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Archives of Gynecology and Obstetrics

, Volume 298, Issue 1, pp 111–120 | Cite as

Operative vaginal delivery in case of persistent occiput posterior position after manual rotation failure: a 6-month follow-up on pelvic floor function

  • Paul Guerby
  • Olivier Parant
  • Elodie Chantalat
  • Christophe Vayssiere
  • Fabien Vidal
Maternal-Fetal Medicine

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

OP operative deliveries are associated with significant perineal morbidity and pelvic floor dysfunction at 6 months postpartum.

Keywords

Occiput posterior position Rotational vaginal birth Severe perineal tears Manual rotation Pelvic floor function Anal incontinence 

Notes

Acknowledgements

We are very grateful to the women in the study and obstetric department staff who recorded and entered the data.

Author contributions

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.

Funding

No funding was received.

Compliance with ethical standards

Conflict of interest

Nothing to declare.

Ethical approval

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

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).

References

  1. 1.
    Barth WH Jr (2015) Persistent occiput posterior. Obstet Gynecol 125(3):695–709CrossRefPubMedGoogle Scholar
  2. 2.
    Ponkey SE, Cohen AP, Heffner LJ, Lieberman E (2003) Persistent fetal occiput posterior position: obstetric outcomes. Obstet Gynecol 101(5 Pt 1):915–920PubMedGoogle Scholar
  3. 3.
    Fitzpatrick M, McQuillan K, O’Herlihy C (2001) Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol 98(6):1027–1031PubMedGoogle Scholar
  4. 4.
    Cheng YW, Norwitz ER, Caughey AB (2006) The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. Am J Obstet Gynecol 195(3):856–862CrossRefPubMedGoogle Scholar
  5. 5.
    Senecal J, Xiong X, Fraser WD (2005) Effect of fetal position on second-stage duration and labor outcome. Obstet Gynecol 105(4):763–772CrossRefPubMedGoogle Scholar
  6. 6.
    Hirsch E, Elue R, Wagner A Jr, Nelson K, Silver RK, Zhou Y et al (2014) Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position. J Perinatol 34(12):898–900CrossRefPubMedGoogle Scholar
  7. 7.
    Benavides L, Wu JM, Hundley AF, Ivester TS, Visco AG (2005) The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries. Am J Obstet Gynecol 192(5):1702–1706CrossRefPubMedGoogle Scholar
  8. 8.
    Simkin P (2010) The fetal occiput posterior position: state of the science and a new perspective. Birth 37(1):61–71CrossRefPubMedGoogle Scholar
  9. 9.
    Le Ray C, Serres P, Schmitz T, Cabrol D, Goffinet F (2007) Manual rotation in occiput posterior or transverse positions: risk factors and consequences on the cesarean delivery rate. Obstet Gynecol 110(4):873–879CrossRefPubMedGoogle Scholar
  10. 10.
    Desbriere R, Blanc J, Le Du R, Renner JP, Carcopino X, Loundou A et al (2013) Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. Am J Obstet Gynecol 208(1):60e1–68e1CrossRefGoogle Scholar
  11. 11.
    Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M (2016) Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG 123(13):2199–2207CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Le Ray C, Lepleux F, De La Calle A, Guerin J, Sellam N, Dreyfus M, Chantry AA (2016) Lateral asymmetric decubitus position for the rotation of occipito-posterior positions: multicenter randomized controlled trial EVADELA. Am J Obstet Gynecol 215(4):511–517CrossRefPubMedGoogle Scholar
  13. 13.
    Le Ray C, Deneux-Tharaux C, Khireddine I, Dreyfus M, Vardon D, Goffinet F (2013) Manual rotation to decrease operative delivery in posterior or transverse positions. Obstet Gynecol 122(3):634–640CrossRefPubMedGoogle Scholar
  14. 14.
    Shaffer BL, Cheng YW, Vargas JE, Caughey AB (2011) Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position. J Matern Fetal Neonatal Med 24(1):65–72CrossRefPubMedGoogle Scholar
  15. 15.
