Document Detail

Influence of persistent occiput posterior position on delivery outcome.
MedLine Citation:
PMID:  11755548     Owner:  NLM     Status:  MEDLINE    
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.
M Fitzpatrick; K McQuillan; C O'Herlihy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  98     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-12-28     Completed Date:  2002-01-14     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1027-31     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University College Dublin and the National Maternity Hospital, Dublin, Ireland.
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MeSH Terms
Anal Canal / injuries*
Analgesia, Epidural
Dystocia / epidemiology*,  etiology
Ireland / epidemiology
Labor Presentation*
Pregnancy Outcome*
Prospective Studies

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