title: Ultrasonographic fetal head position to predict mode of delivery: a systematic review and bivariate meta-analysis.
abstract: OBJECTIVE
  We performed a systematic review to determine whether sonographic assessment of occipital position of the fetal head can contribute to the prediction of the mode of delivery.
  
  
  METHODS
  We performed a systematic literature search of electronic databases from inception to May 2011. Two reviewers independently extracted data from the included studies. We used a bivariate model to estimate point estimates for sensitivity and specificity curves for the outcome Cesarean delivery. Eligible studies were cohort studies or cross-sectional studies that reported on both the position of the fetal head, as assessed by ultrasound, before or at the beginning of active labor as well as the outcome of labor in women at term.
  
  
  RESULTS
  We included 11 primary articles reporting on 5053 women, of whom 898 had a Cesarean section. All studies indicated disappointing values for sensitivity and specificity in the prediction of Cesarean section. Summary point estimates of sensitivity and specificity were 0.39 (95% CI, 0.32-0.48) and 0.71 (95% CI, 0.67-0.74), respectively.
  
  
  CONCLUSIONS
  Sonographic assessment of occipital position of the fetal head before delivery should not be used in the prediction of mode of delivery.
authors.affiliation: Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands. corine.verhoeven@mmc.nl
authors.forename: C J M
authors.initials: CJ
authors.lastname: Verhoeven
authors.forename: M E P F
authors.initials: ME
authors.lastname: Rückert
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: E
authors.initials: E
authors.lastname: Pajkrt
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006257:Head / Q000000981:diagnostic imaging* / Q000196:embryology*; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D007743:Labor, Obstetric; D011237:Predictive Value of Tests; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000009:adverse effects