Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position

Abstract

Objective. To examine mode of delivery and perinatal outcomes in women with occiput posterior (OP) or transverse (OT) position in the second stage of labour with a trial of manual rotation compared to expectant management.

Methods. A retrospective cohort study was designed to examine mode of delivery and perinatal morbidity in women who underwent a trial of manual rotation (n = 731) compared to expectant management (n = 2527) during the second stage of labour with the fetus in OP/OT position. Chi-square test was used to compare categorical outcomes and multivariable logistic regression models were used to control for potential confounders.

Results. Compared to expectant management, women with manual rotation were less likely to have: caesarean delivery (CD) [adjusted odds ratio (aOR) 0.12; 95% confidence interval (CI) 0.09–0.16], severe perineal laceration [aOR 0.64; (0.47–0.88)], postpartum haemorrhage [aOR 0.75; (0.62–0.98)], and chorioamnionitis [aOR 0.68; (0.50–0.92)]. The number of rotations attempted to avert one CD was 4. In contrast, women who had a trial of rotation had an increased risk of cervical laceration [aOR 2.46; (1.1–5.4)].

Conclusions. Compared with expectant management, a trial of manual rotation with persistent fetal OP/OT position is associated with a reduction in CD and adverse maternal outcomes.

Keywords:

• Fetal malposition
• manual rotation
• caesarean
• perinatal outcomes
• occiput posterior

Acknowledgements

Each of the four authors (BLS, YWC, JEV and ABC) have participated substantially in the conception, design, acquisition of data, and analysis and interpretation of data. BLS initially drafted the paper followed by critical revisions by YWC, JEV, and ABC. All authors listed gave final approval of the version submitted. This study was approved by the UCSF Committee on Human Research, Project H41147-29452-03 on August 16, 2006. ABC is supported by the Robert Wood Johnson Foundation as a Faculty Physician Scholar.