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Perinatal outcomes in persistent occiput posterior fetal position: a systematic review and meta-analysis

02 February 2024
Volume 32 · Issue 2



Persistent occiput posterior fetal position is the most common fetal malposition during labour. The aim of this study was to measure the magnitude of the effects of this labour dystocia on perinatal outcomes, as compared to anterior position.


A systematic review of the literature included prospective and retrospective cohort studies of singleton term pregnancies, comparing the effect of occiput posterior fetal position with occiput anterior fetal position. Random-effect meta-analysis was performed.


Overall, eight studies were included, for a total of 140 590 participants. Women with fetuses in occiput posterior position were more likely to give birth via caesarean section (odds ratio: 6.74, P<0.001), based on data from all eight studies. Newborns experienced an increased risk of admission to a neonatal intensive care unit (odds ratio: 1.60, P<0.001), based on data from five of the included studies.


Persistent occiput posterior fetal position negatively affects maternal and neonatal outcomes. Future studies should reduce potential bias, include adjusted analysis and investigate the best clinical management for this labour dystocia.

The physiology of labour and birth is a complex mechanism involving mother and baby. The relationship between the maternal pelvis and the fetus' head, which is the largest part of the newborn (Marshall and Raynor, 2014), is of great importance for birth without dystocia, a ‘difficult or obstructed labour’ (Neilson et al, 2003). The fetal skull, which completes its ossification process only in early adulthood, is able to adapt to the maternal pelvis through a partial overlapping of the skull bones (a process called moulding), allowing passage during labour without complications (Marshall and Raynor, 2014). Areas such as the occiput and vertex region are used by healthcare professionals to ascertain the fetal position in the maternal pelvis. The diameters of the fetal skull are of great importance for this process, and some are more likely to lead to a birth with favourable outcomes.

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