Intrapartum ultrasonogram for the determination of fetal occiput position and risk of cesarean section

Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2010; 93(2):149-53.
Source: PubMed


To evaluate the value of intrapartum ultrasonographically determined occiput position and risk of cesarean section.
Between August 1, 2008 and May 31, 2009, 330 singleton pregnant women, GA 37-42 weeks with cephalic presentation who were in early active phase of labor at Thammasat University hospital were recruited. The fetal occiput position was determined by transabdominal ultrasonography. The occiput posterior defined as cases and non-occiput posterior defined as controls. Perinatal outcomes and delivery methods were recorded. Independent sample t-test, Chi-square and multivariable regression were applied for analysis.
The incidence of occiput posterior was 29.7%. The abnormal cervical dilatation, cesarean delivery, and newborn weight were statistically significantly higher in cases. 44.9% of cases underwent cesarean section compared to 14.7% of controls.
Fetal occiput posterior presentation determined in early stage of active labor by ultrasonography was a significant independent risk of cesarean section.

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Available from: Chamnan Tanprasertkul, Feb 03, 2014
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    Ultrasound in Obstetrics and Gynecology 07/2012; 40(1):1-6. DOI:10.1002/uog.11213 · 3.85 Impact Factor
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    ABSTRACT: Objective We performed a systematic review to determine whether sonographic assessment of occipital position of the fetal head can contribute to the prediction of the mode of delivery.Methods We performed a systematic literature search of electronic databases from inception to May 2011. Two reviewers independently extracted data from the included studies. We used a bivariate model to estimate point estimates for sensitivity and specificity curves for the outcome Cesarean delivery. Eligible studies were cohort studies or cross-sectional studies that reported on both the position of the fetal head, as assessed by ultrasound, before or at the beginning of active labor as well as the outcome of labor in women at term.ResultsWe included 11 primary articles reporting on 5053 women, of whom 898 had a Cesarean section. All studies indicated disappointing values for sensitivity and specificity in the prediction of Cesarean section. Summary point estimates of sensitivity and specificity were 0.39 (95% CI, 0.32–0.48) and 0.71 (95% CI, 0.67–0.74), respectively.Conclusion Sonographic assessment of occipital position of the fetal head before delivery should not be used in the prediction of mode of delivery. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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    ABSTRACT: Abstract The occiput posterior position is one of the most frequent malposition during labor. During the first stage of labor the fetal head may stay in the occiput posterior position in 30% of the cases, but of these only 5-7% remains as such at time of delivery. The diagnosis of occiput posterior position in the second stage of labor is made difficult by the presence of the caput succedaneum or scalp hair, both of which may give some problem in the identification of fetal head sutures and fontanels and their location in relationship to maternal pelvic landmarks. The capability of diagnosing a fetus in occiput posterior position by digital examination has been extremely inaccurate, whereas an ultrasound approach, transabdominal, transperineal and transvaginal, has clearly shown its superior diagnostic accuracy. This is true not only for diagnosis of malpositions, detected in both first and second stage of labor, but also in cases of marked asynclitism.
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