    Shaffer BL, Cheng YW, Vargas JE, Laros RK Jr, Caughey AB (2006) Manual rotation of the fetal occiput: predictors of success and delivery. Am J Obstet Gynecol 194(5):e7–e9CrossRefPubMedGoogle Scholar
  16. 16.
    Bahl R, Van de Venne M, Macleod M, Strachan B, Murphy DJ (2013) Maternal and neonatal morbidity in relation to the instrument used for mid-cavity rotational operative vaginal delivery: a prospective cohort study. BJOG 120(12):1526–1532CrossRefPubMedGoogle Scholar
  17. 17.
    Bradley MS, Kaminski RJ, Streitman DC, Dunn SL, Krans EE (2013) Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstet Gynecol 122(1):132–137CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Burke N, Field K, Mujahid F, Morrison JJ (2012) Use and safety of Kielland’s forceps in current obstetric practice. Obstet Gynecol 120(4):766–770CrossRefPubMedGoogle Scholar
  19. 19.
    Nash Z, Nathan B, Mascarenhas L (2015) Kielland’s forceps. From controversy to consensus? Acta Obstet Gynecol Scand 94(1):8–12CrossRefPubMedGoogle Scholar
  20. 20.
    Stock SJ, Josephs K, Farquharson S, Love C, Cooper SE, Kissack C et al (2013) Maternal and neonatal outcomes of successful Kielland’s rotational forceps delivery. Obstet Gynecol 121(5):1032–1039CrossRefPubMedGoogle Scholar
  21. 21.
    Tempest N, Hart A, Walkinshaw S, Hapangama DK (2013) A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour. BJOG 120(10):1277–1284CrossRefPubMedGoogle Scholar
  22. 22.
    Vidal F, Simon C, Cristini C, Arnaud C, Parant O (2013) Instrumental rotation for persistent fetal occiput posterior position: a way to decrease maternal and neonatal injury? PLoS ONE 8(10):e78124CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Parant O, Simon C, Capdet J, Tanguy Le Gac Y, Reme JM (2007) Can we still perform instrumental rotations using Thierry’s spatula? Preliminary study among primiparous. J Gynecol Obstet Biol Reprod 36(6):582–587CrossRefGoogle Scholar
  24. 24.
    Guerby P, Allouche M, Simon-Toulza C, Vayssiere C, Parant O, Vidal F (2018) Management of persistent occiput posterior position: a substantial role of instrumental rotation in the setting of failed manual rotation. J Matern Fetal Neonatal Med 31(1):80–86CrossRefPubMedGoogle Scholar
  25. 25.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97CrossRefPubMedGoogle Scholar
  26. 26.
    Rothbarth J, Bemelman WA, Meijerink WJ, Stiggelbout AM, Zwinderman AH, Buyze-Westerweel ME et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44(1):67–71CrossRefPubMedGoogle Scholar
  27. 27.
    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330CrossRefPubMedGoogle Scholar
  28. 28.
    Ribiere C, Kabore FA, Chaussenot A, Paquis-Flucklinger V, Lenne-Aurier K, Gaillet S et al (2013) Bladder-sphincter disorders associated with Wolfram syndrome. Prog Urol 23(8):519–523CrossRefPubMedGoogle Scholar
  29. 29.
    Courtois L, Becher P, Maticot-Baptista D, Cour A, Zurlinden B, Millet P et al (2008) Instrumental extractions using Thierry’s spatulas: evaluation of the risk of perineal laceration according to occiput position in operative deliveries. J Gynecol Obstet Biol Reprod 37(3):276–282CrossRefGoogle Scholar
  30. 30.
    Boucoiran I, Valerio L, Bafghi A, Delotte J, Bongain A (2010) Spatula-assisted deliveries: a large cohort of 1065 cases. Eur J Obstet Gynecol Reprod Biol 151(1):46–51CrossRefPubMedGoogle Scholar
  31. 31.
    Parant O, Simon-Toulza C, Capdet J, Fuzier V, Arnaud C, Reme JM (2009) Immediate fetal-maternal morbidity of first instrumental vaginal delivery using Thierry’s spatulas. A prospective continuous study of 195 fetal extractions. Gynecol Obstet Fertil. 37(10):780–786CrossRefPubMedGoogle Scholar
  32. 32.
    Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 35(5):482–487CrossRefPubMedGoogle Scholar
  33. 33.
    Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44(1):77–80CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329(26):1905–1911CrossRefPubMedGoogle Scholar
  35. 35.
