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BMC Pregnancy Childbirth. 2017 Nov 14;17(1):377. doi: 10.1186/s12884-017-1556-5.

Neonatal outcomes of deliveries in occiput posterior position when delayed pushing is practiced: a cohort study.

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Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Obstetrics and Gynaecology, Örnsköldsvik Hospital, SE-891 89, Örnsköldsvik, Sweden.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.



To examine the impact of occiput posterior position, compared to occiput anterior position, on neonatal outcomes in a setting where delayed pushing is practiced. The specific aim was to estimate the risk of acidaemia.


Cohort study from a university hospital in Sweden between 2004 and 2012. Information was collected from a local database of 35,546 births. Umbilical artery sampling was routine. Outcomes were: umbilical artery pH < 7.00 and <7.10 and short-term neonatal morbidity. The association between occiput posterior position and neonatal outcomes was examined using logistic regression analysis, presented as adjusted odds ratio (AOR) with 95% confidence interval (CI).


Of 27,648 attempted vaginal births, 1292 (4.7%) had occiput posterior position. Compared with occiput anterior, there was no difference in pH < 7.00 (0.4% vs. 0.5%) but a higher rate of pH < 7.10 in occiput posterior births (3.8 vs. 5.5%). Logistic regression analysis showed no increased risk of pH < 7.10 (AOR 1.28 95% CI 0.93-1.74) when occiput posterior was compared with occiput anterior births but, an increased risk of Apgar score < 7 at 5 min (AOR 1.84, 95% CI 1.11-3.05); neonatal care admission (AOR 1.68, 95% CI 1.17-2.42) and composite morbidity (AOR 1.66, 95% CI 1.19-2.31).


With delayed pushing, birth in occiput posterior compared with anterior position is not associated with acidaemia. The higher risk of neonatal morbidity is of concern and any long-term consequences need to be investigated in future studies.


Acidaemia; Apgar score; Caesarean delivery; Delayed pushing; Labour; Metabolic acidaemia; Neonatal morbidity; Occipito-posterior position; Occiput anterior position; Occiput posterior position

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