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Prone Lateral Minimally Invasive Retropleural Corpectomy Using a Rotatable Radiolucent Jackson Table
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Persistent occiput posterior.

William H Barth1

  • 1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Obstetrics and Gynecology
|March 3, 2015
PubMed
Summary
This summary is machine-generated.

Persistent occiput posterior (OP) delivery is challenging but improved with ultrasound. Manual rotation or operative vaginal delivery can manage OP, with rotational forceps showing improved outcomes in recent studies.

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Area of Science:

  • Obstetrics
  • Maternal-Fetal Medicine
  • Fetal Positioning

Background:

  • Persistent occiput posterior (OP) malposition is linked to increased maternal and neonatal morbidity.
  • Diagnosing OP via physical exam is difficult, though bedside ultrasonography enhances accuracy.
  • Early-diagnosed OP often resolves spontaneously, but persistent cases require intervention.

Purpose of the Study:

  • To review diagnostic methods for persistent occiput posterior (OP) position.
  • To outline management strategies for persistent OP during labor and delivery.
  • To evaluate the role of rotational forceps in managing persistent OP.

Main Methods:

  • Literature review of diagnostic techniques, including ultrasonography.
  • Analysis of management options for persistent OP: spontaneous resolution, manual rotation, operative vaginal delivery, and cesarean delivery.
  • Evaluation of outcomes associated with different operative interventions, particularly rotational forceps.

Main Results:

  • Bedside ultrasonography improves OP diagnosis compared to physical examination.
  • Prophylactic manual rotation can reduce persistent OP and complications.
  • Cesarean delivery is recommended for suspected fetal macrosomia or specific pelvic shapes. Nonrotational operative vaginal delivery is suitable for certain pelvic anatomies. Rotational forceps show improved outcomes in recent literature.

Conclusions:

  • A pragmatic approach is essential for delivery in persistent OP.
  • Management decisions should consider fetal size, pelvic dimensions, and fetal head position.
  • Rotational forceps, despite challenges, have a role in contemporary obstetrics for managing persistent OP, with improving outcomes.