High straight positioning swept seam in cases of abnormal presentations

This kind of anomaly inserting head is rare (0,06%), nevertheless, the physician should be familiar with its features, because sometimes you may want obstetric care.
The high direct standing swept seam can speak only in the cases when last a long time remains in the direct size of the pelvis (or close to it), as is often short-high straight positioning swept seam observed in the first moments in the normal biomechanism of labor.
Depending on the location of the back of the fruit there are two types of high direct standing swept seam (Fig. 94, a, b):


Fig. 94. High direct state swept seam. a - positio occipitalis pubica; b - positio occipitalis sacralis.

at the back, facing the front, front view (positio occipitalis pubica), backwards - rear view (positio occipitalis sacralis). Front view high direct standing swept seam is more common than back (5 : 3). In front the form of standing childbirth are spontaneous in 50-70%, with the back - only 25-30%.
The shape and size of the head and the entrance to the pelvis contribute to the insertion of heads mainly in oblique, at least - in the transverse and very rarely in direct (overly broad pelvis) the size of the input. When violations balance between the size and shape of the head and pelvis come changes in biomechanism of labor.
If overly broad basins promoting head is made without any biomechanism, in the narrow basins depending on the shape and size of the latter is observed and appropriate biomechanism.
So, for flat basins have long standing swept seam in the transverse size of the pelvis; for poperechnogo (which are rare) is characterized by the standing swept seam in the direct size of the entrance to the pelvis. But high straight positioning swept seam not peculiar exclusively poperechnogo pelvis; it was observed by a number of authors under normal, obsesiones and even flat pelvis. Therefore, the direct cause of high standing head should be sought in some other factors.
It is known that intrauterine fetal position is not something which is permanent. The fetus in the uterus (in whole waters) can change their position prior to the time of disclosure. It's easy to assume that when the fetus from one position to another in the presence of strong labor activity and the sudden discharge of water head can easily be fixed at the entrance to the moment when the back of the fetus will be facing forward or backward. This results in a front or rear view high direct standing swept seam. The front view is more common in multiparous with flabby stomach, and back - in nulliparous with elastic abdominal walls.
In education high direct standing play a role not only anatomic features of the bony pelvis, strongly developed mm. psoates and change the position of the fetus, but variations of the form of the head - an unusual relationship large transverse and oblique small sizes.
In norm large transverse size is slightly less oblique small, so that the plane of the skull on small slanted (planum suboccipito-bregmaticum) is a longitudinal oval; if large transverse size exceeds small scythe, the plane takes the last poperechnopolosta form. This feature, along with other reasons, is an important etiological moment of occurrence of atypical installation of the head at the entrance to the pelvis (, Gender).
The biomechanism of labor. Usually births occur so that swept the seam head first established in an oblique size, and in the pelvic cavity goes in a straight line.
With front-high straight standing swept seam of internal rotation of the head is not happening. The head is mounted swept seam in the direct size; it is strongly bent, leaning suboccipital area in the symphysis. Fronto-parietal area facing the Cape; on Cape primarily slides pane large fontanel, and then his forehead. The birth of heads is in the occipital previa *.
In the back of high direct standing swept seam move the ball through the birth canal in most cases difficult, despite effective tribal activities. To head could enter into a basin, requires a strong twist it and pronounced configuration.
Ahead of the Cape or deeper, ahead of the sacral vertebrae, closer to the midline, there is a small spring. A large fontanel in the study generally to probe fails, as it stands high for the symphysis.
When energetic labor activity descended the pelvis head makes more rotation, which swept the seam goes to slash the size of the pelvis, then - in the transverse size, in the opposite slash and, finally, in a direct size, but the back of his head to the symphysis; birth head is made the same as at the front overlooking occipital presentation. Where internal rotation does not occur, childbirth occasionally (in case of small head) end up in the back. But in most cases, spontaneous expulsion of a fetus in the back as direct standing (positio occipitalis sacralis) doesn't - have to resort to rapid delivery.
The recognition. Overly strong, painful, prolonged labor activity in the absence of promoting head after exclusion of apparent discrepancies between the value of head and size of the pelvis (hydrocephalus, malformations, tumors) should direct our attention to the possible incorrectness in biomechanism insertion.
However, the final recognition of this anomaly is possible only with vaginal examination (sometimes repeated). But when vaginal examination is also possible errors due to the high standing of the head, the difficulties in achieving springs, the availability of generic tumors, located in the area swept seam, and other


Protracted labor, premature rupture of water, long and difficult configuration head, depletion mothers and secondary weakness generic activities tremendously aggravate the forecast for the fetus.
Childbirth high standing swept seam threaten the mother of increasing temperature, stretching the lower segment and uterine rupture. Especially hard progress in labour (for the mother and fetus) at the rear of the live standing (positio occipitalis sacralis), as 70-75% have to resort to surgery, which in itself is not indifferent to the health of the mother and fetus. In front of the live standing swept seam childbirth end spontaneously, about 70%.
The management of deliveries at high direct standing swept seam should be mainly conservative. However, conservatism should not be pushing too far, having in mind the interests not only of a mother and the fetus, and taking into account, in particular, what a strong compression of the exposed head last.
When living fetus and mobile or slightly pressed to the entrance of the pelvis head mothers with normal size pelvis, at full or close to full disclosure of the OS, it is recommended that a manual head rotation about the vertical axis (the reception of Lipmans). Admission is that the doctor the whole hand is in the lower segment of the uterus, captures the head and turns it around the vertical axis in the direction in which it easier turns. Simultaneously with the other hand through the outer skin of the abdomen obstetrician tries to turn in the same direction and trunk of a fetus. After turning the doctor holds head in a given position in several minutes until they are committed her contractions, and only after that the hand out.
As already mentioned, to perform this trick requires a number of conditions that are often lacking (relative mobility of the head with the full opening of the throat and others), as well as high standing swept seam is formed only when retired waters, its long-term standing head at the entrance to the pelvis and provided vigorous labor activity. Said, doctors have to be very cautious in their actions.
In the absence of conditions for turning the head and the occurrence of maternal or fetal indications for fast completion of the birth shows a caesarean section delivery. Practiced in previous years, the application of obstetrical forceps, through which only a highly qualified doctor in exceptional cases could successfully make a rotation of the head of the fruit, currently not carried out because of the risk of causing serious injury to the mother and fetus.
When the fetus's head, descended the pelvis, childbirth usually end up spontaneously. Only in cases arising secondary weakness generic forces or deterioration of the status of the fetus (asphyxia) shows surgical delivery.
Thus, if the birth at high direct standing swept seam not spontaneously over, see the operation caesarean section and in exceptional cases (when the impossibility of its application) - punching head with kranichsee.

* Sometimes head still does internal rotation, i.e. enters one of slanting size, and at the bottom of the pelvis - in direct and childbirth goes as normal occipital previa.