title: Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries.
abstract: OBJECTIVE
  The purpose of this study was to determine whether an occiput posterior (OP) fetal head position increases the risk for anal sphincter injury when compared with an occiput anterior (OA) position in vacuum-assisted deliveries.
  
  
  METHODS
  We conducted a retrospective cohort study of 393 vacuum-assisted singleton vaginal deliveries. Maternal demographics and obstetric and neonatal data were collected from an obstetric database and chart review.
  
  
  RESULTS
  Within the OP group, 41.7% developed a third- or fourth-degree laceration compared with 22.0% in the OA group (OR 2.5, 95% CI 1.4-4.7). In a logistic regression model that controlled for BMI, race, nulliparity, length of second stage, episiotomy, birth weight, head circumference, and fetal head position, OP position was 4.0 times (95% CI 1.7-9.6) more likely to be associated with an anal sphincter injury than OA position.
  
  
  CONCLUSIONS
  Among vacuum deliveries, an OP head position confers an incrementally increased risk for anal sphincter injury over an OA position.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wu
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Williams
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Hundley
authors.forename: AnnaMarie
authors.initials: A
authors.lastname: Connolly
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Visco
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D004841:Episiotomy; D005260:Female; D006801:Humans; D007746:Labor Presentation; D022125:Lacerations / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D016017:Odds Ratio; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012307:Risk Factors; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*