New Assessment of Fetal Descent and Forceps Delivery by Satoru Takeda

Author:Satoru Takeda
Language: eng
Format: epub, pdf
Publisher: Springer Singapore, Singapore

1. Direction of the sagittal suture and the sites of anterior and posterior fontanels

2. Status of rotation (palpation of the fetal ears, sagittal suture) and the lowest part of the fetal head

3. Assessment of the level of the fetal head

4. Whether or not the operator’s fingers can be inserted between the posterior surface of the pubic symphysis and the fetal head

Confirmation of these points allows the level of the fetal head and the presence/absence of rotation abnormality to be objectively assessed, facilitating confirmation of the requirements for forceps delivery and appropriate application of the forceps. When the operator moves the inserted fingers along the sagittal suture, the anterior and posterior fontanels can be palpated. The anterior fontanel is felt as the crossover site of four sutures and the posterior fontanel as the crossover site of three sutures.

Even if the sagittal suture is difficult to touch because of caput succedaneum, a reasonable speculation as to the direction of the sagittal suture can be made by touching the fetal ears. If the posterior or anterior fontanel can be touched, flexion or deflexion of the fetus can be diagnosed (if the posterior fontanel is palpated frontward, showing precedence of the posterior fontanel, the fetus is in flexion in the “occipitoanterior position”; if the anterior fontanel is palpated frontward, showing precedence of the anterior fontanel, the fetus is in deflexion in the “frontoanterior position”).

In extremely rare cases, the posterior fontanel is palpated backward, though the posterior fontanel is in a preceding position. In such cases, the fetal position is diagnosed as the occipitoposterior rather than the frontoanterior position. To perform correct traction of the forceps, it is necessary to distinguish between the frontoanterior position in deflexion and the occipitoposterior position in flexion. The fetus in the frontoanterior position can be extracted by the forceps procedure. However, in the occipitoposterior position, the fetus is already in flexion when it enters the third rotation, thereby making it difficult to complete the third rotation, often resulting in arrested labor and usually a failure to descend into the low position. The US classification of presentation of the fetus refers to a category of left (right) occiput posterior alone, with no distinction between the frontoanterior and occipitoposterior positions. However, it is necessary to distinguish the frontoanterior position from occipitoposterior position because the distinction between flexion and deflexion is important for safely extracting the fetus by applying traction in a correct direction with forceps.

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