Manual Rotation to Decrease Operative Delivery in Posterior or Transverse Positions

Le Ray, Camille MD, PhD; Deneux-Tharaux, Catherine MD, PhD; Khireddine, Imane MD, MSc; Dreyfus, Michel MD, PhD; Vardon, Delphine MD; Goffinet, François MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182a10e43
Original Research
Abstract

OBJECTIVE: To assess the effect of a policy of manual rotation on the mode of delivery of fetuses in posterior or transverse positions at full dilatation.

METHODS: This was a prospective study to compare two policies of management for posterior and transverse positions in two different hospitals (Hospital 1: no manual rotation and Hospital 2: manual rotation). We used univariable and multivariable analyses to study the association between the management policy for posterior and transverse positions at full dilatation in these hospitals and maternal and neonatal outcomes. The principal end point was operative delivery (ie, cesarean or instrumental vaginal delivery). All factors associated with the risk of operative delivery in the univariable analysis (P<.1) were included in the logistic regression models. We then specifically studied whether manual rotation was independently associated with a reduction in operative deliveries.

RESULTS: The rate of posterior or transverse positions at full dilatation was 15.9% (n=111) in Hospital 1 and 15.3% (n=220) in Hospital 2 (P=.75). Of the 172 attempts of manual rotation in Hospital 2, 155 (90.1%) were successful. The rate of operative delivery was significantly lower in Hospital 2, which performed manual rotations (23.2% compared with 38.7% in Hospital 1, adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.28–0.95). After multivariable analysis, manual rotation remained significantly associated with a reduction in the risk of operative delivery (adjusted OR 0.45, 95% CI 0.25–0.85). Five-minute Apgar score and arterial pH at birth were similar in the two hospitals.

CONCLUSION: For fetuses in posterior or transverse positions at full dilatation, a strategy of manual rotation is associated with a reduction in the rate of operative delivery.

LEVEL OF EVIDENCE: III

In Brief

For fetuses in posterior or transverse positions at full dilatation, a strategy of manual rotation is associated with a reduction in operative delivery.

Author Information

Maternité Port-Royal, University Paris-Descartes, DHU Risk in Pregnancy, Sorbonne Paris Cité, Department of Obstetrics and Gynaecology, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and INSERM U953 (exU149), Epidemiological Research Unit on Perinatal Health and Women's and Children Health, Pierre et Marie Curie University, Paris, and CHU de Caen, Service de Gynécologie-Obstétrique et Médecine de le Reproduction, Caen, and Université Caen, UFR Médecine, Caen, France.

Corresponding author: Camille Le Ray, MD, PhD, Maternité Port Royal, 53, avenue de l’Observatoire 75014 Paris, France; e-mail: camille.le-ray@cch.aphp.fr.

Funded by the French Ministry of Health under its clinical research hospital program (contract number P081206). INSERM Unit 953 has received a grant from the Bettencourt Foundation (Coup d’élan pour le recherche française) in support of its research activities.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.