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Published on: February 5, 2019
Management of the occiput posterior presentation: a single institute experience
Keiiku Sen1, Hideki Sakamoto, Yasushi Nakabayashi
1Aiiku Maternal and Child Health Center Hospital Tokyo Metropolitan Hiroo Hospital Tokyo Medical and Surgical Clinic, Tokyo, Japan.
Aim:
We have examined the risk factors and management processes of the persistent occiput posterior (pOP) position by analyzing medical records from our hospital.
Material And Methods:
Medical records and delivery notes from January 2007 to December 2009 were reviewed and 103 patients were identified as having the pOP position during active labor. A total of 1054 patients who had occiput anterior (OA) deliveries were used as control.
Results:
There was no significant difference in population background between the pOP and control groups. Fifty-eight (56%) cases of pOP were identified before the birth of the fetal head whereas 45 were found to be in pOP at the birth. Among these cases identified as pOP before the birth, 30 (52%) patients underwent an attempt to rotate pOP to OA manually. A total of 14 (47%) attempts were successful and delivered OA vaginally. Of 16 cases whose attempts failed, five (31%) had cesarean delivery and 11 had vaginal OP delivery. The overall cesarean rate in this group was 16.7%. Twenty-eight patients who did not have any corrective intervention had a significantly higher rate of cesarean section (60.7%, P<0.001 by χ(2) analysis). The advanced head station and the wider dilatation resulted in a successful manual rotation.
Conclusions:
Attempts to correct pOP by manual rotation have better results when the head is in the mid-pelvis. Also, posture change reduces cesarean section rate. The current data suggest attempts to correct pOP to OA reduce cesarean section rate.
