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. Key Words: Intrapartum sonography, Obstetric analgesia, Oc- ciput posterior position, Labour, delivery, Early com- bined spinal-epidural analgesia, CSE, Sufentanyl, Ropi- vacaine, Side effects. European Review for Medical and Pharmacological Sciences Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine A. MALVASI 1 , A. TINELLI 2 , A. BRIZZI 3 , M. GUIDO 4 , V. MARTINO 1 , S. CASCIARO 5 , D. CELLENO 6 , M.G. FRIGO 6 , M. STARK 7 , D. BENHAMOU 8 1 Department of Obstetrics and Gynaecology, “Santa Maria” Hospital, Bari, (Italy), 2 Department of Obstetrics and Gynaecology, “Vito Fazzi” Hospital, Lecce, (Italy), 3 Department of Anaesthesiology, “Santa Maria” Hospital, Bari, (Italy), 4 Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Di.S.Te.B.A., Faculty of Sciences, University of Salento, Lecce, (Italy), 5 Biomedical Engineering Science and Technology Division, IFC-CNR, Institute of Clinical Physiology, National Council of Research, (Italy), 6 Department of Anaesthesiology, Fatebenefratelli General Hospital, Isola Tiberina, Rome, (Italy), 7 The New European Surgical Academy (NESA), Berlin, (Germany), 8 AP-HP, Service d'Anesthésie-Réanimation, Hôpital Bicêtre,Le Kremlin-Bicêtre, (France) Corresponding Author: Antonio Malvasi, MD; e-mail: antoniomalvasi@gmail.com 799 Introduction In the 1955 Friedman published a study on 500 pregnants in labour, with single fetus at term, underlining the existing relationship between the duration of labour and the cervical dilatation, de- scribing this relationship in a sigmoid curve stat- ed by a latent and active stage 1 . The body mass index (BMI) of the pregnant women was also modified, so as the decreased number of pregnant smokers had a repercussion on the fetal weight and on the dynamics of the birth 2 . During the last 50 years, the introduction of the fetal heart monitoring, the use of oxytocin and the labour analgesia, associated with the re- duction of the forceps and vacuum extractor ap- plications, has changed labour and delivery man- agement. Nevertheless, during labour, since the uterine cervix is not still well dilated and for the occurrence of “caput succedaneum”, the clinical evaluation of the correct position of the foetal head is often limited and wrong 3 , so as in the de- livery management. The occiput posterior position (OPP) occurs in 10-30% of fetuses in the first stage of labour, but mostly rotate spontaneously 4 . Problems arise be- cause the deflexed fetal head presents larger di- ameters, causing prolonged labours, increased oxytocin use, epidural analgesia doses augmenta- tion and higher operative delivery rates 5 . Even if spontaneous vaginal delivery is achieved in the OPP, there is an higher incidence of episioto- 2010; 14: 799-806