Fetal rotation examined with ultrasound in a sub-Saharan population: A longitudinal cohort study.

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-11-20 DOI:10.1111/aogs.15013
Kenneth Bagandanshwa, Bariki Mchome, Upendo Kibona, Raziya Gaffur, Ibrahim Salum, Adelaida Kavishe, Cecilia Mushi, Pendo Mlay, Gileard Masenga, Signe Egenberg, Torbjørn Moe Eggebø
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Abstract

Introduction: Occiput posterior (OP) position rates at birth are 5%-8% in studies mainly comprising white European women. The anthropoid pelvis is common in black African women. This pelvic shape has a narrow anterior segment and an ample room posteriorly. The fetal head is wider posteriorly, and the OP position may be favorable in women with an anthropoid pelvic shape. We aimed to examine the fetal rotation with ultrasound longitudinally during the active phase of labor in a sub-Saharan population. We also aimed to examine associations between fetal position, delivery mode, and duration of labor.

Material and methods: The study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania from the 19th of November 2023 to 13th of April 2024. Women with a single fetus in cephalic presentation, gestational age >37 weeks, without previous or pre-labor cesarean section were eligible. Fetal position was classified as occiput anterior (OA) from 10 to 2 o'clock, occiput transverse (OT) at 3 or 9 o'clock, and OP position from 4 to 8 o'clock.

Results: The study participants comprised 215 women. Fetal positions at admission, in the first and second stage of labor and at birth are presented in the graphical figure. In all, 65/215 (30.2%) fetuses were in OP position at admission, 59/204 (28.9%) in the first stage, 38/210 (18.1%) in the second stage and 35/215 (16.3%) were delivered in OP position. The OP rates at birth were 25/92 (27.2%) in nulliparous and 10/123 (8.1%) in parous women. The operative delivery rate was 10/157 (6.4%) in women with ultrasound assessed fetal position as OA in the second stage (six cesarean section and four vacuum extractions), and 28/48 (58.3%) in the non-OA group (27 cesarean section and one vacuum extraction) (p < 0.01). The hazard ratio for delivery in the second stage was 0.26 (95% CI 0.13-0.52) for the non-OA versus the OA group in nulliparous women and 0.25 (95% CI 0.12-0.52) in parous women.

Conclusions: The persistent OP position rate at birth was higher than previously reported, and the operative intervention rate was nine time higher in women with the fetus in non-OA versus OA position in the second stage.

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用超声波检查撒哈拉以南人口的胎儿旋转情况:纵向队列研究。
简介在主要由欧洲白人妇女进行的研究中,出生时枕后位的比例为 5%-8%。非洲黑人妇女常见的骨盆形状为 "anthropoid"。这种骨盆形状前段狭窄,后段宽敞。胎儿头部后部较宽,OP 位置可能对骨盆呈扁平状的女性有利。我们的目的是在撒哈拉以南地区的人群中,用超声波纵向检查活跃产程中胎儿的旋转情况。我们还旨在研究胎位、分娩方式和产程之间的关联:研究于 2023 年 11 月 19 日至 2024 年 4 月 13 日在坦桑尼亚莫希的乞力马扎罗基督教医疗中心进行。单胎头位、胎龄大于 37 周、既往或产前未进行过剖宫产手术的产妇均符合条件。胎位分为枕前位(OA)(10 点至 2 点)、枕横位(OT)(3 点或 9 点)和枕后位(OP)(4 点至 8 点):研究对象包括 215 名妇女。入院时、第一产程、第二产程和分娩时的胎位见下图。共有 65/215 (30.2%) 的胎儿在入院时为 OP 位,59/204 (28.9%) 的胎儿在第一产程为 OP 位,38/210 (18.1%) 的胎儿在第二产程为 OP 位,35/215 (16.3%) 的胎儿在分娩时为 OP 位。无阴道产妇的 OP 分娩率为 25/92(27.2%),准阴道产妇的 OP 分娩率为 10/123(8.1%)。在第二阶段超声评估胎位为 OA 的产妇中,手术分娩率为 10/157(6.4%)(6 例剖宫产和 4 例真空吸引术),而在非 OA 组中,手术分娩率为 28/48(58.3%)(27 例剖宫产和 1 例真空吸引术):出生时持续OP胎位率高于之前的报道,在第二阶段胎儿为非OA胎位的产妇中,手术干预率是OA胎位产妇的9倍。
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来源期刊
CiteScore
8.00
自引率
4.70%
发文量
180
审稿时长
3-6 weeks
期刊介绍: Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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