Prophylactic manual rotation of occiput posterior and transverse positions to decrease operative delivery: the PROPOP...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Labor and Delivery Management

Background:

• Persistent occiput posterior (OP) and occiput transverse (OT) positions are common fetal head malpositions.
• These malpositions are linked to prolonged labor, increased cesarean and instrumental deliveries, severe perineal tears, postpartum hemorrhage, and chorioamnionitis.
• Manual rotation is a potential intervention for managing these labor complications.

Purpose of the Study:

• To evaluate if prophylactic manual rotation in the early second stage of labor reduces operative delivery rates.
• To assess the impact of manual rotation on labor duration and maternal/neonatal complications.

Main Methods:

• A multicenter, open-label, randomized controlled trial involving 257 women with singleton term pregnancies and OP/OT positions.
• Participants received either prophylactic manual rotation (intervention group) or standard care (control group) in the early second stage of labor.
• Primary outcome was operative delivery; secondary outcomes included labor length and maternal/neonatal complications.

Main Results:

• Operative delivery rates were significantly lower in the intervention group (29.4%) compared to the standard group (41.2%) (P=.047).
• The intervention group experienced a significantly shorter second stage of labor.
• No significant increase in maternal or neonatal complications was noted in the intervention group.

Conclusions:

• Prophylactic manual rotation for OP/OT positions in early labor is associated with a reduced risk of operative delivery.
• This manual maneuver presents a safe and effective strategy for preventing operative interventions during labor.
• Implementing manual rotation could improve labor outcomes and reduce cesarean and instrumental delivery rates.