Operative vaginal delivery in case of persistent occiput posterior position after manual rotation failure: a 6-month follow-up on pelvic floor function
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To compare the short- and long-term perineal consequences (at 6 months postpartum) and short-term neonatal consequences of instrumental rotation (IR) to those induced by assisted delivery (AD) in the occiput posterior (OP) position, in case of manual rotation failure.
A prospective observational cohort study; tertiary referral hospital including all women presenting with persistent OP position who delivered vaginally after manual rotation failure with attempted IR or AD in OP position from September 2015 to October 2016. Maternal and neonatal outcomes of all attempted IR deliveries were compared with OP operative vaginal deliveries. Main outcomes measured were pelvic floor function at 6 months postpartum including Wexner score for anal incontinence and ICIQ-FLUTS for urinary symptoms. Perineal morbidity comprised severe perineal tears, corresponding to third and fourth degree lacerations. Fetal morbidity parameters comprised low neonatal Apgar scores, acidaemia, major and minor fetal injuries and neonatal intensive care unit admissions.
Among 5265 women, 495 presented with persistent OP positions (9.4%) and 111 delivered after manual rotation failure followed by AD delivery: 58 in the IR group and 53 in the AD in OP group. The incidence of anal sphincter injuries was significantly reduced after IR attempt (1.7% vs. 24.5%; p < 0.001) without increasing neonatal morbidity. At 6 months postpartum, AD in OP position was associated with higher rate of anal incontinence (30% vs. 5.5%, p = 0.001) and with more urinary symptoms, dyspareunia and perineal pain.
OP operative deliveries are associated with significant perineal morbidity and pelvic floor dysfunction at 6 months postpartum.
KeywordsOcciput posterior position Rotational vaginal birth Severe perineal tears Manual rotation Pelvic floor function Anal incontinence
We are very grateful to the women in the study and obstetric department staff who recorded and entered the data.
FV and PG had the idea for the original cohort study and, with OP, CV, carried out the design of the study. PG collected the data, PG, FV and EC analysed/interpreted the data and produced the first draft. PG, FV and CV carried out statistical analysis. All authors read, revised and approved the submitted version of the manuscript.
No funding was received.
Compliance with ethical standards
Conflict of interest
Nothing to declare.
All procedures performed in our study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. This study rceived a favourable opinion from the Ethics and Research comittee of CHU Toulouse (CER2015).
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