Persistent occiput posterior: OUTcomes following digital rotation: a pilot randomised controlled trial

Area of Science:

• Obstetrics and Gynecology
• Clinical Trial Methodology
• Maternal-Fetal Medicine

Background:

• Operative delivery rates, including caesarean section (CS) and instrumental delivery, remain a significant concern in modern obstetrics.
• The occiput posterior (OP) fetal head position in the second stage of labor is associated with increased risk of operative delivery.
• Investigating interventions to reduce operative delivery rates is crucial for improving maternal and neonatal outcomes.

Purpose of the Study:

• To assess the feasibility of a multicentre randomised controlled trial (RCT) evaluating digital rotation for fetal OP position.
• To determine if digital rotation of the fetal head from OP position reduces operative delivery rates.

Main Methods:

• A pilot study was conducted in a tertiary hospital involving women with singleton, cephalic pregnancies in the second stage of labor.
• Transabdominal ultrasound identified fetuses in the OP position, who were then randomized to digital rotation or a sham procedure.
• Data on demographics, labor, delivery mode, and neonatal outcomes were collected.

Main Results:

• The study successfully randomized 30 women, with digital rotation and sham procedures proving acceptable to participants and staff.
• Operative delivery rates were similar between groups: 13/15 (87%) in the digital rotation group and 12/15 (80%) in the sham group.

Conclusions:

• A large, double-blinded, multicentre RCT is feasible and acceptable to women and healthcare providers.
• Strategies to enhance recruitment, such as consenting women with effective epidurals, are recommended for future trials.
• This research addresses a clinically significant question with the potential to impact operative delivery rates globally.