Clinical Expert Series
Persistent Occiput Posterior
William H. Barth, Jr., M.D.
Obstet Gynecol 2015;125(3)
Continuing Medical Education credit is provided through joint sponsorship with
The American College of Obstetricians and Gynecologists.
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The American College of Obstetricians and Gynecologists (the College) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
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The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 AMA PRA
Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.
College Cognate Credit(s)
The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 Category 1
College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to
be equivalent to College Cognate Credits.
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control of any commercial interest. All authors, reviewers, and contributors have disclosed to the College all relevant financial
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Submission
Before submitting this form, please print a completed copy as confirmation of your program participation.
College Fellows: To obtain credits, complete and return this form by e-mail (obgyn@greenjournal.org) or fax (202-4790830). Your score, and a copy of the answer key, will be e-mailed to you after receipt of a completed quiz. Credit will be
recorded for those participants answering 80–100% of questions correctly. College Fellows may check their transcripts
online at http://www.acog.org, and any questions related to transcripts may be directed to educationcme@acog.org. For other
queries, please contact the Obstetrics & Gynecology Editorial Office, 202-314-2317 (phone) or obgyn@greenjournal.org (email).
Non–College Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout
of the completed quiz is documentation for your continuing medical education credits.
Continuing medical education credit for “Persistent Occiput Posterior” will be available through March 2018.
1. The most common form of persistent occiput posterior is:
Direct occiput posterior
Right occiput posterior
Left occiput posterior
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CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;125(3)
Credit available through March 2018
Page 1 of 4
2. The majority of fetuses beginning labor in the occiput posterior position will be in what position at
the time of delivery?
Occiput anterior
Occiput posterior
Left occiput anterior
Right occiput posterior
Occiput transverse
3. The most likely delivery position for a vertex fetus discovered to be in the occiput posterior position
at the start of second stage will be in what position at the time of delivery?
Occiput anterior
Occiput posterior
Left occiput anterior
Right occiput posterior
Occiput transverse
4. The highest rate of occiput posterior is among women with pelvic features of which type?
Anthropoid
Gynecoid
Platypelloid
Android
Rachitic
5. The risk of cesarean delivery is greatest when occiput posterior position is diagnosed:
Before term
Before labor
At the onset of labor
During late first stage
During the second stage
6. Which of the following fetal measures represents the greatest diameter when passing through the
maternal pelvis?
Auboccipito-bregmatic
Occipito-mental
Occipito-frontal
Biparietal
Submento-bregmatic
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;125(3)
Credit available through March 2018
Page 2 of 4
7. When cesarean delivery is performed for a persistent occiput posterior in the second stage of labor,
there is an increased risk of:
Erb palsy
Fetal respiratory distress syndrome
Persistent fetal torticollis
Uterine inversion
Inadvertent extension of the hysterotomy
8. A woman aged 20 years is admitted at term with spontaneous rupture of the membranes, irregular
contractions, and uncertain fetal presentation. On ultrasonographic evaluation, the fetus is found to be
in the vertex presentation but an occiput posterior position. The most appropriate management of this
patient is:
Plan cesarean delivery
Labor in left Sims position
Labor in the knee-chest position
Manual rotation of the fetal head
Routine labor care
9. In a digital rotation of an occiput posterior fetus, pressure from the fingers is exerted against the:
Mandible
Posterior fontanel
Zygomatic arch
Occipital bone
Parietal bone
10. Attempts at forceps rotation from an occiput posterior to occiput anterior position is most closely
associated with:
Fetal scalp injury
Fetal subdural hematoma
Postpartum maternal bladder atony
Maternal fourth-degree laceration
Successful delivery in the occiput anterior position
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CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;125(3)
Credit available through March 2018
Page 3 of 4
Actual time spent completing this activity (you may record up to 2 hours):
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;125(3)
Credit available through March 2018
Page 4 of 4