Carseldine Wendy J, Phipps Hala, Zawada Shannon F, Campbell Neil T, Ludlow Joanne P, Krishnan Surya Y, De Vries Bradley S
Maternity and Gynaecology Department, John Hunter Hospital, Newcastle, Australia.
Aust N Z J Obstet Gynaecol. 2013 Jun;53(3):265-70. doi: 10.1111/ajo.12041. Epub 2013 Jan 24.
To assess the impact of occipito-posterior position in the second stage of labour on operative delivery.
Double-blinded prospective cohort study of ultrasound determined occiput-posterior position during the second stage of labour compared with occiput-anterior position. The primary outcome was operative (caesarean section, forceps or vacuum) delivery.
A total of 68% (13/19) women in the occiput-posterior group, and 27% (39/141) in the occiput-anterior group had an operative delivery (unadjusted: P < 0.001). Caesarean section was performed in 37% and 5%, respectively (P < 0.001). The occiput-posterior group had a longer second stage (mean 2 h 59 minutes vs 1 h 54 minutes; P = 0.001) and larger infants (mean 3723 g vs 3480 g, P = 0.024). In the logistic regression, occiput-posterior position, nulliparity, abnormal second stage cardiotocograph and epidural analgesia were independent predictors for operative delivery.
Occiput-posterior position early in the second stage of labour is strongly associated with operative delivery. There is potential to explore interventions such as manual rotation.
评估第二产程枕后位对手术分娩的影响。
一项双盲前瞻性队列研究，将超声确定的第二产程枕后位与枕前位进行比较。主要结局是手术（剖宫产、产钳或真空吸引）分娩。
枕后位组共有68%（13/19）的女性进行了手术分娩，枕前位组为27%（39/141）（未调整：P<0.001）。剖宫产率分别为37%和5%（P<0.001）。枕后位组第二产程更长（平均2小时59分钟对1小时54分钟；P= 0.001），婴儿更大（平均3723克对3480克，P=0.024）。在逻辑回归中，枕后位、初产、第二产程异常胎心监护图和硬膜外镇痛是手术分娩的独立预测因素。
第二产程早期枕后位与手术分娩密切相关。有探索如手法旋转等干预措施的可能性。