    Benifla JL, Abramowitz L, Sobhani I, Ganansia R, Darai E, Mignon M et al (2000) Postpartum sphincter rupture and anal incontinence: prospective study with 259 patients. Gynecol Obstet Fertil 28(1):15–22PubMedGoogle Scholar
  36. 36.
    MacArthur C, Glazener CM, Wilson PD, Herbison GP, Gee H, Lang GD et al (2001) Obstetric practice and faecal incontinence three months after delivery. BJOG 108(7):678–683PubMedGoogle Scholar
  37. 37.
    Parant O, Simon-Toulza C, Cristini C, Vayssiere C, Arnaud C, Reme JM (2010) Faecal incontinence after first instrumental vaginal delivery using Thierry’s spatulas. Int Urogynecol J 21(10):1195–1203CrossRefPubMedGoogle Scholar
  38. 38.
    Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M (2007) Incidence of fecal incontinence after childbirth. Obstet Gynecol 109(2 Pt 1):281–288CrossRefPubMedGoogle Scholar
  39. 39.
    Damon H, Guye O, Seigneurin A, Long F, Sonko A, Faucheron JL et al (2006) Prevalence of anal incontinence in adults and impact on quality-of-life. Gastroenterol Clin Biol 30(1):37–43CrossRefPubMedGoogle Scholar
  40. 40.
    Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C (2003) Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. BJOG 110(4):424–429CrossRefPubMedGoogle Scholar
  41. 41.
    Baud D, Meyer S, Vial Y, Hohlfeld P, Achtari C (2011) Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Int Urogynecol J 22(9):1127–1134CrossRefPubMedGoogle Scholar
  42. 42.
    Hvidman L, Foldspang A, Mommsen S, Nielsen JB (2003) Postpartum urinary incontinence. Acta Obstet Gynecol Scand 82(6):556–563CrossRefPubMedGoogle Scholar
  43. 43.
    Quiboeuf E, Saurel-Cubizolles MJ, Fritel X (2016) Trends in urinary incontinence in women between 4 and 24 months postpartum in the EDEN cohort. BJOG 123(7):1222–1228CrossRefPubMedGoogle Scholar
  44. 44.
    Pregazzi R, Sartore A, Troiano L, Grimaldi E, Bortoli P, Siracusano S et al (2002) Postpartum urinary symptoms: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 103(2):179–182CrossRefPubMedGoogle Scholar
  45. 45.
    Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Dudenhausen JW (2006) Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol 124(1):42–46CrossRefPubMedGoogle Scholar
  46. 46.
    Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of beck depression inventories-IA and -II in psychiatric outpatients. J Pers Assess 67(3):588–597CrossRefPubMedGoogle Scholar
  47. 47.
    Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786CrossRefPubMedGoogle Scholar
  49. 49.
    Scheer I, Andrews V, Thakar R, Sultan AH (2008) Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship? Int Urogynecol J Pelvic Floor dysfunct 19(2):179–183CrossRefPubMedGoogle Scholar
  50. 50.
    Groutz A, Fait G, Lessing JB, David MP, Wolman I, Jaffa A et al (1999) Incidence and obstetric risk factors of postpartum anal incontinence. Scand J Gastroenterol 34(3):315–318PubMedGoogle Scholar
  51. 51.
    Luthander C, Emilsson T, Ljunggren G, Hammarstrom M (2011) A questionnaire on pelvic floor dysfunction postpartum. Int Urogynecol J 22(1):105–113CrossRefPubMedGoogle Scholar
  52. 52.
    Solans-Domenech M, Sanchez E, Espuna-Pons M (2010) Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol 115(3):618–628CrossRefPubMedGoogle Scholar
  53. 53.
    Pretlove SJ, Thompson PJ, Toozs-Hobson PM, Radley S, Khan KS (2008) Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review. BJOG 115(4):421–434CrossRefPubMedGoogle Scholar
  54. 54.
    Hatem M, Pasquier JC, Fraser W, Lepire E (2007) Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec. J Obstet Gynaecol 29(3):232–239Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynaecology, Paule de Viguier HospitalCHU ToulouseToulouseFrance
  2. 2.INSERM I2MC, UMR 1048ToulouseFrance
  3. 3.INSERM, UMR 1027University Paul Sabatier Toulouse IIIToulouseFrance
  4. 4.Department of Gynecology, Rangueil HospitalCHU ToulouseToulouseFrance

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