When in labor, a diagnosis of occipito-posterior presentation is made. The most appropriate management would be:
Emergency CS
Wait and watch for progress of labor
Early rupture of membranes
Start oxytocin drip
Ans. is b, i.e. Wait and watch for progress of laborRef JB Sharma TB of Obs. p 284, Operative Obs and Gynae by Randhir Puri and Narendra Malhotra 7/e, p 173; Williams Obs 23/e, p 479Occipito-posterior positions'Expectant observation is practiced initially as given time, most of the malposition will rotate anteriorly and the baby will be born spontaneously' Ref. JB Sharma Obs. p 284"In practice about 5-10% of women admitted in labor with cephalic presentations present with occipito-posterior presentations. Given time and patience, many of these will rotate and get corrected to occipitoanterior position and deliver normally". --Operative Obs and Gynae 7/e, p 173, Randhir Puri and Narendra MalhotraThis explains that a careful wait and watch policy should be adopted for occipito-posterior position.
Malpresentation