Dystocia due to persistent occipito-transverse position is due to the difficulty of delivery when the fetal position cannot be changed to a normal position during delivery.

　　The occurrence of persistent occipito-transverse position is influenced by a variety of factors, just like persistent occipito-posterior position.

　　1. Abnormal shape and size of the pelvis: Flat and male pelvises are prone to persistent occipito-transverse position. According to the survey, both account for 43.23%, with flat pelvis accounting for 23.88%. The reason why persistent occipito-transverse position is more common in flat and male pelvises is that the anteroposterior diameter of the flat pelvis is short, and the anterior half of the inlet of the male pelvis is narrow, shortening the available anteroposterior diameter of the inlet. Therefore, in these two types of pelvises, the fetal head often enters the pelvis in the occipito-transverse position. The transverse diameters of the flat pelvis are increased, and the anteroposterior diameter is reduced, so the fetal head remains in the occipito-transverse position to the pelvic floor, called low transverse position of the fetal head, and the male pelvis must turn into the occipito-anterior position before reaching the middle pelvis, otherwise the transverse diameter of the middle pelvis of the male pelvis is short, and the fetal head cannot rotate forward on this surface.

　　2. Incongruity between the size of the pelvis and the fetus: This hinders the forward rotation of the occipito-transverse position fetal head.

　　3. Poor fetal head flexion: Even in the occipito-transverse position, poor fetal head flexion can increase the diameter of the fetal head passing through the birth canal, hindering the rotation and descent of the fetal head.

　　4. Uterine inertia: Both natural and anesthetic-induced uterine inertia can affect the rotation and descent of the fetal head.

　　1. Secondary uterine inertia often occurs, leading to prolonged labor and increasing the risk of postpartum hemorrhage and intrauterine infection. The rate of instrumental delivery increases, and instrumental delivery is prone to cause damage to the soft birth canal; at the same time, due to the long-term compression of the fetal head on the soft birth canal, intestinal distension and urinary retention may occur, and even fistula of the reproductive tract may be formed; if the mother does not eat for a relatively long time and does not receive nutritional and fluid supplementation through intravenous injection, it may also lead to electrolyte disorder and acid-base imbalance.

　　2. Prolonged second stage of labor and instrumental delivery can increase the incidence of fetal distress, fetal scalp edema and hematoma, intracranial hemorrhage, and neonatal asphyxia, thus increasing the perinatal mortality rate.

　　The symptoms of dystocia due to persistent occiput transverse position include:

　　(1) The fetal head is connected late after labor, which is prone to uterine contraction weakness, slow expansion of the cervix, and stagnation of fetal head descent.

　　(2) The mother has a sense of anal坠胀 and defecation early.

　　(3) The mother is prone to fatigue: related to the mother's unconscious straining before the cervix is fully dilated.

　　(4) Cervical edema, slow progress of labor.

　　Persistent occiput transverse position has the highest incidence among abnormal fetal head positions and is the mildest abnormal fetal head position. Its degree of dystocia is the mildest among abnormal fetal head positions. However, the rate of cesarean section is higher, although the rate of cesarean section is lower than that of persistent occiput posterior position, the rate of vaginal assistance is higher than that of persistent occiput posterior position. Because it is the mildest abnormal position, the fetal head position is low, often not paid attention to, and eventually leads to serious maternal and fetal complications. The cause of formation is similar to that of persistent occiput posterior position. Vaginal examination and ultrasound examination can be used to confirm the diagnosis. In addition to obvious cephalopelvic disproportion, all can be tried. Maintain good labor force during labor and closely observe the expansion of the cervix and the descent of the fetal head. If the fetal head cannot be connected after sufficient trial labor, or the cervix cannot be fully dilated, cesarean section should be performed to terminate pregnancy. When the fetal head in the oblique position reaches 2 or less, it can be assisted by vaginal surgery. Good labor force should be maintained during the surgical assistance, and the deformation of the fetal head and the pseudohypoplasia of the fetal head position caused by the fetal cephalohematoma should be vigilant.

　　1. Long-term inappropriate or excessive use of antipsychotic drugs or central nervous system stimulants may produce tics or tic-dysphonia syndrome.

　　2. Reasonably arrange the daily routine and activities of the child, avoid excessive tension and fatigue, and can participate in rhythmic sports activities.

　　4. Various mental stimuli, such as excessive tension, fatigue, scolding, reprimands, frequent reminders, and so on, can induce and suggest this condition, making the tic disorder worse. Therefore, it is necessary to avoid the occurrence of the above situations.

