Factors Influencing the Delivery and Obstetric Outcome in Pregnant Women with Persistent Foetal Occiput Posterior Position: A Prospective Cohort Study

Introduction: Occiput posterior position is the most common malposition encountered in labour and have a higher predisposition for caesarean delivery than in occiput anterior position. Aim: To evaluate the effect of maternal and foetal factors on the delivery and obstetric outcome in persistent occiput posterior position at term labouring mothers. Materials and Methods: The prospective cohort study was carried out at Father Muller Medical College Hospital, Mangalore, Karnataka, India, from November 2015 to November 2017. Thousand antenatal mothers carrying singleton, vertex presentation in labour were monitored. Antenatal factors affecting the occiput posterior position like diet and antenatal exercise were noted. They were observed throughout the 1st stage and 2nd stage of labour. The birth weight as a foetal factor affecting the delivery outcome was noted and data were analysed. Categorical data was analysed using the Chi-square test. The t-test was used for continuous data. Results: Of the 1000 antenatal mothers 67 (6.7%) were occiput posterior group. There was a higher need for induction among occiput posterior group (35.8%) as compared to occiput anterior group (15.7%) (p-value <0.001). Mothers in occiput posterior group had higher instrumental vaginal delivery (28.3%) as compared to occiput anterior group (2.8%) (p-value <0.001). Neonatal Intensive Care Unit (NICU) admission was higher in the occiput anterior group (5.7%) as compared to the occiput posterior group (4.9%), which is significant (p-value=0.003). Conclusion: The general physical activity done during the antenatal period may not appear to have an effect on the rotation of the occiput posterior position and for vaginal delivery. Counselling and special obstetric care with persistent occiput posterior position is required for improved obstetric outcome