Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position

Brian Shaffer, Yvonne W. Cheng, Juan E. Vargas, Aaron Caughey

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Objective. To examine mode of delivery and perinatal outcomes in women with occiput posterior (OP) or transverse (OT) position in the second stage of labour with a trial of manual rotation compared to expectant management. Methods. A retrospective cohort study was designed to examine mode of delivery and perinatal morbidity in women who underwent a trial of manual rotation (n = 731) compared to expectant management (n = 2527) during the second stage of labour with the fetus in OP/OT position. Chi-square test was used to compare categorical outcomes and multivariable logistic regression models were used to control for potential confounders. Results. Compared to expectant management, women with manual rotation were less likely to have: caesarean delivery (CD) [adjusted odds ratio (aOR) 0.12; 95% confidence interval (CI) 0.090.16], severe perineal laceration [aOR 0.64; (0.47-0.88)], postpartum haemorrhage [aOR 0.75; (0.62-0.98)], and chorioamnionitis [aOR 0.68; (0.50-0.92)]. The number of rotations attempted to avert one CD was 4. In contrast, women who had a trial of rotation had an increased risk of cervical laceration [aOR 2.46; (1.1-5.4)]. Conclusions. Compared with expectant management, a trial of manual rotation with persistent fetal OP/OT position is associated with a reduction in CD and adverse maternal outcomes.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume24
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

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Odds Ratio
Second Labor Stage
Lacerations
Logistic Models
Chorioamnionitis
Postpartum Hemorrhage
Chi-Square Distribution
Fetus
Cohort Studies
Retrospective Studies
Mothers
Confidence Intervals
Morbidity

Keywords

  • caesarean
  • Fetal malposition
  • manual rotation
  • occiput posterior
  • perinatal outcomes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position. / Shaffer, Brian; Cheng, Yvonne W.; Vargas, Juan E.; Caughey, Aaron.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 24, No. 1, 01.2011, p. 65-72.

Research output: Contribution to journalArticle

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