The association between persistent occiput posterior position and neonatal outcomes

OBJECTIVE: To examine the effect of persistent occiput posterior position on neonatal outcome. METHODS: This is a retrospective cohort study of 31,392 term, cephalic, singleton births. Women with neonates born in persistent occiput posterior position at delivery were compared to those with occiput anterior position. Women with occiput transverse position were excluded. The association between occiput posterior position and neonatal outcomes, including 5-minute Apgar scores, umbilical cord gases, meconium-stained amniotic fluid, meconium aspiration syndrome, birth trauma, admission to the intensive care nursery, and length of stay were examined using chi(2) and Student t tests. Potential confounders (maternal age, ethnicity, parity, gestational age, epidural anesthesia, labor induction, length of labor, meconium, chorioamnionitis, birth weight, and year of delivery) were controlled for by using multivariable logistic regression and linear regression analyses. RESULTS: There were 2,591 (8.2%) neonates delivered in occiput posterior position of the total cohort of 31,392 deliveries. Compared with occiput anterior, neonates delivered in occiput posterior position had higher risks for adverse outcomes, including 5-minute Apgar score less than 7 (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.17-1.91), acidemic umbilical cord gases (OR 2.05, 95% CI 1.52-2.77), meconium-stained amniotic fluid (OR 1.29, 95% CI 1.17-1.42), birth trauma (OR 1.77, 95% CI 1.22-2.57), admission to the intensive care nursery (OR 1.57, 95% CI 1.28-1.92), and longer neonatal stay in the hospital (OR 2.69, 95% CI 2.22-3.25). CONCLUSION: Persistent occiput posterior position at delivery is associated with higher risks of adverse neonatal outcomes compared with neonates delivered in the occiput anterior position. This information may be important in counseling women who experience persistent occiput posterior position in labor. Level of Evidence: II-2.