{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T01:34:38Z","timestamp":1764898478172,"version":"3.46.0"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To investigate the morbidity associated with assisted vaginal birth (AVB) and an occipito\u2010posterior (OP) fetal head position.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Observational study based on secondary analyses of a randomised controlled trial and cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Two university affiliated maternity hospitals in Ireland.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n A combined cohort of 1081 nulliparous women at term who were assessed for AVB in the second stage of labour.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Univariable and multivariable logistic regression analyses were performed.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Postpartum haemorrhage (PPH), obstetric anal sphincter injury (OASI), fetal acidosis, neonatal trauma, failed or abandoned AVB leading to caesarean section (CS).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 1081 AVBs, a total of 192 (17.8%) had an OP position at the outset, with 103 of these (53.6%) rotated to occipito\u2010anterior (OA) prior to AVB and 89 (46.4%) remaining OP. AVB completed in a non\u2010rotated OP position compared with OP rotated to OA was associated with an increased risk of PPH (34% [30\/89] vs. 15% [15\/103], adjusted Odds Ratio (adj OR) 3.57; 95% Confidence Interval (CI) 1.68 to 7.58), OASI (22% [14\/65] vs. 2% [2\/98], adj OR: 12.62; 95% CI: 2.65 to 60.12) and CS (27% [24\/89] vs. 5% [5\/103], adj OR: 8.99; 95% CI: 3.14 to 25.74). There were no significant differences in neonatal outcomes. The diagnosis of OP was incorrectly assigned as either OA or occipito\u2010transverse (OT) in 35 of the 192 cases (18.2%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study highlights the associated morbidity when attempting an AVB with a non\u2010rotated OP position rather than rotating to OA.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.70002","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T06:24:56Z","timestamp":1757917496000},"page":"311-319","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Birth Outcomes Associated With Assisted Vaginal Birth in an Occipito\u2010Posterior Position: Secondary Analyses of a Randomised Controlled Trial and Cohort Study"],"prefix":"10.1111","volume":"133","author":[{"given":"Lauren","family":"Hayes","sequence":"first","affiliation":[{"name":"The Coombe Hospital & Trinity College University of Dublin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meena","family":"Ramphul","sequence":"additional","affiliation":[{"name":"The Rotunda Hospital Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6074-6718","authenticated-orcid":false,"given":"Deirdre J.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Academic Department of Obstetrics and Gynaecology, the Coombe Hospital & Trinity College University of Dublin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"volume-title":"Oxford Textbook of Obstetrics and Gynaecology","year":"2019","author":"Murphy D. 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