Bertholdt C, Piffer A, Pol H, Morel O, Guerby P. Management of persistent occiput posterior position: The added value of manual rotation.
Int J Gynaecol Obstet 2021;
157:613-617. [PMID:
34386977 DOI:
10.1002/ijgo.13874]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE
To evaluate the delivery rate in the occiput posterior position according to the result of manual rotation performed in the case of persistent occiput posterior position. Secondary objectives were perinatal outcomes.
METHODS
This was a prospective cohort study conducted in two French tertiary care units. All women with a singleton pregnancy after 37 weeks of gestation with a fetus in persistent occiput posterior position and an attempt of manual rotation were included. The main outcome was the occiput position at delivery. The secondary outcomes were duration of labor, mode of delivery, and perineal tears. Two groups were compared according to the result of manual rotation.
RESULTS
In total, 460 women were included, with a manual rotation success of 62.4%. The success was significantly associated with a decrease in occiput posterior position at vaginal delivery (1.4% vs 57.2%, P < 0.0001), cesarean (0.7% vs 17.9%, P < 0.0001), operative vaginal delivery (40.1% vs 78%, P < 0.0001), episiotomy (40.1% vs 54.9%, P < 0.0001), and obstetric anal sphincter injury (3.1% vs 8.7%, P = 0.008) compared with a failure.
CONCLUSION
An attempt of manual rotation in the case of persistent occiput posterior position is associated with decreased rates of occiput posterior position at delivery, operative delivery, and anal sphincter injuries.
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