From the Guidelines
The key management of a pathological fetal posture (attitude) involves prompt identification and intervention, with cesarean delivery often being the safest option, particularly for brow presentations, and manual vaginal disimpaction or other advanced disimpaction techniques may be necessary during cesarean delivery. The management approach should start with identifying the type of abnormal attitude through careful clinical examination and ultrasound assessment [ 1 ]. For most pathological attitudes, the initial approach should be expectant management with close monitoring, as many will spontaneously convert to normal presentations. If labor progresses with a persistent abnormal attitude, the decision between cesarean or vaginal delivery should be individualized based on the specific attitude, progression of labor, fetal status, and maternal factors [ 1 ]. Some key techniques for management when an impacted fetal head is encountered during cesarean delivery include:
- Uterine relaxation
- Abdominal cephalic disimpaction
- Manual vaginal disimpaction (vaginal push method)
- Reverse breech extraction
- Patwardhan method Throughout management, continuous fetal monitoring is essential to detect any signs of distress, and maternal positioning, particularly lateral positioning, may help facilitate spontaneous conversion in some cases [ 1 ]. Early consultation with experienced obstetricians is crucial as these presentations increase the risk of prolonged labor, birth trauma, and operative delivery [ 1 ].
From the Research
Pathological Fetal Posture (Attitude) Management
There are no research papers provided that directly address the management of a pathological fetal posture (attitude). The studies provided discuss various topics related to fetal health and obstetrics, such as preterm labor, fetal acidosis, decreased fetal movements, fetal growth restriction, and intrapartum fetal distress, but do not specifically address the management of pathological fetal posture.
- The provided studies focus on:
- Tocolysis for preterm labor 2
- Recognition and significance of maternogenic fetal acidosis during labor 3
- Decreased fetal movements and their assessment and management 4
- Fetal growth restriction, its diagnosis, management, and delivery 5
- Clinical suspicion, management, and outcome of intrapartum fetal distress 6
- However, none of these studies provide information on the key management of a pathological fetal posture (attitude).