Persistent occipitoposterior position : prophylactic manual rotation versus expectant management

Abstract EN

Objective : To evaluate the efficacy and safety of prophylactic manual rotation in the management of persistent occipitoposterior position compared to the usual expectant management.

Methods : We conducted a prospective, non-blinded, randomized trial on 60 parturient women with fetal occipitoposterior position in the second stage of labor whose were randomized into two groups.

Group I included 30 women whose were undergone manual rotation maneuver to convert fetal head to occipitoanterior position and group II that included 30 women whose were undergone the usual expectant management.

Outcome measures including mode of delivery (spontaneous vaginal, instrumental or cesarean delivery), prolonged second stage of labor, maternal and neonatal morbidity were compared between the two groups.

Results: Number of women with spontaneous vaginal delivery was significantly higher in group I than in group II [21 (70%) vs.

10 (33.3%), Relative risk (RR) = 2.1, 95% Confidence Interval (CI) = 1.2- 3.6, p< 0.01].Number of women underwent cesarean delivery was significantly less in group I than those in group II [4 (13.3%) vs.

11 (36.7%), RR= 0.36, 95% CI =0.13-1.01, p< 0.05].

Number of women experienced prolonged second stage of labor was significantly less group I compared to group II [7 (23.3%) vs.

16 (53.3%), RR= 0.43, 95% CI= 0.2-0.9, p < 0.05].

There were no statistical significant differences between both groups regarding maternal morbidity including postpartum hemorrhage, episiotomy, lacerations of birth canal as well as neonatal morbidity including birth trauma, 5 minutes apgar score <7 and admition to neonatal intensive care unit Conclusion: Prophylactic manual rotation of fetal head in persistent occipitoposterior position is safe and beneficial maneuver as it is associated with increased incidence of spontaneous vaginal delivery as well as decreased incidence of cesarean delivery and prolonged second stage of labor compared to expectant management and therefore should be advocated in obstetric practice