OCCIPITOANTER

IOR
PRESENTATION

SIDDHARTH
79
 CONTENTS
• TERMINOLOGIES
• EXAMINATION
• INFERENCE
 TERMINOLOGIES
• LIE: The lie refers to the relationship of the long axis of the fetus to
the long axis of the centralized uterus or maternal spine
• PRESENTATION: The part of the fetus which occupies the lower pole
of the uterus
• PRESENTING PART: The presenting part is defined as the part of the
presentation which overlies the internal os and is felt by the
examining finger through the cervical opening
• ATTITUDE: The relation of the different parts of the fetus to one another
is called attitude of the fetus. The universal attitude is that of flexion.

• DENOMINATOR: bony fixed point on the presenting part which comes in

relation with the various quadrants of the maternal pelvis

• POSITION: It is the relation of the denominator to the different

quadrants of the pelvis
 EXAMINATION
• The cephalic presentation, being the absolute majority amongst the
longitudinal lie, can be explained by:
• (1) Gravitation—the head being heavier comes down to the bottom.
• (2) Adaptation — the smallest circumference of the flexed head is
about 27.5 cm (11") and the circumference of the breech with both
thighs flexed is about 32.5 cm (13”).
• Preliminaries: empty bladder, consent, hip and knee flexed
• Inspection: shape and scars
• Palpation: Fundal height, fundal girth, Leopold maneuvers,
• Auscultation
Fig. : Diagrammatic representation of a
fetus in flexed attitude
V–P—Verti co-podalic diameter;
A–A—Bisacromial diameter;
T–T—Bitrochanteric diameter
P–P—Biparietal diameter
 INFERENCE

Lie: The longitudinal lie is evident from: (1) Longitudinal uterine

ovoid on inspection (2) the poles of the fetal ovoid—cephalic and
podalic are placed, one at the lower and the other at the upper
part of the uterine cavity, as evident from the fundal and first pelvic
grips.
Presentation: The cephalic presentation is evident from the first
pelvic grip—smooth, hard and globular mass.
Attitude: From the first pelvic grip, the relative positions of the sincipital and
occipital poles are determined. In well-flexed head, the sincipital pole is placed
at a higher level but in deflexed state, both the poles remain at a same level
Presenting part: Vertex is diagnosed from the first pelvic grip. The cephalic
prominence, being the sinciput, is placed on the same side toward which
limbs lie.
Position: The occipitoanterior position is diagnosed by: (1) Inspection—
convexity of the uterine contour. (2) Lateral grip—(a) The back is placed
not far from the midline to the same side of the occiput (b) The anterior
shoulder is near the midline (3) Auscultation—maximum intensity of the
FHS is close to the spinoumbilical line on the same side of the back.
Right or left position is to be determined by: (1) Position of the back (2)
Position of the occiput and (3) Location of the FHS