Factors affecting rotation of occiput posterior position during the first stage of labor

被引:10
|
作者
Blanc-Petitjean, P. [1 ,2 ]
Le Ray, C. [1 ,3 ]
Lepleux, F. [4 ]
De La Calle, A. [3 ]
Dreyfus, M. [4 ,5 ]
Chantry, A. A. [1 ,6 ]
机构
[1] Paris Descartes Univ, Obstet Perinatal & Pediat Epidemiol Res Team EPOP, Ctr Epidemiol & Stat, Inserm UMR 1153,Sorbonne Paris Cite CRESS,DHU Ris, F-75014 Paris, France
[2] Paris Descartes Univ, DHU Risks Pregnancy, Hop Louis Mourier, Dept Obstet & Gynecol, F-92700 Colombes, France
[3] Paris Descartes Univ, Hop Cochin, AP HP, Port Royal Matern Unit,DHU Risks Pregnancy, F-75014 Paris, France
[4] CHU Caen, Dept Obstet Gynecol & Reprod Med, F-14000 Caen, France
[5] Univ Caen Normandy, Med Sch, F-14000 Caen, France
[6] Paris Descartes Univ, DHU Risks Pregnancy, AP HP, Midwifery Sch Baudelocque, F-75014 Paris, France
关键词
First stage of labor; Intrapartum care; Occiput posterior position; Oxytocin; Rotation; MANUAL ROTATION; TRANSVERSE POSITIONS; EPIDURAL ANALGESIA; OPERATIVE DELIVERY; CESAREAN DELIVERY; FETAL POSITION; ASSOCIATION; RISK; 2ND-STAGE; IMPACT;
D O I
10.1016/j.jogoh.2017.12.006
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Introduction. - Fetal occiput posterior (OP) positions account for 15 to 20% of cephalic presentations and are associated with poorer maternal and neonatal outcomes than occiput anterior (OA) positions. The aim of this study was to identify maternal, neonatal and obstetric factors associated with rotation from OP to OA position during the first stage of labor. Material and methods. - This secondary analysis of a multicenter randomized controlled trial (EVADELA) included 285 laboring women with ruptured membranes and a term fetus in OP position. After excluding women with cesarean deliveries before full dilatation, we compared two groups according to fetal head position at the end of the first stage of labor: those with and without rotation from OP to OA position. Factors associated with rotation were assessed with univariate and multivariate analyses using multilevel logistic regression models. Results. - The rate of anterior rotation during the first stage was 49.1%. Rotation of the fetal head was negatively associated with excessive gestational weight gain (adjusted odds ratio [aOR]: 0.37, 95% confidence interval [CI]: 0.17-0.80), macrosomia (aOR: 0.35, 95% CI: 0.14-0.90), direct OP position (aOR: 0.24, 95% Cl: 0.09-0.65), and prelabor rupture of membranes (aOR: 0.40, 95% CI: 0.19-0.86). Oxytocin administration was the only factor positively associated with fetal head rotation (aOR: 2.17, 95% Cl: 1.20-3.91). Discussion. - Oxytocin administration may affect rotation of OP positions during the first stage of labor. Further studies should be performed to assess the risks and benefits of its utilization for managing labor with a fetus in OP position. (C) 2018 Elsevier Masson SAS. All rights reserved.
引用
收藏
页码:119 / 125
页数:7
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