Ultrasonographic occiput position in early labour in the prediction of caesarean section.
OBJECTIVE
To investigate the value of ultrasonographically determined occiput position in the early stages of the active phase of labour, in addition to traditional maternal, fetal and labour-related characteristics, in the prediction of the likelihood of caesarean section.


METHODS
Prospective observational study.


METHODS
District general hospital in the UK.


METHODS
Six hundred and one singleton pregnancies with cephalic presentation in active labour at term with cervical dilatation of 3-5 cm.


METHODS
Transabdominal sonography to determine fetal occiput position was carried out by an appropriately trained sonographer immediately before or after the routine clinical examination by the attending midwife or obstetrician.


METHODS
Caesarean section.


RESULTS
Delivery was vaginal in 514 (86%) cases and by caesarean section in 87 (14%). The fetal occiput position was posterior in 209 (35%) cases and in this group the incidence of caesarean section was 19% (40 cases), compared with 11% (47 of 392) in the non-occiput posterior group. Multiple regression analysis revealed that significant independent contribution in the prediction of caesarean section was provided by maternal age (OR 1.1, 95% CI 1.0-1.2), Afro-Caribbean origin (OR 2.4, 95% CI 1.2-4.6), height (OR 0.93, 95% CI 0.89-0.97), parity (OR 0.2, 95% CI 0.1-0.4), type of labour (OR 2.2, 95% CI 1.3-3.8), gestation (OR 1.4, 95% CI 1.1-1.7), fetal head descent (OR 0.6, 95% CI 0.4-0.9), occiput posterior position (OR 2.2, 95% CI 1.3-3.7) and male gender (OR 2.0, 95% CI 1.2-3.5).


CONCLUSIONS
The risk of caesarean section can be estimated during the early stage of active labour by the sonographically determined occiput position, in addition to traditional maternal, fetal and labour-related characteristics.
Akmal
Serap
S
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Kametas
Nikos
N
Tsoi
Elly
E
Howard
Richard
R
Nicolaides
Kypros H
KH
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007746:Labor Presentation; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D016216:Ultrasonography, Prenatal / Q000379:methods*