POSICIÓN de la CABEZA FETAL durante el PARTO - Ginecología y Obstetricia -

Dr. Piñel, from his teaching Instagram account @obste_gram, explains how to determine the position of the fetal head during delivery. More videos, podcasts, PDFs, and more... AULAGINECOLOGIA.COM (Follow us also on Facebook, Twitter, and Instagram @aulaginecologia) FETAL HEAD POSITION How the position of the fetal head is assessed during delivery is very important for making decisions when necessary. It helps us decide how to perform a delivery, or how to proceed if necessary. Through vaginal examination, we can examine the fetal head. We must have clear anatomical references: At the top, looking at the patient, we have the pubic symphysis. Below is the sacrococcygeal area. On the sides are the sciatic spines. These references are important because they are the points we can palpate, and therefore, we can reference anatomically. This is important for determining the height of the presentation (as we will see in the Hodge plane video), as well as for what we are going to discuss today, which is the position of the fetal head. We are going to assess the position of the fetal head using the fontanelles. The fetal fontanelles, which we palpate to determine the position of the baby, are: The lesser fontanelle, which is located in the occipital region of the fetal head and is triangular in shape. The greater fontanelle, which is more rhomboidal in shape and is located in the most anterior part of the fetal head. This way, by touching these two fontanelles, we can determine the position of the baby and therefore make the appropriate decisions. OCCIPUTO-PUBIC The most common position is the occipito-anterior or occipitopubic position. In this position, the lesser fontanelle is on top (anterior) and the greater fontanelle is on the bottom (posterior). Remember that the lesser fontanelle is located on the occipital surface, and it will always be the one that determines the name of the presentation. OCCIPITO-SACRAL Another possible situation is where the lesser fontanelle is lower (posterior) and the greater fontanelle, which is rhomboid in shape, is higher (anterior). This position is called occipito-posterior or occipito-sacral. Occipito-posterior births (in which the fetus faces upward) tend to be more complicated. OCCIPITO-ILIAC-TRANSVERSE It often happens that the head is neither occipito-anterior nor occipito-posterior, but is in an intermediate position. We call these transverse presentations. So, taking into account the anatomical landmarks we already know, we'll name them based on where the lesser fontanelle (occipital) is located. If the lesser fontanelle is on the left (of the mother), we'll call it a left occipito-iliac-transverse presentation (LOIT). Why left? Because we always talk about the mother's side, even though for the gynecologist performing this delivery, it's the right. If the lesser fontanelle (occipital) is on the mother's right, we'll call this presentation right occipito-iliac-transverse (ROIT). The greater fontanelle (bregma) will be located on the mother's left. It's very important to know the fetal presentation because this, along with the height of the presentation (Hodge planes), will help us determine what and how to use instruments in case an instrumental delivery is necessary. INTERMEDIATE POSITIONS It is very common for the fetal head to be in an intermediate position when examining patients. In fact, the left occipito-iliac-anterior presentation is the most common presentation we encounter during delivery. This position, which is between an occipito-anterior and a left occipito-iliac-transverse position, is called LIO, because the occipital fontanelle is to the left and anterior to the mother. Similarly, if the lesser fontanelle is posterior (below) and to the left, it is called left occipito-iliac-posterior (LIPO). Related Topics: Liver Disease and Pregnancy: https://www.youtube.com/watch?v=oq4W0... Cholestasis of Pregnancy:    • COLESTASIS INTRAHEPÁTICA DEL EMBARAZO: cau...   Heart Disease and Pregnancy: https://www.youtube.com/watch?v=jdnUl... Postpartum Depression: https://www.youtube.com/watch?v=sjpbU... More information, videos, podcasts, and PDFs at AULAGINECOLOGIA.COM