UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

枕后位胎儿的处理

Authors
Cynthia Holcroft Argani, MD
Andrew J Satin, MD, FACOG
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
滕莉荣, 副教授

引言

足月时95%以上的胎儿都是头先露。胎儿枕部的方位可以为前位、横位或后位(图 1A-C)。临产前15%-20%的足月胎儿处于枕后(occipit position, OP)位[1,2]。这些胎儿中的大多数在分娩过程中发生旋转：阴道分娩时枕后位的发生率大约为5%。持续性枕后位意义重大的原因在于，它可以导致产程异常情况以及母体与新生儿的并发症(例如，产伤和新生儿酸中毒)[3]。

以往人们认为，出生时枕后位是由于枕后位的胎儿未能自发旋转为枕前位(occiput anterior, OA)所引起的。针对胎方位的超声研究对这一假设提出了质疑，并提出枕后位实际上常常是从枕前位旋转不良的结果。例如，一项在引产前对270例妊娠大于或等于36周的头位胎儿进行超声检查的研究发现，25例以枕后位娩出的胎儿中有17例在临产前非枕后位[2]。

危险因素和后果

分娩时枕后位的危险因素包括[4-9]：

●未经产妇

●母体年龄大于35岁

        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-12-19.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Gardberg M, Laakkonen E, Sälevaara M. Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries. Obstet Gynecol 1998; 91:746.
  2. Peregrine E, O'Brien P, Jauniaux E. Impact on delivery outcome of ultrasonographic fetal head position prior to induction of labor. Obstet Gynecol 2007; 109:618.
  3. Cheng YW, Shaffer BL, Caughey AB. The association between persistent occiput posterior position and neonatal outcomes. Obstet Gynecol 2006; 107:837.
  4. Ponkey SE, Cohen AP, Heffner LJ, Lieberman E. Persistent fetal occiput posterior position: obstetric outcomes. Obstet Gynecol 2003; 101:915.
  5. Cheng YW, Shaffer BL, Caughey AB. Associated factors and outcomes of persistent occiput posterior position: A retrospective cohort study from 1976 to 2001. J Matern Fetal Neonatal Med 2006; 19:563.
  6. Le Ray C, Carayol M, Jaquemin S, et al. Is epidural analgesia a risk factor for occiput posterior or transverse positions during labour? Eur J Obstet Gynecol Reprod Biol 2005; 123:22.
  7. Lieberman E, Davidson K, Lee-Parritz A, Shearer E. Changes in fetal position during labor and their association with epidural analgesia. Obstet Gynecol 2005; 105:974.
  8. Floberg J, Belfrage P, Ohlsén H. Influence of the pelvic outlet capacity on fetal head presentation at delivery. Acta Obstet Gynecol Scand 1987; 66:127.
  9. Senécal J, Xiong X, Fraser WD, Pushing Early Or Pushing Late with Epidural study group. Effect of fetal position on second-stage duration and labor outcome. Obstet Gynecol 2005; 105:763.
  10. Wheeler TL 2nd, Richter HE. Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol 2007; 19:474.
  11. Lowder JL, Burrows LJ, Krohn MA, Weber AM. Risk factors for primary and subsequent anal sphincter lacerations: a comparison of cohorts by parity and prior mode of delivery. Am J Obstet Gynecol 2007; 196:344.e1.
  12. Fitzgerald MP, Weber AM, Howden N, et al. Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol 2007; 109:29.
  13. Wu JM, Williams KS, Hundley AF, et al. Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries. Am J Obstet Gynecol 2005; 193:525.
  14. Ben-Haroush A, Melamed N, Kaplan B, Yogev Y. Predictors of failed operative vaginal delivery: a single-center experience. Am J Obstet Gynecol 2007; 197:308.e1.
  15. Fitzpatrick M, McQuillan K, O'Herlihy C. Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol 2001; 98:1027.
  16. Sizer AR, Nirmal DM. Occipitoposterior position: associated factors and obstetric outcome in nulliparas. Obstet Gynecol 2000; 96:749.
  17. Mazouni C, Porcu G, Bretelle F, et al. Risk factors for forceps delivery in nulliparous patients. Acta Obstet Gynecol Scand 2006; 85:298.
  18. Cheng YW, Norwitz ER, Caughey AB. The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. Am J Obstet Gynecol 2006; 195:856.
  19. Yancey MK, Zhang J, Schweitzer DL, et al. Epidural analgesia and fetal head malposition at vaginal delivery. Obstet Gynecol 2001; 97:608.
  20. Rouse DJ, Owen J, Hauth JC. Active-phase labor arrest: oxytocin augmentation for at least 4 hours. Obstet Gynecol 1999; 93:323.
  21. Akmal S, Kametas N, Tsoi E, et al. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 2003; 21:437.
  22. Chou MR, Kreiser D, Taslimi MM, et al. Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor. Am J Obstet Gynecol 2004; 191:521.
  23. Verhoeven C, Ruckert M, Opmeer B, et al. Ultrasonographic fetal head position to predict mode of delivery: a systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol 2012; 40:9.
  24. Desbriere R, Blanc J, Le Dû R, et al. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. Am J Obstet Gynecol 2013; 208:60.e1.
  25. Le Ray C, Serres P, Schmitz T, et al. Manual rotation in occiput posterior or transverse positions: risk factors and consequences on the cesarean delivery rate. Obstet Gynecol 2007; 110:873.
  26. Hawkins JL, Hess KR, Kubicek MA, et al. A reevaluation of the association between instrument delivery and epidural analgesia. Reg Anesth 1995; 20:50.
  27. GRIFFIN RJ. MANAGEMENT OF THE OCCIPUT POSTERIOR. J Ky Med Assoc 1964; 62:860.
  28. Reichman O, Gdansky E, Latinsky B, et al. Digital rotation from occipito-posterior to occipito-anterior decreases the need for cesarean section. Eur J Obstet Gynecol Reprod Biol 2008; 136:25.
  29. Cargill YM, MacKinnon CJ, Arsenault MY, et al. Guidelines for operative vaginal birth. J Obstet Gynaecol Can 2004; 26:747.
  30. Dennen, PC. Dennen's forceps deliveries, 3rd ed, FA Davis Company, Philadelphia 1989.
  31. Tarnier, S, Chantreiul, G, Lauwergus, H. Traité de l'art des accouchements (Tome 2), Paris 1982.
  32. Shaffer BL, Cheng YW, Vargas JE, et al. Manual rotation of the fetal occiput: predictors of success and delivery. Am J Obstet Gynecol 2006; 194:e7.
  33. Stock SJ, Josephs K, Farquharson S, et al. Maternal and neonatal outcomes of successful Kielland's rotational forceps delivery. Obstet Gynecol 2013; 121:1032.
  34. Vidal F, Simon C, Cristini C, et al. Instrumental rotation for persistent fetal occiput posterior position: a way to decrease maternal and neonatal injury? PLoS One 2013; 8:e78124.
  35. Bradley MS, Kaminski RJ, Streitman DC, et al. Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstet Gynecol 2013; 122:132.
  36. Kariminia A, Chamberlain ME, Keogh J, Shea A. Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth. BMJ 2004; 328:490.