Fetal malposition in labour and health outcomes for women and their newborn infants: A retrospective cohort study

INTRODUCTION: Occiput-posterior (OP) or occiput-transverse (OT) fetal malposition has a prevalence of 33–58% in the first-stage of labour with 12–22% persisting until delivery. Malposition is associated with significant maternal and neonatal morbidity. Most previous studies report the incidence and adverse maternal and fetal outcomes of persistent fetal malposition in the second stage of labour and do not include outcomes that may be present in the first stage of labour. AIMS: To assess the incidence and health outcomes for women and their newborn infants of a fetal malposition in the first or second stage of labour. MATERIALS AND METHODS: A retrospective cohort study of 738 maternity records (randomly selected) from a tertiary hospital in New Zealand. Maternal and neonatal characteristics are described. Outcomes for women with a fetus in an OP or OT position in labour are compared to those for women with a fetus in an occiput-anterior position (OA). RESULTS: 499 (68%) women had an OP/OT positioned fetus and 239 (32%) had an OA positioned fetus on vaginal examination in labour. Women had similar characteristics except a body mass index ≥30 kg/m(2) was more common in the OP/OT group. Fetal malposition appears to be more likely in women with a right-sided fetal occiput. Three quarters of OP/OT fetuses rotated anteriorly by birth. Fetal malposition compared to no malposition was associated with oxytocin augmentation, epidural use, a longer first stage of labour, fewer normal vaginal births, and more caesarean sections. Fetal malposition during labour was not associated with adverse neonatal outcomes. CONCLUSION: Interventions such as maternal posture in the first and second stage of labour could potentially reduce the incidence of malposition and improve health outcomes for mothers.