Persistent occiput posterior position outcomes following manual rotation: a randomized controlled trial

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Persistent occiput posterior (OP) position during labor is linked to adverse maternal and perinatal outcomes.
• Prophylactic manual rotation to occiput anterior (OA) is a procedure suggested to prevent operative deliveries.

Purpose of the Study:

• To evaluate the efficacy of prophylactic manual rotation in preventing operative delivery for term pregnancies with OP position in early labor.
• To test the hypothesis that manual rotation reduces operative delivery rates compared to sham rotation.

Main Methods:

• A double-blinded, randomized controlled trial involving 254 women with term pregnancies and OP position.
• Participants were randomized to prophylactic manual rotation (n=127) or sham rotation (n=127).
• Primary outcome was operative delivery; secondary outcomes included cesarean and instrumental delivery rates, and maternal/perinatal morbidity.

Main Results:

• Operative delivery occurred in 62% (manual rotation) vs. 71% (sham rotation), a nonsignificant difference (P=.09).
• Cesarean delivery rates were similar (17% in both groups).
• Instrumental delivery rates were 45% (manual rotation) vs. 54% (sham rotation), also nonsignificant (P=.14).

Conclusions:

• Prophylactic manual rotation did not significantly reduce operative delivery rates in this trial.
• The study may have been underpowered, suggesting a need for further randomized trials.
• Investigating the impact of operator experience on manual rotation outcomes requires additional research.