Influence of persistent occiput posterior position on delivery outcome.

Abstract

OBJECTIVE:

To evaluate the influence of intrapartum persistent occiput posterior position of the fetal head on delivery outcome and anal sphincter injury, with reference to the association with epidural analgesia.

METHODS:

We conducted a prospective observational study of 246 women with persistent occiput posterior position in labor during a 2-year period, compared with 13,543 contemporaneous vaginal deliveries with occiput anterior position.

RESULTS:

The incidence of persistent occiput posterior position was significantly greater among primiparas (2.4%) than multiparas (1.3%; P <.001; 95% confidence interval 1.4, 2.4) and was associated with significantly higher incidences of prolonged pregnancy, induction of labor, oxytocin augmentation of labor, epidural use, and prolonged labor. Only 29% of primiparas and 55% of multiparas with persistent occiput posterior position achieved spontaneous vaginal delivery, and the malposition was associated with 12% of all cesarean deliveries performed because of dystocia. Persistent occiput posterior position was also associated with a sevenfold higher incidence of anal sphincter disruption. Despite a high overall incidence of use of epidural analgesia (47% versus 3%), the institutional incidence of persistent occiput posterior position was lower than that reported 25 years ago.

CONCLUSION:

Persistent occiput posterior position contributed disproportionately to cesarean and instrumental delivery, with fewer than half of the occiput posterior labors ending in spontaneous delivery and the position accounting for 12% of all cesarean deliveries for dystocia. Persistent occiput posterior position leads to a sevenfold increase in the incidence of anal sphincter injury. Use of epidural analgesia was not related to the malposition.

• Authors: M Fitzpatrick, K McQuillan, C O'Herlihy
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 98 Issue 6 Pg. 1027-31 (Dec 2001) ISSN: 0029-7844 [Print] United States
• PMID: 11755548 (Publication Type: Journal Article)

Topics

• Anal Canal (injuries)
• Analgesia, Epidural
• Dystocia (epidemiology, etiology)
• Female
• Humans
• Incidence
• Ireland (epidemiology)
• Labor Presentation
• Parity
• Pregnancy
• Pregnancy Outcome
• Prospective Studies