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Eur J Obstet Gynecol Reprod Biol. 2005 Nov 1;123(1):22-6.

Is epidural analgesia a risk factor for occiput posterior or transverse positions during labour?

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  • 1Department of Obstetrics and Gynecology, Maternity Port-Royal, Cochin-Saint Vincent-de-Paul Hospital, AP-HP University Paris V, 123 Bd de Port-Royal, 75014 Paris, France.

Abstract

OBJECTIVE:

The aim of this study was to assess whether the station of the fetal head at epidural placement is associated with the risk of malposition during labour.

STUDY DESIGN:

Retrospective study (covering a 3-month period) of patients in labour with singleton cephalic term fetuses and epidural placement before 5 cm of dilatation. We studied the following risk factors for malposition: station and cervical dilatation at epidural placement, induction of labour, parity and macrosomia. Malposition, defined as all occiput posterior and occiput transverse positions, was assessed at 5 cm of dilatation because of our policy of systematic manual rotation for malpositions.

RESULTS:

The study included 398 patients, 200 of whom had malpositions diagnosed at 5 cm of dilatation. In both the univariate and multivariate analyses, station at epidural placement was the only risk factor significantly associated with this malposition (adjusted OR: 2.49, 95% CI 1.47-4.24). None of the other factors studied was significantly associated with malposition: nulliparity (OR 1.45, 95% CI 0.96-2.20), macrosomia (OR 0.75, 95% CI 0.37-1.50), induction of labour (OR 0.84, 95% CI 0.49-1.45), or dilatation less than 3 cm at epidural administration (OR 1.16, 95% CI 0.59-2.30). Only three infants of the 365 delivered vaginally (0.8%) were born in occiput posterior positions.

CONCLUSION:

Epidural placement when the fetal head is still "high" is associated with an increased rate of occiput posterior and transverse malpositions during labour.

PMID:
16260336
[PubMed - indexed for MEDLINE]
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