Related Experiment Video
Updated: Aug 6, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Manual rotation and maternal positioning for managing fetal occiput posterior position during labor: a network
Mahsa Maghalian1, Somayeh Abdolalipour1, Nafiseh Ghassab-Abdollahi2
1Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
Background:
The occiput posterior (OP) foetal position is a global obstetric challenge associated with increased maternal and neonatal complications. Manual rotation and specific maternal positioning (hands-and-knees, lateral position) are potential interventions for managing persistent OP position during labour; however, their comparative effectiveness remains uncertain. This systematic review and network meta-analysis aimed to evaluate the efficacy of these interventions versus standard care.
Methods:
A systematic search of multiple databases was conducted from inception to January 3, 2025 following PRISMA-NMA guidelines. An updated literature search using the same criteria was performed on July 5, 2026 during the final stage of peer review, which yielded no additional studies for inclusion. Randomised controlled trials comparing manual rotation, hands-and-knees position, or lateral position to standard care or each other were included. The primary outcome was spontaneous vaginal delivery. Secondary outcomes included caesarean delivery, severe perineal lacerations, and low Apgar score. Bayesian and frequentist network meta-analysis was performed using MetaInsight software.
Results:
Fifteen randomised trials involving 2,934 participants were analysed. No intervention demonstrated statistically significant benefits for any primary or secondary outcome. For spontaneous vaginal delivery, the lateral position showed the highest point estimate (OR: 1.97, 95% CrI 0.83 to 4.88), though all credible intervals were wide and crossed the null value. The evidence was characterised by substantial imprecision and methodological limitations, resulting in low to very low certainty for all comparisons.
Conclusion:
Current evidence does not support the routine use of manual rotation or specific maternal positions for managing persistent OP position. The substantial uncertainty and methodological limitations preclude definitive recommendations. Future high-quality trials with larger sample sizes and standardised protocols are essential.
