Outcome of labor in vertex malposition in Cameroon

Elie Nkwabong, Marie Foe Mba, Joseph Nelson Fomulu


Background: Vertex malposition is associated with increased maternal and neonatal adverse effects, but its magnitude has not been well established in sub-Saharan women. This study aimed at evaluating labor outcome in cases of Vertex Malposition (VM) in Cameroon.

Methods: This prospective cohort study was conducted in the University Teaching Hospital of Yaoundé (Cameroon) from March 1st, 2013 to February 28th, 2014. Women carrying singletons with or without VM in labor were monitored during labor. The main variables recorded included the duration of the second stage of labor, mode of delivery, birth weight and neonatal wellbeing. Data of women with VM were compared to those of women without it. Fisher’s exact test and t-test were used for comparison where appropriate. P<0.05 was considered statistically significant.

Results: A total of 100 women were recruited in each group. There was no difference in the mean birth weights (P=0.56). VM was significantly associated with prolonged second stage of labor (RR 12.1, 95%CI 4.4-33.1), cesarean section (RR 12.6, 95%CI 5.3-30), instrumental delivery (RR 7.7, 95%CI 2.6-22.3), episiotomy (RR 6.2, 95%CI 2.8-13.7) and neonatal death (RR 8, 95%CI 1.01-62.7).

Conclusions: VM is associated with increased maternal and neonatal adverse effects. Hence, delivery should be carried out in settings where cesarean section, instrumental delivery and neonatal resuscitation can rapidly be performed. 


Cameroon, Labor outcome, Maternal outcome, Neonatal outcome, Vertex malposition

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Adam G, Sirbu O, Voicu C, Dominic D, Tudorache S, Cernea N. Intrapartum ultrasound assessment of fetal head position, tip the scale: natural or instrumental delivery? Curr Health Sci J. 2014;40(1):18-22.

Haeri S, Baker AM. Estimating the impact of pelvic immaturity and young maternal age on fetal malposition. Arch Gynecol Obstet. 2012;286(3):581-4.

Guittier MJ, Othenin-Girard V. Correcting occiput posterior position during labor: the role of maternal positions [French]. Gynecol Obstet Fertil. 2012;40(4):255-60.

To WW, Li IC. Occipital posterior and occipital transverse positions: reappraisal of the obstetric risks. Aust N Z J Obstet Gynaecol. 2000;40(3):275-9.

Malvasi A, Tinelli A, Barbera A, Eggebø TM, Mynbaev OA, Bochicchio M, et al. Occiput posterior position diagnosis: vaginal examination or intrapartum sonography? A clinical review. J Matern Fetal Neonatal Med. 2014;27(5):520-6.

Fitzpatrick M, McQuillan K, O’Herlihy C. Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol. 2001;98(6):1027-31.

Martino V, Iliceto N, Simeoni U. Occipito-posterior fetal head position, maternal and neonatal outcome. [Italian]. Minerva Ginecol. 2007;59(4):459-64.

Ridley RT. Diagnosis and intervention for occiput posterior malposition. J Obstet Gynecol Neonatal Nurs. 2007;36(2):135-43.

Senécal J, Xiong X, Fraser WD. Effect of fetal position on second-stage duration and labor outcome. Obstet Gynecol. 2005;105(4):763-72.

Kopas ML. A review of evidence-based practices for management of the second stage of labor. J Midwifery Women’s Health. 2014;59(3):264-76.

Yancey MK, Zhang J, Schweitzer DL, Schwarz J, Klebanoff MA. Epidural analgesia and fetal head malposition at vaginal delivery. Obstet Gynecol. 2001;97(4):608-12.

Tempest N, Hart A, Walkinshaw S, Hapangama DK. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labor. BJOG. 2013;120(10):1277-84.

Wanyonyi SZ, Achila B, Gudu N. Factors contributing to failure of vacuum delivery and associated maternal/neonatal morbidity. Int J Gynaecol Obstet. 2011;115(2):157-60.

Graham K, Phipps H, Hyett JA, Ludlow JP, Mackie A, Marren A, et al. Persistent occiput posterior: outcomes following digital rotation: a pilot randomised controlled trial. Aust N Z J Obstet Gynaecol. 2014;54(3):268-74.

Ponkey SE, Cohen AP, Heffner LJ, Lieberman E. Persistent fetal occiput posterior position: obstetric outcomes. Obstet Gynecol. 2003;101(5 Pt 1):915-20.

Briggs ND. Outcome of labor in occipito posterior position in an African population. Br J Obstet Gynaecol. 1989;96(10):1234-6.

Parente MP, Jorge RM, Mascarenhas T, Fernandes AA, Martins JA. The influence of an occipito-posterior malposition on the biomechanical behavior of the pelvic floor. Eur J Obstet Gynecol Reprod Biol. 2009;144(Suppl 1):S166-9.