The management of persistent occipito-posterior position.

Persistent occipito-posterior position (POP) is found in about 1% of labors, and its management is still controversial. A study group of 319 patients with POP deliveries were screened and analyzed for prepartum, intrapartum and postpartum parameters. A control group of the same size was matched for maternal age (mean 27-28 +/- 5.22 yrs), gravidit (mean 2.52 +/- 1.95) and parity (mean 1.13 +/- 1.67). Statistically significant differences were found between the study and the control groups regarding the incidence of instrumental (forceps/vacuum) deliveries, prolonged second stage, pregnancy-induced hypertension, prostaglandin E2 induction, premature rupture of membranes and episiotomy. A discussion is presented evaluating the possible significance of these findings. Although the high rate of instrumental deliveries encourages active management of POP labors, the authors advocate a more conservative approach.