In occipito-posterior position when occiput points towards sacrum is referred as:
A. Persistent occipito-posterior positions
B. Left occipito-posterior position
C. Direct occipito-posterior position
D. Right occipito-posterior position
Correct Answer: C. Direct occipito-posterior position
Explanation
In occipito-posterior (OP) position, the occiput (back of the fetal head) is directed towards the maternal sacrum instead of the pubic symphysis.
Correct term:
👉 Direct occipito-posterior (DOP) position
Explanation:
- In OP positions, the fetal occiput lies in the posterior half of the maternal pelvis.
- When the occiput is:
- Exactly towards the sacrum (midline posterior) → it is called Direct occipito-posterior position
- Towards left sacro-iliac joint → Left occipito-posterior (LOP)
- Towards right sacro-iliac joint → Right occipito-posterior (ROP)
Key point:
✔ Occiput pointing directly towards sacrum = Direct occipito-posterior position
This position often causes prolonged labor because internal rotation of the head is difficult.
Other Options Details
These terms describe occipito-posterior (OP) positions of the fetal head in vertex presentation, based on the direction of the occiput in relation to the maternal pelvis.
A. Persistent occipito-posterior position
- The fetal occiput remains posterior (towards the maternal sacrum) throughout labour.
- Normally, OP positions rotate anteriorly to become occipito-anterior (OA).
- Failure of this rotation leads to a persistent OP.
- Clinical significance:
- Prolonged labour
- Increased backache
- Higher chance of instrumental delivery or cesarean section
B. Left occipito-posterior (LOP) position
- The occiput points towards the left sacro-iliac joint of the mother.
- One of the most common OP positions at the onset of labour.
- May rotate:
- Anteriorly → Left occipito-anterior (LOA) (favourable), or
- Posteriorly → Direct OP or persistent OP
C. Direct occipito-posterior (DOP) position
- The occiput is directly towards the maternal sacrum.
- Sagittal suture lies in the antero-posterior diameter of the pelvis.
- Often results from incomplete rotation of LOP or ROP.
- Clinical features:
- Long second stage
- “Face-to-pubis” delivery may occur
- Increased operative interference
D. Right occipito-posterior (ROP) position
- The occiput is directed towards the right sacro-iliac joint.
- Similar mechanism and significance as LOP.
- Rotation may be:
- Anterior (to ROA), or
- Remain posterior → persistent OP
Summary Table
Position Occiput Direction LOP Left sacro-iliac joint ROP Right sacro-iliac joint DOP Directly towards sacrum Persistent OP Occiput remains posterior throughout labour
✅ Key point: OP positions are common at labour onset, but problems arise when they fail to rotate anteriorly.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group