title: Is there an association between sonographically determined occipito-transverse position in the second stage of labor and operative delivery?
abstract: OBJECTIVE
  To evaluate if ultrasound-determined occipito-transverse position early in the second stage of labor is associated with operative delivery.
  
  
  METHODS
  Retrospective review of two prospective cohort studies.
  
  
  METHODS
  An Australian tertiary referral hospital.
  
  
  METHODS
  Women with term, cephalic singleton pregnancies.
  
  
  METHODS
  Retrospective analysis of data from two prospective studies. Logistic regression was undertaken to assess the independent contribution of the occipito-transverse position to operative delivery.
  
  
  METHODS
  Operative delivery (cesarean section, forceps or vacuum extraction).
  
  
  RESULTS
  Among 422 women included, the occipito-transverse position was present in 80, occipito-anterior in 303 and the occipito-posterior in 39. Compared with occipito-anterior, the adjusted odds ratio for operative delivery was 2.1 (95% confidence interval 1.2-3.8, p = 0.02) for the occipito-transverse position, and 7.4 (95% confidence interval 3.2-17) for the occipito-posterior position. Factors that independently predicted operative delivery were nulliparity, abnormal second stage cardiotocography, maternal place of birth and epidural analgesia. The length of second stage of labor was longer for the occipito-transverse group than for the occipito-anterior group (median 2 h 7 min vs. 1 h 36 min, p = 0.003).
  
  
  CONCLUSIONS
  The occipito-transverse position early in the second stage of labor was associated with an increased operative delivery rate.
authors: RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Faculty of Nursing, University of Sydney, Sydney, New South Wales, Australia.
authors: Hala
authors: H
authors: Phipps
authors: Jon A
authors: JA
authors: Hyett
authors: Kathy
authors: K
authors: Graham
authors: Wendy J
authors: WJ
authors: Carseldine
authors: Jane
authors: J
authors: Tooher
authors: Bradley
authors: B
authors: de Vries
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005323:Fetal Monitoring / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007746:Labor Presentation; D007748:Labor Stage, Second / Q000502:physiology*; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D047929:Term Birth / Q000502:physiology; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000706:statistics & numerical data
keywords: Occipito-transverse position; cesarean section; instrumental delivery; occipito-anterior position; operative delivery; ultrasound