Does occiput posterior position in the second stage of labour increase the operative delivery rate?

OBJECTIVES: To assess the impact of occipito-posterior position in the second stage of labour on operative delivery. METHODS: Double-blinded prospective cohort study of ultrasound determined occiput-posterior position during the second stage of labour compared with occiput-anterior position. The primary outcome was operative (caesarean section, forceps or vacuum) delivery. RESULTS: A total of 68% (13/19) women in the occiput-posterior group, and 27% (39/141) in the occiput-anterior group had an operative delivery (unadjusted: P < 0.001). Caesarean section was performed in 37% and 5%, respectively (P < 0.001). The occiput-posterior group had a longer second stage (mean 2 h 59 minutes vs 1 h 54 minutes; P = 0.001) and larger infants (mean 3723 g vs 3480 g, P = 0.024). In the logistic regression, occiput-posterior position, nulliparity, abnormal second stage cardiotocograph and epidural analgesia were independent predictors for operative delivery. CONCLUSIONS: Occiput-posterior position early in the second stage of labour is strongly associated with operative delivery. There is potential to explore interventions such as manual rotation.

Surgical and patient outcomes using mechanical bowel preparation before laparoscopic gynecologic surgery: a randomized controlled trial.

OBJECTIVE: Mechanical bowel preparation is a common practice before laparoscopic gynecologic surgery. This study aims to evaluate its capacity to improve surgical view and bowel handling in the deep pelvis. METHODS: A single-blinded, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients assigned to one of the following three groups: fasting only; minimal residue diet for 2 days; or minimal residue diet for 2 days plus mechanical bowel preparation with oral sodium picosulphate. Outcomes included intraoperative surgical view and bowel handling, preoperative patient symptomatology, hematologic and biochemical characteristics, and bowel function. RESULTS: Three hundred eight participants were randomized. The intraoperative surgical view and bowel handling was minimally but statistically better in the minimal residue plus mechanical bowel preparation group compared with the other groups with less than a 1-point difference on a 10-point visual analog scale (P<.01 and P<.04, respectively). Women were assessed at baseline and on the day of surgery for the difference in visual analog scale score in the fasting only, minimal residue diet, and minimal residue diet with mechanical bowel preparation groups for headache (2.2 compared with 10.5 compared with 21; P<.01), thirst (14.7 compared with 24.7 compared with 30.9; P<.01), weakness (-0.2 compared with 16.6 compared with 25; P<.01), tiredness (-4.5 compared with 8.1 compared with 15.4; P<.01), anxiety (12.5 compared with 10.1 compared with 10.3; P=.66), and discomfort (-8.2 compared with 8.7 compared with 6.6; P<.01), respectively. Hematologic parameters were not different among the groups, and there was no significant difference in bowel function between the groups. CONCLUSION: Minimal residue diet plus mechanical bowel preparation provides statistical improvement in surgical view and bowel handling, but the benefit is likely of little clinical significance given overall blinded ratings from surgeons. Given the significant symptoms and discomfort caused for patients undertaking minimal residue diet with or without mechanical bowel preparation, fasting only without any preoperative diet or bowel preparation is a preferable alternative for laparoscopic gynecologic surgery involving the posterior pelvic compartment.