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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References
- Persistent occiput posterior.Obstet Gynecol. 2015; 125: 695-709
- Influence of persistent occiput posterior position on delivery outcome.Obstet Gynecol. 2001; 98: 1027-1031
- Persistent fetal occiput posterior position: obstetric outcomes.Obstet Gynecol. 2003; 101: 915-920
- Associated factors and outcomes of persistent occiput posterior position: a retrospective cohort study from 1976 to 2001.J Matern Fetal Neonatal Med. 2006; 19: 563-568
- Lateral asymmetric decubitus position for the rotation of occipito-posterior positions: multicenter randomized controlled trial EVADELA.Am J Obstet Gynecol. 2016; 215: 511.e1-511.e7
- Hands-and-knees posturing and fetal occiput anterior position: a systematic review and meta-analysis.Am J Obstet Gynecol MFM. 2021; 3: 100346
- Rotational vaginal delivery with Kielland’s forceps: a systematic review and meta-analysis of effectiveness and safety outcomes.Curr Opin Obstet Gynecol. 2015; 27: 438-444
- Kielland’s rotational forceps delivery: a comparison of maternal and neonatal outcomes with rotational ventouse or second stage caesarean section deliveries.Eur J Obstet Gynecol Reprod Biol. 2020; 254: 175-180
- Management of persistent occiput posterior position: a substantial role of instrumental rotation in the setting of failed manual rotation.J Matern Fetal Neonatal Med. 2018; 31: 80-86
- Intrapartum ultrasound during rotational forceps delivery: a novel tool for safety, quality control, and teaching.Am J Obstet Gynecol. 2021; 224: 93.e1-93.e7
- A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.BJOG. 2013; 120: 1277-1284
- UK Audit Ressearch Trainee Collaborative in Obstetrics, Gynecology (UK-ARCOG). Babies in occiput posterior position are significantly more likely to require an emergency cesarean birth compared with babies in occiput transverse position in the second stage of labor: a prospective observational study.Acta Obstet Gynecol Scand. 2020; 99: 537-545
- Manual rotation of the transverse posterior occiput.Obstet Gynecol. 1971; 37: 464-467
- Manual rotation in occiput posterior or transverse positions: risk factors and consequences on the cesarean delivery rate.Obstet Gynecol. 2007; 110: 873-879
- Digital rotation from occipito-posterior to occipito-anterior decreases the need for cesarean section.Eur J Obstet Gynecol Reprod Biol. 2008; 136: 25-28
- Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position.J Matern Fetal Neonatal Med. 2011; 24: 65-72
- Manual rotation of the fetal occiput: predictors of success and delivery.Am J Obstet Gynecol. 2006; 194: e7-e9
- Higher rates of operative delivery and maternal and neonatal complications in persistent occiput posterior position with a large head circumference: a retrospective cohort study.Fetal Diagn Ther. 2018; 44: 51-58
- Predictors of successful manual rotation for occiput posterior positions.Int J Gynaecol Obstet. 2019; 144: 210-215
- Manual rotation to decrease operative delivery in posterior or transverse positions.Obstet Gynecol. 2013; 122: 634-640
- Prophylactic manual rotation of occiput posterior and transverse positions to decrease operative delivery: the PROPOP randomized clinical trial.Am J Obstet Gynecol. 2021; 225: 444.e1-444.e8
- Persistent occiput posterior position outcomes following manual rotation: a randomized controlled trial.Am J Obstet Gynecol MFM. 2021; 3: 100306
- Clinical effectiveness of position management and manual rotation of the fetal position with a U-shaped birth stool for vaginal delivery of a fetus in a persistent occiput posterior position.J Int Med Res. 2020; 48300060520924275
- A randomized controlled trial of prophylactic early manual rotation of the occiput posterior fetus at the beginning of the second stage vs expectant management.Am J Obstet Gynecol MFM. 2021; 3: 100327
- Delivery mode after manual rotation of occiput posterior fetal positions: a randomized controlled trial.Obstet Gynecol. 2021; 137: 999-1006
- Using rotation to aid normal birth-OUTcomes following manual rotation (The TURN-OUT Trial): a randomized controlled trial.Am J Obstet Gynecol MFM. 2021; 4: 100488
- Manual rotation of persistent occiput posterior position: more research is warranted.Am J Obstet Gynecol MFM. 2021; 3: 100387
- Persistent occiput posterior: OUTcomes following digital rotation: a pilot randomised controlled trial.Aust N Z J Obstet Gynaecol. 2014; 54: 268-274
- Management of persistent occiput posterior position: the added value of manual rotation.Int J Gynaecol Obstet. 2021; ([Epub ahead of print])
- Prophylactic manual rotation for fetal malposition to reduce operative delivery.Cochrane Database Syst Rev. 2014; 12: CD009298
- Sonographic knowledge of occiput position to decrease failed operative vaginal delivery: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2021; ([Epub ahead of print])
- Fetal head position during the second stage of labor: comparison of digital vaginal examination and transabdominal ultrasonographic examination.Eur J Obstet Gynecol Reprod Biol. 2005; 123: 193-197
- ISUOG Practice Guidelines: intrapartum ultrasound.Ultrasound Obstet Gynecol. 2018; 52: 128-139
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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- 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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