Occiput Posterior (OP) - Gynecology

What is Occiput Posterior (OP) Position?

The Occiput Posterior (OP) position refers to a fetal position during labor where the back of the baby's head (occiput) is against the mother's back. This position is also known as the "sunny side up" position. Unlike the more common Occiput Anterior (OA) position, the OP position can make labor more challenging.

How Common is OP Position?

About 15-30% of fetuses are in the OP position at the onset of labor, but only 5-7% remain in this position at the time of delivery. The majority of fetuses rotate to the OA position during labor.

What are the Causes of OP Position?

The exact cause of the OP position is not well understood, but several factors may contribute:

Pelvic shape – Certain pelvic shapes, such as android or anthropoid, may predispose to OP position.
Fetal factors – Large baby size or an extended fetal head can influence the position.
Maternal factors – Poor posture or a sedentary lifestyle may contribute.

What are the Risks and Complications Associated with OP Position?

Labor with the baby in the OP position can be more difficult and prolonged. Some of the risks and complications include:

Prolonged labor – The labor process may take longer, leading to exhaustion and increased risk of interventions.
Back labor – Intense back pain is common due to the baby's head pressing against the mother's spine.
Operative delivery – Increased likelihood of needing interventions such as vacuum extraction, forceps delivery, or cesarean section.
Perineal trauma – Higher risk of severe perineal tears or episiotomy.

How is OP Position Diagnosed?

Diagnosis of OP position is typically made through clinical examination during labor. The healthcare provider may feel the baby's position through abdominal palpation or during a vaginal exam. Ultrasound can also be used to confirm the fetal position.

What are the Management and Treatment Options for OP Position?

Several strategies can help manage and potentially rotate the baby to a more favorable position:

Maternal positioning – Techniques such as hands-and-knees position, pelvic rocking, and the use of a birthing ball can encourage rotation.
Manual rotation – The healthcare provider may attempt to manually rotate the baby to the OA position during labor.
Epidural anesthesia – Pain relief can help the mother relax, potentially facilitating the baby's rotation.
Operative delivery – If the baby does not rotate, interventions such as forceps or vacuum may be necessary.

Can OP Position be Prevented?

While it is not always possible to prevent OP position, certain measures may reduce the likelihood:

Maintaining good posture and staying active during pregnancy.
Practicing exercises that encourage optimal fetal positioning, such as pelvic tilts.
Attending prenatal classes that provide information on labor positions and techniques.

Conclusion

While the Occiput Posterior (OP) position can present challenges during labor, understanding the risks, management strategies, and potential interventions can help improve outcomes for both the mother and baby. It is essential for expecting mothers to work closely with their healthcare providers to navigate labor effectively.