Objective
The primary objective of this systematic review was to assess the association between
spontaneous vaginal delivery and manual rotation during labor for occiput posterior
or transverse positions. Our secondary objective was to assess maternal and neonatal
outcomes.
Data Sources
An electronic search of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Register of Controlled Trials covered the period from January 2000
to September 2021, without language restrictions.
Study Eligibility Criteria
The eligibility criteria included all randomized trials with singleton pregnancies
at ≥37 weeks of gestation comparing the manual rotation groups with the control groups.
The primary outcome was the rate of spontaneous vaginal delivery. Additional secondary
outcomes were rate of occiput posterior position at delivery, operative vaginal delivery,
cesarean delivery, postpartum hemorrhage, obstetrical anal sphincter injury, prolonged
second stage of labor, shoulder dystocia, neonatal acidosis, and phototherapy. Subgroup
analyses were performed according to types of position (occiput posterior or occiput
transverse), techniques used (whole-hand or digital rotation), and parity (nulliparous
or parous).
Methods
The quality of each study was evaluated with the revised Cochrane risk-of-bias tool
for randomized trials, known as RoB 2. The meta-analysis used random-effects models
depending on their heterogeneity, and risks ratios were calculated for dichotomous
outcomes.
Results
Here, 7 of 384 studies met the inclusion criteria and were selected. They included
1402 women: 704 in the manual rotation groups and 698 in the control groups. Manual
rotation was associated with a higher rate of spontaneous vaginal delivery: 64.9%
vs 59.5% (risk ratio, 1.09; 95% confidence interval, 1.03–1.16; P=.005; 95% prediction interval, 0.90–1.32). This association was no longer significant
after stratification by parity or technique used. Manual rotation was associated with
spontaneous vaginal delivery only for the occiput posterior position (risk ratio,
1.08; 95% confidence interval, 1.01–1.15). Furthermore, it was associated with a reduction
in occiput posterior or transverse positions at delivery (risk ratio, 0.64; 95% confidence
interval, 0.48–0.87) and episiotomies (risk ratio, 0.84; 95% confidence interval,
0.71–0.98). The groups did not differ significantly for cesarean deliveries, operative
vaginal deliveries, or neonatal outcomes.
Conclusion
Manual rotation increased the rate of spontaneous vaginal delivery.
Key words
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Article Info
Publication History
Published online: November 17, 2021
Accepted:
November 4,
2021
Received in revised form:
November 1,
2021
Received:
August 10,
2021
Footnotes
The authors report no conflict of interest.
This work received no funding.
This review was registered on July 6, 2021, with the International Prospective Register of Systematic Reviews (registration number CRD42021266223).
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Manual rotationsAmerican Journal of Obstetrics & GynecologyVol. 227Issue 1
- PreviewWe read with great interest the meta-analysis by Bertholdt et al,1 about the association between spontaneous vaginal delivery and manual rotation during labor for occiput posterior or transverse positions. This article concluded that “manual rotation increased the rate of spontaneous vaginal delivery” citing a 64.9% vs 59.5% success rate (risk ratio, 1.09; 95% confidence interval, 1.03–1.16).
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