Clinical Study Intrapartum Ultrasound Assessment of Fetal Spine Position Salvatore Gizzo, 1,2 Alessandra Andrisani, 1 Marco Noventa, 1 Giorgia Burul, 1 Stefania Di Gangi, 1 Omar Anis, 1 Emanuele Ancona, 1 Donato D’Antona, 1 Giovanni Battista Nardelli, 1 and Guido Ambrosini 1 1 Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128 Padova, Italy 2 Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy Correspondence should be addressed to Salvatore Gizzo; salvatoregizzo@libero.it Received 15 April 2014; Revised 4 July 2014; Accepted 10 July 2014; Published 4 August 2014 Academic Editor: Jose Guilherme Cecatti Copyright © 2014 Salvatore Gizzo et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We investigated the role of foetal spine position in the irst and second labour stages to determine the probability of OPP detection at birth and the related obstetrical implications. We conducted an observational-longitudinal cohort study on uncomplicated cephalic single foetus pregnant women at term. We evaluated the accuracy of ultrasound in predicting occiput position at birth, inluence of fetal spine in occiput position during labour, labour trend, analgesia request, type of delivery, and indication to CS. he accuracy of the foetal spinal position to predict the occiput position at birth was high at the irst labour stage. At the second labour stage, CS (40.3%) and operative vaginal deliveries (23.9%) occurred more frequently in OPP than in occiput anterior position (7% and 15.2%, resp.), especially in cases of the posterior spine. In concordant posterior positions labour length was greater than other ones, and analgesia request rate was 64.1% versus 14.7% for all the others. he assessment of spinal position could be useful in obstetrical management and counselling, both before and during labour. he detection of spinal position, more than OPP, is predictive of successful delivery. In concordant posterior positions, the labour length, analgesia request, operative delivery, and caesarean section rate are higher than in the other combination. 1. Introduction he foetal head typically engages in the transverse diameter late in the third trimester and usually rotates to an occipi- toanterior (OAP) or occipitoposterior (OPP) position. OPP occurs in 15–20% of women before labour at term [1]. Approximately 90–95% of these foetuses rotate during labour once the head reaches the pelvic loor [1, 2]. hus, most of the OPP deliveries seem to arise as a consequence of a malrotation from the initial OAP or transverse position (OTP), rather than a persistent OPP. OPP incidence at birth ranges between 1 and 5% [2, 3]. Intrapartum ultrasound may improve the detection of fetal head position [4]. Although the identiication of OPP before or during labour is not predictive of the same position at delivery, its early detection argues for a greater monitoring of the labour evolution [4, 5]. Blasi et al. [6] showed that the diagnostic sonographic accuracy of the foetal occiput position assessment at the second stage of labour had a sensitivity of 100%, speciicity of 78%, positive predictive value (PPV) of 26%, and negative predictive value (NPV) of 100% to predict the same position at birth. Considering the foetal spinal position, ultrasound showed a sensitivity of 100%, speciicity of 98%, PPV of 85%, and NPV of 100% [6]. Peregrine et al. [1] demonstrated that the foetal spine and occiput were oten not concordant, but the posterior positioned spine was detected in nearly 14.5% of deliveries frequently associated with OPP [1]. Recent literature conirms that OPP represents an obstetric challenge because it is associated with an increased maternal foetal and neonatal morbidity, and its management is still debated [6]. In obstetrical practice, pregnant women with OPP foe- tuses present prolonged second stages of labour, higher rates of episiotomy, and severe perineal lacerations, mainly owing to the higher rates of instrumental delivery and increased risks of Caesarean section (CS) by nearly 4-fold [7]. Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 783598, 8 pages http://dx.doi.org/10.1155/2014/783598