　　1) Abdominal examination: Half of the maternal abdomen is occupied by the fetal limbs, and the other half is occupied by the fetal back. The fetal head felt above the symphysis pubis is wider than the occiput anterior position. When the fetal head in the oblique position does not flex forward, the ends of the occipitofrontal diameter can be felt on both sides of the fetal head, averaging 11.3 cm, which can be slightly smaller according to the degree of flexion. The top of the skull felt above the symphysis pubis is not equal in height, with the side where the occipital bone is located higher than the side where the frontal bone is located. If it is the left oblique position, the occiput can be felt on the left side of the lower abdomen above the symphysis pubis (round and hard), 3 fingers above the symphysis pubis, while the right frontal bone may only be one finger high. If it is the right oblique position, the direction is opposite. The descent of the fetal head should be followed up with the occipital side as the standard. When the left oblique position of the occiput, the occiput is always touched on the left lower abdomen of the mother, and it is absolutely not allowed to change to the right lower abdomen next time to touch it. The part felt is only one finger above the symphysis pubis, and it is mistakenly believed that the fetal head has descended 2 fingers. On the opposite side of the fetal occiput, the chin can be felt below the frontal bone, but because the chin is too lateral, it is not as easy to touch as the occiput posterior position. The fetal heart sound is the loudest on the same side of the fetal occiput as the maternal lower abdomen obliquely.

　　(2) Anal and vaginal examination: The fetal head suture is on the transverse diameter of the pelvis. At the time of impending childbirth, or when there is a malpresentation of the head and pelvis, the fetal head can be laterally flexed to reduce the diameter of entry into the pelvis. The fetal head enters the pelvis with an uneven tilt, allowing the posterior vertex to enter the pelvis first, using the凹sacrum to retreat backward to allow the anterior vertex to slide down from the pubic symphysis to form an even tilt, and then descend. Therefore, the fetal head suture first approaches the pubic symphysis and then returns to the transverse diameter of the pelvis in the middle, which is the normal process of delivery. If the occipitotransverse position adopts an uneven tilt entry (uneven tilt position) as abnormal delivery. When the occiput is in the right transverse position, the anterior fontanelle is on the left side of the pelvis, and the posterior fontanelle is on the right; when the occiput is in the left transverse position, the anterior fontanelle is on the right side of the pelvis, and the posterior fontanelle is on the left.

　　3. Diagnosis

　　(1) Pelvic examination: For flat and male pelvic types, if the fetal head enters the pelvis in an occipitotransverse position, one should be vigilant about the possibility of persistent occipitotransverse position.

　　(2) Abnormalities in the birth process chart: When there are signs of difficult labor in the occipitotransverse position, the birth process curve shown in the birth process chart is abnormal, roughly the same as that of persistent occiput posterior position.

　　Postpartum dietary remedies for persistent occipitotransverse position difficult labor:

　　(1) Egg flower congee

　　Eggs have the effects of nourishing yin and moistening dryness, nourishing blood and calming the mind. Boiling eggs with glutinous rice has the effects of benefiting the five internal organs and enriching essence and blood. It is suitable for postpartum women with physical weakness.

　　Ingredients: 100 grams of glutinous rice, 3 eggs, appropriate amounts of salt and lard.

　　Preparation:

　　Crack the eggs into a bowl, beat them with chopsticks; wash the glutinous rice clean and set aside. Place a pot on the stove, pour in some water, add glutinous rice, bring to a boil, then turn to low heat and continue to cook until the rice blooms. Pour the eggs into the boiling congee, add lard, cook for a while, add salt to taste and it is ready.

　　(2) Steamed ginger egg

　　Eggs contain high-quality protein and a lot of calcium, iron, vitamin A, D and other nutrients, which have the effects of nourishing yin and moistening dryness, nourishing blood and calming the wind; brown sugar and ginger, in addition to providing sugar, also have the effects of promoting blood circulation and removing phlegm, warming the middle and dispelling coldness, and can prevent the occurrence of wind-cold and blood stasis after childbirth and other diseases.

　　Ingredients: 10 eggs, 50 grams of fresh ginger, appropriate amounts of brown sugar and vinegar.

　　Preparation:

　　One, wash the fresh ginger, use a knife to beat it loose, and cut it into pieces.

　　Two, place a pot on the stove, pour in boiling water, add brown sugar and a little vinegar, ginger cubes, boil for 5 minutes, pour out, remove the ginger cubes, cool the ginger syrup and set aside.

　　Three, crack the eggs into a bowl and beat them, then add the cooled ginger syrup and mix well. Pour them into small bowls separately, steam for 10 minutes and it is ready.

　　Nutritional effects: Prevent the occurrence of wind-cold and blood stasis after childbirth.

　　(One) Treatment

　　All cases with the fetus entering the pelvis in a transverse position, except for obvious head and pelvis disproportion, should be attempted. However, during the process of trial labor, if abnormal labor is found, attention should be paid. Generally, abnormal labor after 8 hours of labor should raise the suspicion of dystocia, and treatment should begin. If after various treatments, the labor remains abnormal for 6 hours, dystocia can be diagnosed. Generally, labor should end before 18 hours of labor, and at the longest, before 24 hours. Abnormal progress of labor usually involves the following two situations:

　　1. Malpresentation of the head and pelvis: If the pelvis is a series of narrow anteroposterior diameters from the inlet to the outlet, or a male-type pelvis in the漏型狭窄, with the fetus being large and the head and pelvis scoring ≤6 points, especially at the outlet, it is not advisable to attempt too much trial labor. If the cervix cannot be fully dilated, or the fetal head cannot engage, cesarean section must be performed to end labor.

