the position of the fetal head is low, and it is often not taken seriously, eventually leading to serious complications of mother and child. The cause of formation is similar to the persistence of the posterior occipital position. Vaginal examination, B-ultrasound can confirm the diagnosis. In addition to the obvious head basin is not called, can be trial production. Maintain good productivity during the labor process, and closely observe the expansion of the cervix and the decline of the fetal head. After full trial production, if the fetal head can not be connected, or the cervix can not fully expand, cesarean section terminates the pregnancy. When the occipital transverse head reaches 2 or less, it can be used for vaginal surgery. Surgical midwifery should have good productivity, alert to the illusion that the fetal head deforms and the tumor produces a lower fetal head position.
1. Inadequate or extensive application of antipsychotics or central nervous system stimulants may result in tics of tics or tics.
2, reasonable arrangements for children's daily work schedule and activities, to avoid excessive tension and fatigue, can participate in rhythmic sports activities.
Complication
Persistent occipital transverse dystocia complications Complications postpartum hemorrhagic shock
Postpartum hemorrhage: clinical manifestations are mainly vaginal bleeding, hemorrhagic shock, secondary anemia, if excessive blood loss can be complicated by diffuse intravascular coagulation. The severity of the symptoms is different from the amount of blood loss, the speed and the combination of anemia. In the short term, hemorrhage can occur quickly. It should be noted that in the early stage of shock, due to the compensatory mechanism in the body, vital signs such as pulse and blood pressure may be within the normal range. However, strict monitoring is still needed at this time, early identification of common risk factors, evaluation of blood loss and active treatment. . In clinical practice, when there is a certain degree of decompensation, such as pulse increase and blood pressure drop, attention is paid to the loss of blood, so that the best time for treatment is lost. In addition, if the mother has already suffered from anemia, even if there is not much bleeding, shock can occur and it is difficult to correct. Therefore, each woman must be thoroughly observed and analyzed to avoid delays in rescue.
Symptom
Persistent occipital lateral dystocia symptoms Common symptoms Fatigue male pelvic postpartum poor flexion fatigue cervical edema soft birth canal abnormal occipital transverse position into the basin head basin does not call anus bulge defecation
Symptom
(1) After the delivery, the fetal head is connected late, which may lead to weak uterine contractions, slow expansion of the cervix and stagnation of the fetal head.
(2) Maternal conscious angulation and bowel movements are early.
(3) maternal fatigue: related to the maternal not to open the mouth of the palace is not consciously holding hands.
(4) Cervical edema, the progress of labor is slow.
2. Signs
(1) Abdominal examination: At the bottom of the palace, the fetal hip is touched, and the fetal back is biased to the rear or side of the mother. The front abdominal wall is easy to touch the fetal limb. If the fetal head is connected, sometimes the fetal ankle can be touched on the side of the fetal limb above the pubic symphysis. On the face, because the fetal back is biased to the rear or side of the mother, the fetal heart sound is easy to hear on the lower side of the umbilicus, that is, the part close to the fetal back is heard most clearly.
(2) Anal examination: the anal examination of the pelvic cavity is empty, the sagittal suture of the fetal head is located on the pelvic slant or anteroposterior diameter, the anterior and posterior sacral sulcus are located on both sides of the pelvis, and the sagittal suture of the fetal head is located in the pelvic transverse diameter. Upper and lower ridges are located on the left side of the pelvis, which is the left lateral position of the pillow, and vice versa (Fig. 1).
(3) vaginal examination: When the cervix is open, there is fetal head edema, and when the skull overlaps, the vaginal examination is feasible. The fetal position is determined according to the fetal auricle and tragus direction, and the auricle is oriented to the side of the pelvis. The diagnosis is Pillow horizontal position.
Examine
Continuous occipital dystocia examination
The accuracy of ultrasound imaging examination can reach more than 90%. Ultrasound imaging can be used to understand the changes of the lateral position of the occipital and timely treatment.
Diagnosis
Diagnosis and identification of persistent occipital dystocia
Diagnostic criteria
1. Pelvic examination: Where flat and male pelvis, fetal head into the basin with the occipital position, should be alert to the possibility of persistent occipital transverse position.
