90: A randomized controlled trial of prophylactic early manual rotation of the occiput posterior fetal head at the beginning of the second stage of labor vs. expectant management in nulliparas

Assisted Vaginal Birth

“…26 A second RCT including 65 women showed a reduction in the duration of the second stage of labour (65 minutes versus 82 minutes; P = 0.04). 27 Neither study reported any adverse effects related to manual rotation. Larger RCTs are needed to establish if prophylactic manual rotation early in the second stage of labour can lead to a reduction in operative births.…”

“…A pilot RCT of 30 women where fetal malposition was corrected by manual rotation early in the second stage of labour reported a similar rate of assisted vaginal birth . A second RCT including 65 women showed a reduction in the duration of the second stage of labour (65 minutes versus 82 minutes; P = 0.04) . Neither study reported any adverse effects related to manual rotation.…”

Digital and Manual Rotation of the Persistent Occiput Posterior Fetus

“…In a prospective analysis in Israel (2005), 61 women with term fetus in confirmed OP position were assigned to either digital rotation (n = 31) or no intervention (n = 30), with a significant decrease in duration of second stage of labor found in the digital rotation group ( P < .003) 15 . A separate RCT (N = 65) compared early manual rotation (n = 33) with routine care (n = 32) and found a significant decrease in the second stage of labor in the group undergoing early manual rotation ( P = .04) 29 . Current evidence to guide clinicians on the use of prophylactic rotation versus rotation after a diagnosis of dystocia has been made is limited 30 .…”

“…Current evidence to guide clinicians on the use of prophylactic rotation versus rotation after a diagnosis of dystocia has been made is limited 30 . Although some experts promote prophylactic rotation prior to the time of diagnosis of dystocia, 29 others promote a more cautious approach that allows time for potential spontaneous rotation 1 . Another consideration in the timing of rotation includes whether to perform rotation with 11,31,32 or between contractions 1 .…”

To rotate or not to rotate: that is the question

“…3 In an RCT of 65 nulliparas where manual rotation was attempted at the beginning of the second stage of labor, also published in this issue of the AJOG MFM, the manual rotation group had a similar rate of OD, OVD, and CD, and a shorter second stage of labor (about 13 minutes) compared with controls. 4 In another RCT in which all women got manual rotation, when assisted using ultrasound to detect the location of the fetal spine, the success rate of manual rotation was improved, and SVD rate was improved without adverse neonatal effects. 6 At the 2021 meeting of the Society for Maternal-Fetal Medicine, Blanc et al 5 presented and published in abstract form the long-awaited French RCT.…”