Occipitoposterior position: associated factors and obstetric outcome in nulliparas

Sizer, Andrew; Nirmal, Daisy

doi:10.1016/s0029-7844(00)01030-9

Cited by 81 publications

(66 citation statements)

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“…In contrast to the literature [3,5], in our large cohort we did not find an increased prevalence of persistent OP position in "big babies," i.e., those with a BW ≥90th or 95th centile, or among primiparae [3][4][5]13], nor was the rate of OP position increased in cases of labor induction [3,13] or maternal diabetes; the observed difference in gestational age at delivery was not clinically significant. However, we did find that persistent OP position was more prevalent among infants with an HC ≤10th centile than in the cohort as a whole, but not more prevalent among babies with an HC ≥90th centile or a BW ≤10th centile.…”

Section: Main Findingscontrasting

confidence: 99%

“…At term, approximately 15-20% of fetuses are in this position; at delivery, some 5% will remain so [1][2][3][4]. Risk factors [3,5] for OP position at delivery described in the literature include nulliparity, maternal age, body habitus, ethnicity, decreased pelvic outlet dimensions, anterior placenta [6], gestational age ≥41 weeks, birth weight (BW) ≥4,000 g, epidural anesthesia [7,8], and previous pregnancy with OP position [9]. Some investigators also identify labor induction as increasing the risk of OP position [3].…”

mentioning

confidence: 99%

“…OP position has been implicated in obstetric and neonatal complications [3][4][5][10][11][12][13][14][15][16], including prolonged first and second stages [4,5,15] of labor or arrested second stage [15], and higher rates of operative delivery [11,13,17], as well as neonatal acidemia [12], 5-min Apgar score <7 [4,12], neonatal intensive care unit (NICU) admission [12], meconium staining [12], birth trauma and shoulder dystocia [2,4,12], and intrapartum disruption of the maternal anal sphincter [10, 13,14,16]. The possible effect of a large head circumference (HC) combined with OP position at delivery on rates of obstetric outcomes has not been investigated.…”

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confidence: 99%

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Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study

et al. 2017

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Introduction: We investigated whether large head circumference (HC) combined with persistent occiput posterior (OP) position is associated with higher rates of operative delivery and obstetric and neonatal complications than OP deliveries without large HC or in occiput anterior (OA) position. Materials and Methods: Term singleton deliveries in our centers from January 2010 to December 2014, delivered in cephalic OA (n = 41,038) or OP position (n = 1,740), were assessed. We compared delivery modes, maternal and neonatal complications in OA versus OP deliveries, and HC ≥90th centile versus HC <90th centile in persistent OP position. Results: Persistent OP position combined with HC ≥90th centile was associated with higher rates of vacuum extraction and unplanned cesarean delivery than HC <90th centile in OP position (20.1 vs. 17.2%, OR 1.53 [95% CI 0.99-2.36], and 23.4 vs. 9.2%, OR 3.326 [95% CI 2.17-5.11], respectively). Rates of prolonged second stage of labor and neonatal intensive care unit admission were also increased compared to those in either OA position with HC ≥90th centile or OP position with HC <90th centile. Discussion: Large HC combined with OP position is associated with higher rates of operative delivery and prolonged second stage of labor compared to OP delivery with HC <90th centile. HC might be included with other measures to assess women in labor, as it is associated with fetal outcomes in OP deliveries.

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Section: Main Findingscontrasting

confidence: 99%

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Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study

et al. 2017

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“…But until several decades, only few studies explore the variables explaining position and rotation of the foetal head. For Sizer and Nirman [5], a computer literature search about occipitoposterior presentation for the period 1970 to 1999 yields very few references and only two studies examine possible associated factors. Moreover, these studies only consider obstetrical factors, i.e., incidence of premature rupture of membrane, induction of labour [6] or the length of labour [7] as possible associated factors rather than anatomical factors.…”

Section: Introductionmentioning

confidence: 99%

Which foetal pelvic variables are useful for predicting right-rotational or left-rotational birth?

Frémondière¹

2017

Obstet Gynecol Rep

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Objective: To assess the variables useful to predict right-rotational birth (ROA) and left-rotational birth (LOA), through the analysis of a large number of foetalpelvic variables, using discriminant analysis. Materials and methods:One hundred and two pregnant women were included in this single centre prospective study. For each mother-foetus pair, 43 pelvic and 18 foetal variables were measured. Partial least squares-discriminant analysis was performed to identify foetal-pelvic variables that could statistically separate the 3 delivery modality groups: non-rotational birth or occiput anterior (OA), right-rotational birth and left-rotational birth.Results: For the OA versus LOA model, the most efficient variable for discrimination was the inlet-mid-plane angle. For the OA versus ROA model, the most important variable was the sacral overhang. For both model, we found that women with small foetuses, anthropoïd inlet, reduce posterior space of the mid-plane and reduce oulet were more likely to have non-rotational birth. Conclusion:This analysis helps us in identifying foetal-pelvic conditions to the rotation in physiological cases. It should be relevant to perform a similar work with cases of posterior position during explusion stage.

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“…There is evidence that pre-induction cervical length and the position of the fetal occiput in addition to maternal characteristics, including parity, gestational age, maternal age, and body mass index, provides useful prediction of the likelihood of cesarean section [4][5][6] . For example, the odds of cesarean section increases by about 10% with each increase of 1 mm in cervical length above 20 mm and the odds are about 75% lower in multiparae, compared to nulliparae with the same cervical length [7] .…”

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confidence: 99%

Ultrasound in Labor and Delivery

Molina

Nicolaides

2010

Fetal Diagn Ther

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Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of pregnancies. Pre-induction cervical length, measured by transvaginal sonography, has been shown to have a significant association with the induction-to-delivery interval and the risk for cesarean section. In the management of labor there is extensive evidence that digital pelvic examination does not provide accurate assessment of the position and descend of the fetal head both during the first but also in the second stage of labor. Several recent studies using both two- and three-dimensional ultrasound have now described objective measures of progression of the fetal head during labor. In instrumental deliveries an important determinant of a successful and safe use of vacuum and forceps is the correct determination of the fetal head position and appropriate application of the instrument. However, ultrasound studies have shown that digital examination before instrumental delivery fails to identify the correct fetal position in a high proportion of cases. The use of ultrasound is of crucial importance in performing a safe operative delivery and can help in the prediction of whether a vaginal delivery would be successful.

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Occipitoposterior position: associated factors and obstetric outcome in nulliparas

Abstract: Epidural analgesia and oxytocin augmentation are associated with increased incidence of occipitoposterior position, which leads to increased operative obstetric intervention for delivery.

Cited by 81 publications

References 10 publications

Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study

Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study

Which foetal pelvic variables are useful for predicting right-rotational or left-rotational birth?

Ultrasound in Labor and Delivery

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