A 30-year-old G2P1 has an occiput posterior position diagnosed at full dilation after 2 hours of pushing. Station is +2. The MOST appropriate immediate action is:
- A Immediate emergency caesarean section
- B Manual rotation to occiput anterior position followed by assessment ✓
- C Apply Kjelland forceps without rotation
- D Continue pushing for another hour before intervention
Correct answer: B. Manual rotation to occiput anterior position followed by assessment
Explanation
Persistent occiput posterior (OP) at full dilation with +2 station is best managed by attempting manual rotation to occiput anterior (OA) position, as this converts the presentation to a more favourable diameter and allows vaginal delivery. Forceps or ventouse can then be applied if pushing is insufficient. Immediate caesarean section is premature when descent has occurred to +2 station. Kielland forceps specifically can rotate an OP, but manual rotation is safer as first step.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.