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

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.