　　2. Poor uterine contraction: In cases where there is no malpresentation of the head and pelvis but poor uterine contraction, such as entering the active phase, artificial rupture of membranes and intravenous infusion of oxytocin can be tried to promote labor progress.

　　When the cervix is dilated 3 to 5cm, two fingers can be inserted into the uterine cavity to hold the fetal head and rotate it forward, while also coordinating with the position (lateral recumbent position) and the assistant pushing the fetal shoulders to the anterior position of the spine. If it fails, the fetal head can be rotated forward by separating the thumb and four fingers naturally when the cervix is almost fully dilated or fully dilated. After rotation to the anterior position, the fetal head usually drops quickly, and even natural delivery is possible. If natural delivery is not achieved, the fetal head can be assisted with a vacuum extractor or forceps. If manual rotation fails, those who are proficient in the use of forceps can also use Kjelland forceps to rotate the fetal head to the occipital anterior position and then use general forceps to pull. When the fetal head is low transverse and wedged in the pelvic cavity, there is often an inlet outlet disproportion, and it is possible to damage the bladder if forceps are forced onto it, especially when the anterior blade of the forceps is inserted. Therefore, when preparing for forceps version assistance, a detailed vaginal examination must be performed, and the anteroposterior diameter of the middle pelvis and outlet should not be less than 10.5cm, and the interischial diameter plus the posterior sagittal diameter should not be less than 15cm. It is estimated that the biparietal diameter of the fetal head can pass through the middle pelvis and outlet, so it is possible to assist delivery; otherwise, cesarean section should be considered. The pelvic scoring should also be made according to the size of the fetus, and those with an outlet pelvic scoring ≥6 points should not undergo vaginal assistance.

　　In cases where only the pelvic inlet is narrow in the supine position, it is easier to handle. Abnormalities in labor may appear early, allowing sufficient time for trial labor. Once the inlet is cleared, the normal labor process can be followed. However, it should be cautious to explore around the sacral promontory when performing a diagonal measurement during vaginal examination to avoid missing an elongated sacral promontory. In the past, there was a case where an abnormality appeared early in labor, and a diagonal measurement was taken during a vaginal examination, which was considered to be >11.5cm (normal value), so the trial labor was continued until the fetal head was visible outside the vaginal orifice, and it was only then that it was found that the fetal head had not actually entered the pelvis but was an illusion caused by an extremely deformed fetal head and significant edema. The anteroposterior diameter of the pelvic inlet was only 8.7cm, which is a severe narrowing. If the first vaginal examination could have identified this, an immediate cesarean section should have been performed, and trial labor should not have continued. If the inlet is narrow and the pelvic scoring is 6 points, a short-term trial labor may still be possible.

　　When the fetal head is in a low transverse position, if there is no cephalopelvic disproportion, using a vacuum extractor for delivery is beneficial. Firstly, it is easier to place a vacuum extractor in the transverse position than a forceps, and secondly, the vacuum extractor can help rotate the fetal head and pull the fetal head, increasing the chance of success. It is advisable to rotate and pull the fetal head while the uterine contraction is occurring during vacuum extractor delivery. If the uterine contraction is poor, oxytocin intravenous drip can be supplemented. If the vacuum extractor is used to pull the fetal head, and the fetal head cannot be delivered after two contractions, it should be considered that the assistance has failed, and cesarean section should be performed. It is not recommended to perform a forceps operation after the failure of vacuum extractor delivery, as this increases the chance of fetal intracranial injury.

　　(II) Prognosis

　　1. Effects on the Mother: Secondary uterine contraction weakness often occurs, causing prolonged labor, increasing the chance of postpartum hemorrhage and intrauterine infection. The rate of surgical assistance increases, and it is easy to cause soft birth canal injury during surgical assistance; at the same time, due to the long-term compression of the fetal head on the soft birth canal, intestinal bloating and urinary retention may occur, even leading to fistula of the genital tract; if the mother does not eat for a longer period of time and does not receive nutritional and fluid supplements through intravenous injection, it may also lead to electrolyte imbalance and acid-base imbalance.

　　2. Effects on the Fetus: Prolongation of the second stage of labor and surgical assistance can increase the incidence of fetal distress, fetal scalp edema and hematoma, intracranial hemorrhage, and neonatal asphyxia, thereby increasing the perinatal mortality rate.

　　When dealing with persistent occipitotransverse position, if there is no obvious cephalopelvic disproportion, the prognosis of mother and child depends on the skill level of the midwife in mastering the main delivery method, as well as whether there is good uterine contraction. For the higher position of occipitotransverse position, after sufficient trial labor, delivery has been completed by cesarean section. Most of the mothers who deliver by vaginal surgery assistance have a lower occipitotransverse position, with the fetal head reaching the middle pelvis and below. If the fetal head is rotated during uterine contractions, because the fetal head is embedded between the pelvis, manual rotation is often difficult to succeed, and the damage to the maternal birth canal by forceps rotation is greater. The author believes that using a vacuum extractor, after the vacuum is formed, to push the fetal head upwards during the intercontraction period, to make the fetal head slightly loose in the pelvis, and then to rotate it, and to pull the fetal head during uterine contractions, the chance of success is greater, and the impact on the mother and child is smaller.