Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine.

Abstract. – Aim: To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine. Material and Methods: This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer. Results: In the second stage, 79 were persis- tent occiput posterior position (POPP) fetuses and 36 were translated from anterior to posterior position (TAPP) fetuses. Specifically, in sponta- neous labour on 25 women in anterior position, there were 17 TAPP and in CSE analgesia on 28 women in anterior, there were 19 in TAPP, with- out significant differences. The number of asyn- clitisms was higher in the POPP group (84%) re- spect to the TAPP group (75%), so as the rate of caesarean section (67% versus 52.7%). Conclusions: The labour with low dose of ropi- vacaine and sufentanyl does not increase the oc- ciput posterior position during fetal descent, lead- ing to a POPP. Finally, since in the occiput anterior presentation labour analgesia significantly length- ens time to delivery, in the occiput posterior posi- tion this is significantly increased, with a pro- longed second stage of labour and reduced time of descent of fetal head in obstetric pelvis.