Occipito posterior position (OPP) can be defined as a cephalic presentation with the occiput pointing to any of the sacro-iliac joint(reduced occipito posterior position) or the hollow of the sacrum(persistent occipito posterior position). In other word it is a mal-positioning and not a mal-presentation since it is the head that is presenting.
What Are The Possible Outcomes of Occipito Posterior Position
- About 90 percent of cases with Occipito posterior position will result in long internal rotation, that is 3/8 of a circle to anterior position provided the uterine contraction are good and effective.
- Approximately 10 percent will do short internal rotation causing the sinciput to lead; hence the baby is delivered face to pubis.
- Deep transverse arrest: this occurs where there is prominent ischial spine.
- There may be partial extension of the head leading to brow presentation.
- There may be complete extension of the head leading to face presentation.
The Effect of Reduced and Persistent Occipito Posterior Position on The Outcome of Labour
- If the head is well flexed it will have a little effect on labour, and with good uterine contraction the head will rotate and be delivered normally.
- If the head is deflexed e.g in case of primigravida with strong abdominal muscles, the baby’s back will be straightened since the baby’s back is against the mothers back.
- The membranes will rupture early as it is not well applied to the cervix and its shape is oblong instead of round.
- Labour will be delayed because of larger diameter of the deflexed head which descends slowly even with good uterine contractions.
- The deflexed head is not well applied to the cervix hence poor stimulation of the cervix and poor uterine contraction leading to prolonged labour.
- There may be cord prolapse.
- Moulding occurs in an unfavourable direction(sugar loaf) therefore cerebral injury is more likely to occur.
- Backache is more likely to be troublesome.
- There is difficulty in micturition.
- The desire to push in the first stage is more likely because the occiput is presenting at the rectum.
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Possible Nursing Diagnoses That May Be Present During Occipito-Posterior Position
- Acute pain related to pressure of the presenting part on the sacro-iliac joint and strong rhythmic uterine contraction, evidenced by her verbalization of backache
- Anxiety related to prolonged labour associated with OPP evidenced by her verbalization.
- Urinary retention, related to pressure of the presenting part on the neck of the urinary bladder evidenced by passage of small urine.
- Fatigue related to exhaustion associated with prolonged labour evidenced by her reluctance to cooperate.
- Activity intolerance related to backache evidenced by her inability to perform activity of daily living.
- Risk for infection, related to the numerous vaginal examination.
- Risk for trauma related to difficult labour.
- Risk for deficient fluid volume, related to dehydration associated with prolonged labour.
What is Induction of Labour?
Induction of labour is defined as the stimulation of regular uterine contraction after 20-24 weeks of pregnancy, but prior to the onset of spontaneous labour, by artificial or natural means for the interest of the mother or the fetus or both.
Indications For Induction of Labour
Maternal Indication
- Pregnancy induced hypertension(pre-eclampsia), if not controlled the woman may die through pre-eclampsia or the fetus may die through pre-eclampsia or the fetus will die through placenta insufficiency.
- Ante-partum haemorrhage caused by abruptio placenta
- Hydramnios associated by fetal abnormality.
- Uncontrolled diabetes mellitus to prevent the woman from having diabetic coma.
- Essential hypertension and chronic nephritis because they are associated with placenta insufficiency.
- Severe hepatitis as in acute yellow fever.
- The woman may request for induction.
- The doctor’s convenience, probably he has appointment and the woman may want to deliver in his presence.
Fetal Indication
- Post maturity of the fetus because there is danger of placenta insufficiency and the fetal head may be ossified leading to difficult moulding.
- Rhesus incompatibility: to reduce the duration so that the fetus will not experience haemolysis in
- Fetal abnormality: where prolongation of pregnancy is not necessary e.g severe fetal malformation.
- For stabilizing induction: it is done following external cephalic version in cases of unstable or oblique lie(shoulder presentation) to prevent fetus from returning back to former position.
- Evidence of diminished well being of fetus e.g in cases of reduced pregnancy hormone, poor fetal respiration, sluggish fetal movement shown by ultra sound or no fetal kick count, low fetal heart rate count e.t.c
Possible Nursing Diagnoses that May Occur due to Induction of Labour
- Acute pain related to strong uterine contraction evidenced by restlessness.
- Anxiety related to unknown outcome of induction evidenced by her reluctance to consent for the procedure.
- Deficient knowledge related to induction evidenced by her numerous questions.
- Impaired walking related to induction procedure, evidenced by her confinement on bed.
- Situational low self esteem related to her inability to deliver baby without indiction evidenced by her complaint of being weak.
- Risk for bleeding related to undiagnosed low lying placement.
- Risk for infection related to techniques of induction.
Bishop Score
This is defined as the rating system to asses suitability of cervix for induction of labour with regards to the following parameters;
- Dilatation of the cervix.
- Effacement of the cervix.
- Station of the cervix in relation to the ischial spine.
- Consistency of the cervix.
- Position of the cervix.
Importance of Bishop Score.
- It is used for clinical appraisal of the cervix on digital vaginal examination.
- It is used to know if induction of labour will be favourable or not. E.g the score ranges from 5-14, a score of 9 and above will be favourable whereas a score of 0-4 is unfavourable for induction of labour.
Contraindication For Induction of Labour
- Placenta previa.
- Cephalon-pelvic disproportion.
- Cord presentation/prolapse.
- Transverse lie.
- Compound fetal presentation.
- Severe fetal compromise or seriously impaired placement function.
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