Article

Persistent fetal occiput posterior position: Obstetric outcomes

Division of General Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, United States
Obstetrics and Gynecology (Impact Factor: 4.37). 05/2003; 101(5 Pt 1):915-20. DOI: 10.1016/S0029-7844(03)00068-1
Source: PubMed

ABSTRACT To evaluate the obstetric outcomes associated with persistent occiput posterior position of the fetal head in term laboring patients.
We performed a cohort study of 6434 consecutive, term, vertex, laboring nulliparous and multiparous patients, comparing those who delivered infants in the occiput posterior position with those who delivered in the occiput anterior position. We examined maternal demographics, labor and delivery characteristics, and maternal and neonatal outcomes.
The prevalence of persistent occiput posterior position at delivery was 5.5% overall, 7.2% in nulliparas, and 4.0% in multiparas (P <.001). Persistent occiput posterior position was associated with shorter maternal stature and prior cesarean delivery. During labor and delivery, the occiput posterior position was associated with prolonged first and second stages of labor, oxytocin augmentation, use of epidural analgesia, chorioamnionitis, assisted vaginal delivery, third and fourth degree perineal lacerations, cesarean delivery, excessive blood loss, and postpartum infection. Newborns had lower 1-minute Apgar scores, but showed no differences in 5-minute Apgar scores, gestational age, or birth weight.
Persistent occiput posterior position is associated with a higher rate of complications during labor and delivery. In our population, the chances that a laboring woman with persistent occiput posterior position will have a spontaneous vaginal delivery are only 26% for nulliparas and 57% for multiparas.

1 Follower
 · 
406 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Les forceps obstétricaux sont utilisés quotidiennement depuis plus de 400 ans. En 2003, ils sont utilisés dans 6,3% des accouchements effectués dans le réseau de maternités Aurore - Grand Lyon. En cas de suspicion de souffrance fœtale nécessitant une extraction urgente, ils permettent de soustraire rapidement le fœtus à une situation anoxique. Le travail réalisé pendant 4 ans en collaboration étroite avec deux équipes d'ingénieurs chercheurs du laboratoire de physique de la matière et du laboratoire d'automatique industrielle a permis de concevoir un forceps instrumenté d'une part avec des capteurs de position spatiale et d'autre part avec des capteurs de pression d'interface. Intégré au simulateur d'accouchement que nous avons conçu et breveté ces nouveaux forceps sont les premiers qui permettent non seulement l'étude de la phénoménologie de la pose de l'instrument et de l'extraction proprement dite mais aussi l'enseignement sans danger de l'extraction instrumentale. L'utilisation conjointe du forceps instrumenté et du simulateur d'accouchement permet d'assurer un contrôle qualité de l'extraction instrumentale. La valorisation de ce travail par le biais de la création d'un centre de formation aux techniques d'extraction instrumentale est aujourd'hui envisageable.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Group B streptococci (GBS) are bacteria that colonise the genital tract in a significant proportion of pregnant women. Bacteriological screening of the low vagina is positive in 22% of women but this figure increases to 27% if the rectum is also swabbed. Early-onset GBS sepsis in the neonate is associated with significant morbidity and mortality. GBS infection is more likely following prolonged rupture of the membranes, and intrapartum antibiotic prophylaxis significantly reduces the incidence of early-onset neonatal sepsis. Secondary arrest of labour occurs in 6% of nulliparous women and 2% of multiparous women. One of the causes of secondary arrest is an occipitoposterior position. Breech presentation is associated with higher rates of perinatal morbidity and mortality. External cephalic version reduces the incidence of noncephalic presentation. This article describes three case scenarios highlighting these problems, and provides a rational clinical approach to them based on available evidence.
    Obstetrics Gynaecology & Reproductive Medicine 01/2001; DOI:10.1016/j.ogrm.2007.06.002