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. 2014 Dec 22;2014(12):CD009298.
doi: 10.1002/14651858.CD009298.pub2.

Prophylactic manual rotation for fetal malposition to reduce operative delivery

Hala Phipps  1 , Bradley de Vries, Jon Hyett, David A Osborn
Affiliations

Prophylactic manual rotation for fetal malposition to reduce operative delivery

Hala Phipps et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Manual rotation is commonly performed to increase the chances of normal vaginal delivery and is perceived to be safe. Manual rotation has the potential to prevent operative delivery and caesarean section, and reduce obstetric and neonatal complications.

Objectives: To assess the effect of prophylactic manual rotation for women with malposition in labour on mode of delivery, and maternal and neonatal outcomes.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), the Australian and New Zealand Clinical Trials Registry (ANZCTR), ClinicalTrials.gov, Current Controlled Trials and the WHO International Clinical Trials Registry Platform (ICTRP) (all searched 23 February 2014), previous reviews and, references of retrieved studies.

Selection criteria: Randomised, quasi-randomised or cluster-randomised clinical trials comparing prophylactic manual rotation in labour for fetal malposition versus expectant management, augmentation of labour or operative delivery. We defined prophylactic manual rotation as rotation performed without immediate assisted delivery.

Data collection and analysis: Two review authors independently assessed study eligibility and quality, and extracted data.

Main results: We included only one small pilot study (involving 30 women). The study, which we considered to be at low risk of bias, was conducted in a tertiary referral hospital in Australia, and involved women with cephalic, singleton pregnancies. The primary outcome was operative delivery (instrumental delivery or caesarean section).In the manual rotation group, 13/15 women went on to have an instrumental delivery or caesarean section, whereas in the control group, 12/15 women had an operative delivery. The estimated risk ratio was 1.08 (95% confidence interval 0.79 to 1.49). There were no maternal or fetal mortalities in either groupThere were no clear differences for any of the secondary maternal or neonatal outcomes reported (e.g. perineal trauma, analgesia use duration of labour).In terms of adverse events, there were no reported cases of umbilical cord prolapse or cervical laceration and a single case of a non-reassuring or pathological cardiotocograph during the procedure.

Authors' conclusions: Currently, there is insufficient evidence to determine the efficacy of prophylactic manual rotation early in the second stage of labour for prevention of operative delivery. One additional study is ongoing. Further appropriately designed trials are required to determine the efficacy of manual rotation.

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Conflict of interest statement

David A Osborn: none known.

Dr Bradley de Vries, Hala Phipps and Clinical Professor Jon Hyett were involved in the designing and conducting of the one study (pilot randomised controlled trial) included in this review (Graham 2014). Brad de Vries, Hala Phipps and Jon Hyett have an NHMRC (National Health and Medical Research Council) grant and are currently performing a randomised controlled trial to assess the efficacy of manual rotation for malposition in the second stage of labour for reducing operative delivery. This randomised controlled trial is potentially eligible for inclusion in this review. All decisions relating to the inclusion of this trial, as well as assessment of risk of bias and data extraction, will include a member of the review team (David Osborn) who is not directly involved in the trials.

Figures

1
1
Study flow diagram.
1.1
1.1. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 1 Operative delivery.
1.2
1.2. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 2 Maternal mortality.
1.3
1.3. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 3 Perinatal mortality.
1.4
1.4. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 4 Caesarean section.
1.5
1.5. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 5 Forceps delivery.
1.6
1.6. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 6 Vacuum‐assisted delivery.
1.7
1.7. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 7 Third‐ or fourth‐degree perineal trauma.
1.8
1.8. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 8 Nitrous oxide analgesia in labour.
1.9
1.9. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 9 Opiate analgesia in labour.
1.10
1.10. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 10 Epidural analgesia in labour.
1.11
1.11. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 11 Duration of second stage of labour.
1.12
1.12. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 12 Blood loss (mL).
1.13
1.13. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 13 Primary postpartum haemorrhage ≥ 500 mL.
1.14
1.14. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 14 Maternal blood transfusion.
1.15
1.15. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 15 Maternal postnatal infection.
1.16
1.16. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 16 Length of maternal hospital stay (days).
1.17
1.17. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 17 Non‐reassuring or pathological cardiotocograph during procedure.
1.18
1.18. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 18 Non‐reassuring or pathological cardiotocograph at any time after allocation.
1.19
1.19. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 19 Cord blood gas acidosis.
1.20
1.20. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 20 Admission to neonatal intensive care unit.
1.21
1.21. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 21 Neonatal resuscitation (positive pressure ventilation, cardiac compression or drug therapy).
1.22
1.22. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 22 Mechanical ventilation (intermittent positive‐pressure ventilation/continuous positive airways pressure after resuscitation).
1.23
1.23. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 23 Neonatal jaundice treated with phototherapy.
1.24
1.24. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 24 Neonatal exchange transfusion.
1.25
1.25. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 25 Polycythaemia treated with partial volume exchange transfusion.
1.26
1.26. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 26 Neonatal stroke.
1.27
1.27. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 27 Neonatal intracranial bleed.
1.28
1.28. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 28 Neonatal fracture.
1.29
1.29. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 29 Scalp haematoma (e.g. cephalohaematoma or subgaleal haemorrhage).
1.30
1.30. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 30 Neonatal encephalopathy.
1.31
1.31. Analysis
Comparison 1 Manual rotation versus no manual rotation, Outcome 31 Neonatal neuropraxia.
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