The Occiput

Posterior Fetus

Oleh :
Wiliyanto. Wijaya

Pembimbing :
Dr. IMS Murah Manoe, SpOG (K)
Belly Mapping
 Incidence of OP

Onset pada persalinan :15% - 32%.

Keberhasilan persalinan:
A Manual of Midwiferyby AL Galabin, London, 1893
5.5% - 7% (primipara) dan 4% (multipara)
Ponkey dkk 2003 : 26% (nullipara) dan 57%
(multipara).
Persalinan dengan epidural 13%, tanpa epidural
3.3%.
 Causes Of Posterior Positioning

Menurut penelitian :
Dextrorotation: like other natural objects, the human body
has a tendency to move in a clockwise direction
Muscular imbalance: psoas muscles and round ligaments
can be tighter on one side than the other, pulling the uterus to
one side
Posture: poor maternal posture and lack of forward movement
(e.g.housework) increase the risk
Morphology: short stature and short waistedness increase the
risk of posterior positioning
Placental location: increased incidence with anterior placental
sites
 Clinical Concerns With OP

Longer labor
Maternal fatigue/discouragement
Increased need for psychological support
Transfer to hospital
Medical interventions
Surgical delivery
Traumatic birth for mother and/or baby
Post-Traumatic Stress Disorder?
 What to Do: Determine Cause
for Prolonged Labor
Recognize reasons other than OP for prolonged
labor:
Persistent asynclitism/OT (fetal dystocia)?
Inadequate contractions (uterine dystocia)?
Emotional dystocia?
Cervical dystocia?
Pelvic dystocia?
Iatrogenic dystocia?
 Diagnosis POPP
1. Sutura sagitalis terbalik di dalam Pelvis
2. Fontanella anterior ke arah simfisis
3. Bunyi jantung Terkeras jauh di lateral.
4. Kapus suksedaneum pada bagian
belakang kepala :
* Di kanan pada oksiput posterior kiri
* Di kiri dalam oksiput posterior kanan.
 Know the basic term fetal head diameters
Depending on the presentation, the fetal head will deliver easily, as in occiput anterior
position, when the presenting diameter is 9.5 cm, or with difficulty, as when the presenting
diameter is 11.5 cm or more.
 Mekanisme Persalinan

1. Bagian terkemuka Fontanella Posterior

2. Dimensi yang dipresentasikan Diameter
suboksipitobregmatika
3. Fulkrum (bag kepala yang menjadi hipomoclion)
Fontanella anterior
4. Proses persalinan Fleksi sedang kemudian banyak
ekstensi
 Prinsip patologis POPP

Kelainan defleksi
Derajat fleksi tertentu Tengkuk bayi
berada pada sakrum ibu, fontanella
posterior dan sutura sagitalis pada lantai
pelvis
Fontanella anterior fulkrum untuk fleksi
pada arkus subpubis
Kepala harus didefleksikan lebih lanjut pada pintu keluar pelvis
sampai oksiput berada di atas perineum.
Ilustrasi
 What to Teach

Positions & Movements

Baths
Measures to increase contractions
Pain Relief
Non-pharmacological
Pharmacological
Time and Patience
Optimal Fetal Positioning, J.Sutton, 2002
 Solutions
Prolonged 2 nd Stage

Exaggerated
Lithotomy
(McRoberts)
Success!
Stitely & Gherman
 Consider possible causePrimary

Physiologicalinterventions based on
Primary action
presumed cause Result No

Result No change Worsening condition

OB interventions
Secondary action

Labor progress & Problem persists &

Outcome
vaginal birth cesarean birth