P14 .12: What is the operative delivery rate of fetal occiput transverse position in the second stage of labour?

Abstract

Background: Occiput Transverse (OT) position has a reported prevalence of 19%-37% at the onset of labour and 3%-16% at birth. There is scant evidence in the literature on the operative delivery rate of OT position in the second stage of labour. Aim: To assess the operative delivery rate of the occipito-transverse position in the second stage of labour compared with occipito-anterior (OA). Methods: Data were combined from two prospective studies of ultrasound determined fetal head position early in the second stage of labour. Data regarding demographics, mode of delivery, labour, postnatal period and neonatal outcomes were also collected. Logistic regression analysis was performed to assess the independent contribution of OT position to operative delivery (caesarean section, vacuum or forceps). Results: 49% (39/80) women in the OT group and 31% (92/296) in the OA group had an operative delivery. Caesarean section was performed in 11% (9/80) and 5% (14/303) respectively. The OT group had a longer second stage (mean 2 hr 17 min versus 1 hr 49 mins). OT position early in the second stage of labour was associated with operative delivery in the logistic regression analysis (OR 2.03, 95% CI 1.1-3.7, p = 0.02). Other factors which independently predicted operative delivery were nulliparity, abnormal second stage cardiotocograph, and epidural analgesia. Conclusion: OT position early in the second stage of labour is strongly associated with operative delivery. There is potential to explore interventions such as manual rotation for reducing operative delivery for OT position.