Factors affecting rotation of occiput posterior position during the first stage of labor

Blanc-Petitjean, Pauline; Ray, Camille Le; Lepleux, F.; Dreyfus, Michel; Chantry, Anne

doi:10.1016/j.jogoh.2017.12.006

“…Further research is therefore needed in the black African population to establish the relationship between mode of delivery and first stage occiput positions. In a related subject, the administration of oxytocin has been reported as an influence on the rotation of occiput posterior position (16) , which would make…”

Section: Conflict Of Interestmentioning

confidence: 99%

Comparing intrapartum ultrasound and clinical examination in the assessment of fetal head position in African women

Wiafe

¹

,

Whitehead

²

,

Venables

³

et al. 2019

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Introduction:We aimed to examine the agreement between intrapartum ultrasound and digital vaginal examination in assessing the occiput position in black African women who were in the first stage of labor and to evaluate the influence of ruptured membranes on this agreement. Material and method: This was a cross-sectional study conducted in a teaching hospital in Ghana. Transabdominal ultrasound determination of the fetal head position was compared with digital vaginal examination of women in labor. The agreement between the two methods was examined with Cohen's kappa statistics. Results: Altogether, 196 women in active labor were studied. The fetal head position could not be determined by digital vaginal examination in 62 cases (32%) while ultrasound could determine all. Moderate agreement (kappa = 0.4) was obtained in the 134 cases determined by both methods. Agreement on the occiput posterior position was very low (kappa = 0.1). Agreement on the occiput posterior position was not significantly different in ruptured versus intact membranes. Conclusion:This study shows poor agreement between ultrasound and digital VE on the occiput posterior position in black African women who were in the first stage of labor. Again, over 85% of fetal head positions that could not be determined by digital vaginal examination were occiput transverse and posterior positions. This confirms that digital vaginal examination has difficulty in detecting malpositions, with no significant influence of intact or ruptured membranes. Ultrasound is therefore more useful than digital vaginal examination whenever malposition is suspected in the first stage of labor.

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“…The abnormality of the fetal position can be corrected by manual intervention. For instance, fetal occiput posterior (OP) positions account for 15 to 20% of cephalic presentations and are associated with poorer maternal and neonatal outcomes than occiput anterior (OA) positions [ 14 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Manipulative Reduction for Abnormal Uterine Inclination in Vaginal Delivery

Chen

¹

,

Yuan

²

,

Wang

³

2022

Computational and Mathematical Methods in Medicine

0

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Objective. To investigate the manipulative reduction in abnormal uterine inclination in vaginal delivery. Methods. With the independently developed uterine inclination surveyor, 40 primiparas with abnormal uterine inclination were randomly divided into two groups: treatment group (Group A, 20 cases) and control group (Group B, 20 cases). The general condition of the primipara, the labor stages, the changes in uterine inclination after treatment, postpartum hemorrhage at 2 hours, and the general condition of fetuses were observed to study the therapeutic value of manual reduction in abnormal uterine inclination. Result. In the control group, one uterine inclination was not corrected with the change in labor process, and the pregnancy was terminated due to stagnation of the active phase. In the first stage of labor, the time spent in the treatment group ( 393.4 ± 31.3 mins) was significantly lower than that in the control group ( 440.7 ± 34.9 mins) ( P = 0.001 ). Compared with the control group ( 49.8 ± 6.5 mins), the treatment group ( 42.6 ± 7.2 mins) also exhibited a significantly shortened second stage of labor ( P = 0.02 ). Sixteen cases (16/20) in the treatment group returned to normal after manual reduction, and 9 cases (9/20) in the control group returned to normal with the progression of natural labor. Manual reduction could be used as an option to treat abnormal uterine inclination ( P = 0.01 ). There was no significant difference in the third stage of labor ( P = 0.2 ), 2-hour postpartum hemorrhage ( P = 0.35 ), Apgar score ( P = 0.64 ), or body weight ( P = 0.76 ) between the two groups. Conclusion. Manual reduction in the treatment of abnormal uterine inclination has obvious effects, shortens the birth process, and is safe for the fetus.

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“…The incidence of persistent OP position is between 5% and 12% 17,38,39 , and that of persistent OT position varies from 3-8% 12,36,40 . A study by Petitjean et al 41 identi ed oxytocin augmentation, excessive gestational weight gain, direct OP position and macrosomia as independent factors associated with non-OA to OA rotation during the rst stage of labor. In our study, maternal height is the single individual factor associated with internal fetal occiput rotation.…”

Section: Discussionmentioning

confidence: 99%

Simple Models to Predict Vaginal Delivery and Spontaneous Fetal Occiput Rotation Based on Intrapartum Ultrasound and Maternal Characteristics

Chen

¹

,

Zhang

²

,

Guo

³

et al. 2022

Preprint

0

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It is important to monitor labor progress and identify the possibility of vaginal birth. Based on intrapartum sonographic findings, we describe the prediction models for evaluating fetal occiput rotation and vaginal delivery. We performed serial intrapartum ultrasonography in nulliparous women with singleton cephalic presentation at term in the latent phase and every three hours after that. Six hundred and fourteen women were included in our study, of whom 524 underwent vaginal delivery, and 90 required cesarean section. The percentage of women with fetuses in non-occiput anterior(non-OA) position at the latent phase was 53.9% (331 cases), as 257(77.6%) women underwent spontaneous rotation to OA position before delivery, 74 (22.4%) women were with persistent occiput posterior (OP) position or occiput transverse (OT) position. We developed a model based on the maternal height and middle angle to predict the spontaneous fetal occiput rotation, with the C statistic was 0.667 (95%CI 0.583-0.751). Moreover, a prediction model based on the maternal height and angle of progression to evaluate whether women underwent vaginal delivery was also developed, of which the C statistic was 0.738(95% CI: 0.763-0.793). Both models showed satisfactory calibration. Our approach provides helpful information for predicting vaginal delivery and internal fetal occiput rotation.

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Factors affecting rotation of occiput posterior position during the first stage of labor

Cited by 10 publications

References 22 publications

Comparing intrapartum ultrasound and clinical examination in the assessment of fetal head position in African women

Comparing intrapartum ultrasound and clinical examination in the assessment of fetal head position in African women

Manipulative Reduction for Abnormal Uterine Inclination in Vaginal Delivery

Simple Models to Predict Vaginal Delivery and Spontaneous Fetal Occiput Rotation Based on Intrapartum Ultrasound and Maternal Characteristics

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