Technology for predicting the outcome of labor in the fetal occiput posterior presentation

Introduction. Delivery in the fetal occiput posterior presentation is a subject of close attention of obstetricians and gynecologists. Despite the classification of this category of childbirth as physiological, the outcome directly depends on the transition of the occiput posterior position to the occiput anterior one during labor. Persistence of the posterior position is a risk factor for operative delivery.
Aim. Development of a technology for predicting the outcome of labor in the fetal occiput posterior presentation.
Materials and Methods. A prospective analysis of 118 cases of childbirth in the period 2018–2021 was carried out at the Perinatal Center of the Regional Clinical Hospital, Chita. The total sample was divided into 3 groups: group 1 included 80 parturient women with the fetal occiput anterior presentation; group 2 included 18 patients with the fetal occiput posterior presentation, during the delivery of which there was a turn into the anterior position; group 3 included 20 parturient women with the fetal occiput posterior presentation, during the delivery of which a turn to the anterior position did not occur. The groups were comparable in age and extragenital pathology. All women underwent physical and ultrasound examination 1–2 days ahead of the delivery.
Results.. The technology for predicting the outcome of labor in the fetal occiput posterior presentation is implemented on the basis of a multilayer perceptron, the rate of incorrect predictions in the learning process of which was 11.1%. The structure of the trainable neural network included 8 input neurons: parity of childbirth, height, body weight and distantia spinarum of a woman, biparietal diameter and femur length of a fetus, presence or absence of pre-induction of labor.
Conclusion. An integrated approach based on neural network analysis of the history, as well as data of physical and ultrasound examinations, makes it possible to predict the outcome of labor with an accuracy of up to 90.0% in the fetal occiput posterior presentation. The use of this technology in clinical practice will reduce the incidence of adverse obstetric and perinatal outcomes in the fetal occiput posterior presentation.

1. Arnt O.S., Bolotskikh V.M. The intrapartum fetal occiput posterior position predictors. Journal of Obstetrics and Women’s Diseases. 2017;66(3):34–41. doi: 10.17816/JOWD66334-41. (In Russ.)

2. Radzinsky V.E., Fuks А.М. (eds.) (2016). Obstetrics: Textbook. Мoscow: GEOTAR-Media. 1040 p. (In Russ.)

3. Kurtser M.A. (ed.) (2015). Munro Kerr’s Operative Obstetrics (P.I. Medvedeva, Trans. from English). Мoscow: Read Elsivier. 392 p.

4. Arnt O.S., Troik E.B., Gadzhiyeva T.S. The fetal occipit posterior position. Journal of Obstetrics and Women’s Diseases. 2014;63(2):12–21. doi: 10.17816/JOWD63212-21. (In Russ.)

5. Gardberg M., Leonova Y., Laakkonen E. Malpresentations – impact on mode of delivery. Acta Obstet. Gynecol. Scand. 2011;90(5):540–542. doi: 10.1111/j1600-0412.2011.01105x.

6. Guittier M.J., Othenin-Girard V. Correcting occiput posterior position during labor: the role of maternal positions. Gynecol. Obstet. Fertil. 2012;40(4):255–260. doi: 10.1016/j.gyobfe.2011.05.006.

7. Morozova E.A., Petrova A.V. Actual issues of the fetal occiput posterior position delivery, neonatal outcomes. Child and Adolescent Rehabilitation. 2017;3(31):11–14. (In Russ.)

8. Healthcare delivery in single births in the occiput posterior position (without complications) and in the postpartum period: Clinical recommendations (treatment protocol), approved by the Ministry of Health of the Russian Federation on May 6, 2014. Moscow, 2014. URL: https://minzdrav.ryazangov.ru/upload/iblock/861/odnoplodnye-rody-v-zatylochnom-predlezhanii.pdf (accessed 15.10.2021).

9. Mertz E. (2016). Ultrasound Diagnostics in Obstetrics and Gynecology. Мoscow: MEDpress-inform. Vol. 1: Obstetries. 719 p. (In Russ.)

10. Uniform requirements for manuscripts submitted to biomedical journals: writing and editing for biomedical publication. International Committee of Medical Journal Editors (updated Oct. 2008). URL: https://www.icjme.org (accessed 15.10.2021).

11. Lang T.A., Altman D.G. Statistical analyses and methods in the published literature: The SAMPL guidelines. Med. Writing. 2016;25(3):31–36. doi: 10.18243/eon/2016.9.7.4.