Does occiput posterior position in the second stage of labour increase the operative delivery rate?

Does occiput posterior position in the second stage of labour increase the operative delivery rate?

Objectives To assess the impact of occipito‐posterior position in the second stage of labour on operative delivery. Methods Double‐blinded prospective cohort study of ultrasound determined occiput‐posterior position during the second stage of labour compared with occiput‐anterior position. The prima...

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Published in:Australian & New Zealand journal of obstetrics & gynaecology Vol. 53; no. 3; pp. 265 - 270
Main Authors: Carseldine, Wendy J., Phipps, Hala, Zawada, Shannon F., Campbell, Neil T., Ludlow, Joanne P., Krishnan, Surya Y., De Vries, Bradley S.
Format: Journal Article
Language:English
Published: Australia Blackwell Publishing Ltd 01-06-2013
Subjects:
Adult
caesarean section
Cesarean Section
Delivery, Obstetric - methods
Double-Blind Method
Extraction, Obstetrical
Female
Humans
instrumental delivery
Labor Presentation
Labor Stage, Second
Obstetrical Forceps
occiput-posterior
operative delivery
Pregnancy
Prospective Studies
ultrasound
Vacuum Extraction, Obstetrical
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Summary:Objectives To assess the impact of occipito‐posterior position in the second stage of labour on operative delivery. Methods Double‐blinded prospective cohort study of ultrasound determined occiput‐posterior position during the second stage of labour compared with occiput‐anterior position. The primary outcome was operative (caesarean section, forceps or vacuum) delivery. Results A total of 68% (13/19) women in the occiput‐posterior group, and 27% (39/141) in the occiput‐anterior group had an operative delivery (unadjusted: P < 0.001). Caesarean section was performed in 37% and 5%, respectively (P < 0.001). The occiput‐posterior group had a longer second stage (mean 2 h 59 minutes vs 1 h 54 minutes; P = 0.001) and larger infants (mean 3723 g vs 3480 g, P = 0.024). In the logistic regression, occiput‐posterior position, nulliparity, abnormal second stage cardiotocograph and epidural analgesia were independent predictors for operative delivery. Conclusions Occiput‐posterior position early in the second stage of labour is strongly associated with operative delivery. There is potential to explore interventions such as manual rotation.
Bibliography:ark:/67375/WNG-H8CZXRKG-5
istex:5B9A91940108FD35498EFDC8B2922F7E337EB476
ArticleID:AJO12041
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0004-8666
1479-828X
DOI:10.1111/ajo.12041