§ Digital rotation from occipito-posterior to occipito-anterior decreases the need for cesarean section

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The authors identify that 10-20% of fetal heads present in an occipito-posterior (OP) position at the onset of labour and that 2-5% will remain in a persistent occipitoposterior (POP) position. They cite the likelihood of spontaneous vaginal birth in POP positions as less than 40%, especially in primigravida, resulting in increased maternal morbidity due to increased rates of assisted and operative births, severe perineal trauma, postpartum haemorrhage and infection.The paper also identifies the limited availability of clinical trials and research evidence to evaluate and support digital or manual rotation of the fetal head to the occipitoanterior (OA) position.Objectives:The purpose of this study was to evaluate the effectiveness of digital rotation to reduce both the incidence of POP and the associated negative effects on maternal well-being.Study design:This was a prospective study in which, during the first half of the study period, the women recruited were allowed to continue to labour as usual (non-intervention group), while those recruited into the second half of the study underwent digital rotation (intervention group).Participants/sample:In the second stage of labour, 61 women with a singleton pregnancy with the fetal head in an OP position were enrolled prospectively into the study.Results:The study found that digital/manual rotation resulted in a significant increase in OA positions (93% in the intervention group as compared to 15% in the nonintervention group), spontaneous vaginal births (77% in the intervention group as compared to 27% in the nonintervention group) and a corresponding decrease in assisted and operative deliveries following digital rotation.Key conclusions:The authors conclude that digital rotation should be considered when managing a labour with a fetus in the OP position and highlight, when the manoeuvre is successful, that it rotates the fetus into an OA position and reduces the need for assisted and operative delivery with its associated morbidities.

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