It often has been said that the vertex occipitoposterior position is the obstetric complication taking the greatest toll of fetal and maternal life and predisposing toward the greatest morbidity and permanent damage among surviving mothers. Reports that one sees, from time to time, adequately bear out this statement, and all writers are apparently in agreement that mismanagement, particularly faulty diagnosis resulting in neglect of a persistent posterior position, and subsequent maternal exhaustion and fetal distress is the chief offending factor. One teacher within the past two years has gone so far as to suggest that the improper management of this malposition contributed considerably to the high fetal and maternal mortality in his city.
Diagnosis is unquestionably of paramount importance in the intelligent handling of these cases and should not be difficult. Vaginal examination to determine the position of the vertex is rarely essential. Careful abdominal palpation and auscultation, combined with
SAMUEL M. DODEK. THE VERTEX OCCIPITOPOSTERIOR POSITIONTHE TREATMENT OF MORE THAN FIVE HUNDRED CONSECUTIVE CASES. JAMA. 1931;96(20):1660–1664. doi:10.1001/jama.1931.02720460006002