Open AccessIs there an association between sonographically determined occipito‐transverse position in the second stage of labor and operative delivery?
Author(s) -
Phipps Hala,
Hyett Jon A.,
Graham Kathy,
Carseldine Wendy J.,
Tooher Jane,
Vries Bradley
Publication year - 2014
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12465
Subject(s) - medicine , obstetrics , odds ratio , confidence interval , prospective cohort study , forceps delivery , retrospective cohort study , pregnancy , stage (stratigraphy) , forceps , logistic regression , tertiary referral hospital , vaginal delivery , cohort study , surgery , paleontology , biology , genetics
Objective To evaluate if ultrasound‐determined occipito‐transverse position early in the second stage of labor is associated with operative delivery. Design Retrospective review of two prospective cohort studies. Setting An Australian tertiary referral hospital. Population Women with term, cephalic singleton pregnancies. Methods Retrospective analysis of data from two prospective studies. Logistic regression was undertaken to assess the independent contribution of the occipito‐transverse position to operative delivery. Main outcome measure Operative delivery (cesarean section, forceps or vacuum extraction). Results Among 422 women included, the occipito‐transverse position was present in 80, occipito‐anterior in 303 and the occipito‐posterior in 39. Compared with occipito‐anterior, the adjusted odds ratio for operative delivery was 2.1 (95% confidence interval 1.2–3.8, p = 0.02) for the occipito‐transverse position, and 7.4 (95% confidence interval 3.2–17) for the occipito‐posterior position. Factors that independently predicted operative delivery were nulliparity, abnormal second stage cardiotocography, maternal place of birth and epidural analgesia. The length of second stage of labor was longer for the occipito‐transverse group than for the occipito‐anterior group (median 2 h 7 min vs. 1 h 36 min, p = 0.003). Conclusion The occipito‐transverse position early in the second stage of labor was associated with an increased operative delivery rate.