2. When the labor chart is abnormal, when the occipital position has dystocia performance, the labor curve shown by the labor chart is abnormal, which is roughly the same as the persistent posterior position.
3. Characteristics of the transverse position of the pillow:
(1) Abdominal examination: 1/2 of the mother's abdomen is occupied by the fetal limbs, 1/2 is occupied by the back of the fetus, the upper part of the shame is touched wider than the front of the occipital position, and the occipital position of the occipital transverse head is not flexed and the fetal head is two The side is the two ends of the occipital forehead, the average is 11.3cm, which can be slightly less than this according to different degrees of flexion. The cranial ridge on the shame is not equal, and the side of the fetal occipital bone is higher than the frontal bone. The side, such as the left lateral position of the pillow, can be combined with the upper left iliac crest and the occipital part (round, hard) on the left side of the lower abdomen. The occiput is 3 fingers high on the pubic symphysis, while the right side of the forehead may be only one finger. High, such as the right lateral position of the pillow, the direction is opposite, the follow-up of the fetal head should be based on the occipital side as the standard. When the left lateral position of the occipital is always in the left lower abdomen of the mother, the height of the occipital part should be touched. To touch, the first part of the forehead is only on the shame, and the misunderstanding that the fetal head has dropped by 2 fingers. On the opposite side of the fetal occipital region, the crotch can be touched under the forehead, but it is too biased. The lateral side is not as easy to reach as the posterior position of the pillow, and the fetal heart is most loud on the side of the lower abdomen of the same side of the occiput.
(2) Anal examination and vaginal examination: the sagittal suture of the fetal head is on the transverse diameter of the pelvis. When the birth is not in use, or when the head basin is not called, the fetal head can be laterally flexed and reduced into the diameter of the basin. All of them are poured into the basin, so that the back top enters the basin first, and the sacral sag is used to retreat to make the front top slide down from the shame to form a uniform inclination, and then fall, so the sagittal suture of the fetal head is first forward and close to the shame. Union, and then back to the pelvis in the middle of the transverse diameter, is the normal childbirth machine, if the occipital transverse position to take the front uneven inclination into the basin (pre-uniform dip) for abnormal childbirth, will be discussed in the next chapter, pillow right In the position, the front squat is on the left side of the pelvis and the squat is on the right side; when the left side of the pillow is in the horizontal position, the front squat is on the right side of the pelvis and the squat is on the left side.
Differential diagnosis
1. The uneven position of the occipital position and the head basin are not called: the occipital transverse position can not be diagnosed as the uneven uneven position, and the uneven position after the occipital transverse position is accompanied by the head basin. According to the identification, the uneven head tilt combined with the head basin does not mean that the fetal head can not be connected and descended, the sagittal suture of the fetal head is in front of the transverse diameter of the pelvis, and the posterior uneven tilt of the left occipital lateral position, the fetal head edema is On the left parietal bone, when the right occipital transverse position is unevenly tilted, the fetal head edema is on the right parietal bone, which can be distinguished from the anterior uneven tilt.
2. The horizontal position of the occipital position: the common point is that the sagittal suture of the fetal head is consistent with the transverse diameter of the pelvis. The difference is that the uneven insertion of the fetal head into the basin before the occipital transverse position is more difficult than the horizontal position of the occipital Vaginal examination of the sagittal suture is not in the middle of the pelvic plane and tends to be paralyzed. Most of the anterior inferior tilting position is difficult to deliver through the vagina. The edema of the parietal bone in the postpartum can assist in the identification.
3. The front position of the pillow, the back position of the pillow: the front anterior and posterior iliac crests are moved backwards when the front is unevenly tilted. If the left occipital lateral position is unevenly tilted into the basin, the front squat is at 7 to 8 o'clock. Position, easy to mistakenly think that the left occipital position, the posterior iliac crest at 4 to 5 o'clock position, easy to mistakenly think that the left occipital posterior position, the key to diagnosis is to find out the sagittal suture direction, parallel to the transverse diameter of the pelvis, transverse radial Transfer to the front uneven tilt position, and finally to observe the fetal head edema site, the previous uneven tilting position through the vaginal delivery is more difficult, vaginal delivery is prone to soft birth canal laceration.
