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Persistent fetal occiput posterior position: obstetric outcomes. Obstet Gynecol

Division of General Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 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.

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    • "Malpositions in labour in a vertex-presenting fetus are known to be associated with increased prolonged first and second stages of labour, oxytocin augmentation, use of epidural analgesia, chorioamnionitis, assisted vaginal delivery, third and fourth degree perineal lacerations, caesarean delivery, excessive blood loss, and postpartum infection [5-9]. Trial of instrumental delivery in theatre is twice as likely to fail in occipito-posterior (OP) positions and failed trials are associated with increased neonatal and maternal morbidity and trauma [8,10,11]. "
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    ABSTRACT: Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496
    Full-text · Article · Sep 2012 · BMC Pregnancy and Childbirth

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    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.
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