Predictors of successful manual rotation for occiput posterior positions

Abstract

Objective: To identify predictors of the success of manual rotation of fetuses in an occiput posterior position.

Methods: A prospective, observational, single-center study included all women with a singleton pregnancy at term with a fetus in an occiput posterior position for whom manual rotation was attempted from December 1, 2013, to April 30, 2015 at a tertiary care maternity unit in Nancy, France. Occiput posterior position was confirmed by ultrasonography, and success of manual rotation was defined by the occiput anterior position of the fetus after the attempt.

Results: Occiput posterior position was diagnosed in 233 (9.2%) of the 2522 deliveries during the study period and the majority of cases were managed successfully by manual rotation (167 [71.7%]). Factors associated with successful rotation were fetal engagement (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.05-4.56), spontaneous labor (aOR 1.85, 95% CI 1.01-3.43), and no failure to progress (aOR 2.01, 95% CI 1.02-3.94). Successful manual rotation was associated with lower rates of cesarean (P<0.001) and instrumental (P<0.001) deliveries.

Conclusion: Study findings suggested that manual rotation, especially after fetal engagement, succeeded more often when performed systematically than when it was attempted after failure to progress.

Keywords: Cesarean; Digital rotation; Instrumental delivery; Manual rotation; Operative delivery Persistent occiput posterior; Success factors; Vaginal delivery.