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Related Concept Videos

Anatomical Positions01:11

Anatomical Positions

In anatomy, several standard anatomical positions are used as references for describing the position and orientation of different body parts. These positions help provide a common frame of reference when discussing anatomical structures. The anatomical position is the standard reference point for describing the body's position and orientation. In this position:
The body is upright, facing forward, and standing erect.
The feet are parallel and flat on the floor.
The arms are hanging by the...

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Manual rotation to decrease operative delivery in posterior or transverse positions.

Camille Le Ray1, Catherine Deneux-Tharaux, Imane Khireddine

  • 1Maternité Port-Royal, University Paris-Descartes, DHU Risk in Pregnancy, Sorbonne Paris Cité, Paris, France. camille.le-ray@cch.aphp.fr

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Manual rotation of fetuses in posterior or transverse positions significantly reduces operative delivery rates. This obstetric maneuver improves delivery outcomes for challenging fetal presentations.

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Area of Science:

  • Obstetrics and Gynecology
  • Fetal Medicine
  • Clinical Obstetrics

Background:

  • Fetal malpositions, such as posterior or transverse presentations, at full dilatation can complicate labor and delivery.
  • Management strategies for these malpositions aim to optimize maternal and neonatal outcomes, often involving interventions to facilitate vaginal birth.

Purpose of the Study:

  • To evaluate the impact of a policy of routine manual rotation on the mode of delivery for fetuses presenting in posterior or transverse positions at full dilatation.
  • To determine if manual rotation is independently associated with a reduced rate of operative delivery.

Main Methods:

  • A prospective comparative study was conducted in two hospitals with differing management policies: one with manual rotation and one without.
  • Univariable and multivariable logistic regression analyses were employed to assess the association between the management policy and operative delivery rates.
  • Key outcomes included operative delivery (cesarean or instrumental vaginal delivery) and neonatal indicators like the 5-minute Apgar score and arterial pH at birth.

Main Results:

  • The rate of posterior or transverse positions at full dilatation was comparable between the two hospitals.
  • Manual rotation was successful in 90.1% of attempts in the intervention group.
  • The rate of operative delivery was significantly lower in the hospital employing manual rotation (23.2% vs. 38.7%), a finding sustained after multivariable adjustment (adjusted OR 0.45).

Conclusions:

  • Implementing a strategy of manual rotation for fetuses in posterior or transverse positions at full dilatation is associated with a reduced incidence of operative delivery.
  • Neonatal outcomes, including 5-minute Apgar scores and arterial pH, were similar between the groups, suggesting safety.