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Manual rotation of occiput posterior or transverse positions: a systematic review and meta-analysis of randomized controlled trials

  • Charline Bertholdt
    Correspondence
    Corresponding author: Charline Bertholdt, MD.
    Affiliations
    Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Pôle de la Femme, Nancy, France

    International Adaptive Diagnosis Imaging, Institut National de la Santé et de la Recherche Médicale U1254, Rue du Morvan, Vandœuvre-lès-Nancy, France
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  • Olivier Morel
    Affiliations
    Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Pôle de la Femme, Nancy, France

    International Adaptive Diagnosis Imaging, Institut National de la Santé et de la Recherche Médicale U1254, Rue du Morvan, Vandœuvre-lès-Nancy, France
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  • Stéphane Zuily
    Affiliations
    Unité Mixte de Recherche_S 1116, Institut National de la Santé et de la Recherche Médicale, Université de Lorraine, Nancy, France

    Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
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  • Gaëlle Ambroise-Grandjean
    Affiliations
    Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Pôle de la Femme, Nancy, France

    International Adaptive Diagnosis Imaging, Institut National de la Santé et de la Recherche Médicale U1254, Rue du Morvan, Vandœuvre-lès-Nancy, France

    Midwifery Department, Université de Lorraine, Nancy, France
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Published:November 17, 2021DOI:https://doi.org/10.1016/j.ajog.2021.11.033

      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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