BACKGROUND AND PURPOSE:

• Blanc et al. (AJOG, 2021) determined whether the trial of prophylactic manual rotation at the early second stage of labor is associated with a decrease in operative deliveries

METHODS:

• Multicenter, open-label, randomized controlled trial
• Participants
  • Singleton term pregnancy
  • Occiput posterior or occiput transverse position (ultrasound confirmation)
  • Early second stage of labor (at the diagnosis of full dilation)
  • Ruptured membranes
  • Epidural analgesia
• Interventions
  • Intervention group: Trial of prophylactic manual rotation
  • Standard care
• Study design
  • Analysis was by intention to treat
• Primary outcome
  • Operative delivery: Instrumental and/or cesarean
• Secondary outcomes
  • Length of the second stage of labor
  • Maternal complications: PPH | Operative complications
  • Neonatal complications: Apgar score of <5 at 10 minutes | Arterial umbilical pH of <7.10 | Neonatal injuries | NICU

RESULTS:

• Intervention group: 126 women | standard group: 131 women
  • Mean age: 30.4 years
  • Mean gestational age: 40.1 weeks
• Operative delivery was significantly less frequent in the intervention group
  • Intervention: 29.4%
  • Standard: 41.2%
  • Differential between the 2 groups:  −11.8 (95% CI, −15.7 to −7.9); P=0.047
  • Unadjusted odds ratio:  0.593 (95% CI, 0.353 to 0.995)
• Women in the intervention group were more likely to have a significantly shorter second stage of labor 
  • Intervention: 146.7±64.4 min
  • Standard: 164.4±58.2 min   
  • 18 minute differential
  • P=0.028
• No significant differences were found between other secondary outcomes

CONCLUSION:

• Early second stage trial of prophylactic manual rotation for women with pregnancies in the occiput posterior and occiput transverse positions was associated with significantly reduced risk for operative delivery
• The authors state

These findings supported that the prophylactic manual rotation should be considered as an effective and safe procedure to deal with OP or OT positions of the fetal head

Learn More – Primary Sources:

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

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