ArticleBMC pregnancy and childbirth2025
The association between fetal head malrotation and labor analgesia: a propensity score-matched analysis.
Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFetal head malrotation is associated with prolonged labor, instrumental delivery, and perinatal complications. Previous studies have suggested an association between malrotation and labor analgesia, but this remains controversial. This study aimed to clarify whether malrotation increases with the use of labor analgesia.
methodsThis retrospective cohort study using propensity score matching. Medical records from January 2020 to January 2023 were reviewed. The study subjects were full-term pregnant women with singleton cephalic fetuses whose cervixes were fully dilated. The group without labor analgesia (Group C) was matched with the labor analgesia group (Group A) by propensity score matching. The primary outcome was the occurrence of malrotation. Secondary outcomes included rates of normal vaginal delivery, instrumental delivery, cesarean section, and success rate of attempted manual rotation. Pearson’s chi-square test was used to assess the association between the use of labor analgesia and outcomes.
resultsDuring the study period, 3868 women were included, 1164 cases were excluded due to the exclusion criteria, and 971 cases were further excluded due to missing data. Of 1735 eligible women, 88.4% received labor analgesia. After propensity score matching, 804 women were included, of whom 75% received labor analgesia (Group A) and 25% did not (Group C). The rate of malrotation was significantly higher in Group A compared to that in Group C (11.6% vs. 6.5%, p = 0.03). The rate of instrumental delivery was significantly higher in Group A (25.7% vs. 14.9%, p = 0.001). The distribution of the instrumental deliveries in Group A was as follows: Naegele forceps delivery was used in 87.1% of the cases, Kielland forceps in 5.2%, and vacuum extraction in 7.7%. There was no significant difference in the rate of vaginal delivery. Manual rotation was attempted in 84.3% of malrotation cases in Group A with a 64.4% success rate, with no significant difference of the success rate between the two groups.
conclusionsLabor analgesia is associated with an increased rate of malrotation and instrumental delivery. However, it does not seem to decrease the rate of vaginal delivery, given the high attempt and success rates of manual rotation and the availability of Kielland forceps delivery.
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