Neonatal outcomes of deliveries in occiput posterior position when delayed pushing is practiced: a cohort study

Kristina Dahlqvist,Maria Jonsson

doi:10.1186/s12884-017-1556-5

Kristina Dahlqvist, Maria Jonsson

Open Access

https://doi.org/10.1186/s12884-017-1556-5

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Abstract

BackgroundTo examine the impact of occiput posterior position, compared to occiput anterior position, on neonatal outcomes in a setting where delayed pushing is practiced. The specific aim was to estimate the risk of acidaemia.MethodsCohort study from a university hospital in Sweden between 2004 and 2012. Information was collected from a local database of 35,546 births. Umbilical artery sampling was routine. Outcomes were: umbilical artery pH < 7.00 and <7.10 and short-term neonatal morbidity. The association between occiput posterior position and neonatal outcomes was examined using logistic regression analysis, presented as adjusted odds ratio (AOR) with 95% confidence interval (CI).ResultsOf 27,648 attempted vaginal births, 1292 (4.7%) had occiput posterior position. Compared with occiput anterior, there was no difference in pH < 7.00 (0.4% vs. 0.5%) but a higher rate of pH < 7.10 in occiput posterior births (3.8 vs. 5.5%). Logistic regression analysis showed no increased risk of pH < 7.10 (AOR 1.28 95% CI 0.93–1.74) when occiput posterior was compared with occiput anterior births but, an increased risk of Apgar score < 7 at 5 min (AOR 1.84, 95% CI 1.11–3.05); neonatal care admission (AOR 1.68, 95% CI 1.17–2.42) and composite morbidity (AOR 1.66, 95% CI 1.19–2.31).ConclusionsWith delayed pushing, birth in occiput posterior compared with anterior position is not associated with acidaemia. The higher risk of neonatal morbidity is of concern and any long-term consequences need to be investigated in future studies.

Highlights

To examine the impact of occiput posterior position, compared to occiput anterior position, on neonatal outcomes in a setting where delayed pushing is practiced
Umbilical cord blood sampling was successful in 74%, with no difference in sampling rate between vaginal deliveries in occiput posterior (76%), and anterior (73%) positions (p 0.06) whereas there were more samples performed in deliveries in the occiput posterior position if all deliveries were considered (79% vs. 74%, p < 0.001)
The higher rate of missing values for duration of pushing in occiput posterior position deliveries can be explained by the higher rate of caesarean deliveries in that group

Summary

Introduction

To examine the impact of occiput posterior position, compared to occiput anterior position, on neonatal outcomes in a setting where delayed pushing is practiced. Persistent occiput posterior position occurs in approximately 5% of births and is the most common malposition in labour [1–5]. Previous studies have reported an association with longer labour duration [1–5], oxytocin augmentation [1, 3, 4], epidural analgesia [1, 3–5], operative vaginal delivery [1–4], severe perineal. Occiput posterior delivery has been found to be a risk factor for acidaemia at birth [1, 6]. The risk of having an umbilical artery pH < 7.00 increased three fold in occiput posterior, compared with occiput anterior delivery, at a unit with a policy of immediate pushing once full cervical dilation is reached [1]. There is an increase in the incidence of serious neonatal morbidity with an umbilical artery pH < 7.00 [7, 8], giving this finding important clinical implication.

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