• Hala Phipps, Jon A Hyett, Kathy Graham, Wendy J Carseldine, Jane Tooher, and Bradley de Vries.
• 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.
• Acta Obstet Gynecol Scand. 2014 Oct 1; 93 (10): 1018-24.

ObjectiveTo evaluate if ultrasound-determined occipito-transverse position early in the second stage of labor is associated with operative delivery.DesignRetrospective review of two prospective cohort studies.SettingAn Australian tertiary referral hospital.PopulationWomen with term, cephalic singleton pregnancies.MethodsRetrospective analysis of data from two prospective studies. Logistic regression was undertaken to assess the independent contribution of the occipito-transverse position to operative delivery.Main Outcome MeasureOperative delivery (cesarean section, forceps or vacuum extraction).ResultsAmong 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).ConclusionThe occipito-transverse position early in the second stage of labor was associated with an increased operative delivery rate.© 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

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