Diagnosis and intervention for occiput posterior malposition

OBJECTIVES: To evaluate diagnostic methods used to detect occiput posterior and to describe the efficacy of posturing to enhance rotation from occiput posterior to occiput anterior. DATA SOURCES: Keyword search using PubMed, CINAHL, Cochrane Review, and Dissertation Abstracts International. STUDY SELECTION: Studies published from 1996 to 2006 (except one published in 1983) that focused on the use of ultrasonography versus digital vaginal examination to diagnose fetal position and maternal posturing to enhance rotation from occiput posterior to occiput anterior. DATA EXTRACTION: Eight prospective studies regarding malposition diagnosis were reviewed and analyzed for error rates and predictors affecting ability to detect fetal position; five randomized controlled trials were evaluated for effects of various maternal postures on fetal rotation from occiput posterior to occiput anterior. DATA SYNTHESIS: If fetal malposition is accurately diagnosed in early labor, subsequent nursing management can focus on rotation toward occiput anterior position, leading to a safer delivery for mother and baby. CONCLUSIONS: Antepartum ultrasonography is more accurate than digital vaginal examination in diagnosing fetal malposition; however, its efficacy needs to be further explored using randomized controlled trials and cost-benefit analyses before routine use is recommended. Furthermore, Sims' posture on the same side as the fetal spine is recommended during labor to enhance rotation from occiput posterior to occiput anterior.