Persistent occiput posterior position outcomes following manual rotation: a randomized controlled trial.

Australia Female Humans Labor Presentation Obstetric Labor Complications Pregnancy Rotation Ultrasonography, Prenatal
cesarean delivery fetal position instrumental delivery manual rotation operative delivery posterior position prolonged labor second stage of labor

Journal

American journal of obstetrics & gynecology MFM
ISSN: 2589-9333
Titre abrégé: Am J Obstet Gynecol MFM
Pays: United States
ID NLM: 101746609

Informations de publication

Date de publication:
03 2021
Historique:
received: 09 12 2020
revised: 31 12 2020
accepted: 31 12 2020
pubmed: 9 1 2021
medline: 25 6 2021
entrez: 8 1 2021
Statut: ppublish

Résumé

Persistent occiput posterior position in labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation from the occiput posterior position to the occiput anterior position in the second stage of labor is considered a safe and easy to perform procedure that in observational studies has shown promise as a method for preventing operative deliveries. This study aimed to determine the efficacy of prophylactic manual rotation in the management of occiput posterior position for preventing operative delivery. The hypothesis was that among women who are at least 37 weeks pregnant and whose baby is in the occiput posterior position early in the second stage of labor, manual rotation will reduce the rate of operative delivery compared with the "sham" rotation. A double-blinded, parallel, superiority, multicenter, randomized controlled clinical trial in 4 tertiary hospitals was conducted in Australia. A total of 254 nulliparous and parous women with a term pregnancy and a baby in the occiput posterior position in the second stage of labor were randomly assigned to receive either a prophylactic manual rotation (n=127) or a sham rotation (n=127). The primary outcome was operative delivery (cesarean, forceps, or vacuum delivery). Secondary outcomes were cesarean delivery, combined maternal mortality and serious morbidity, and combined perinatal mortality and serious morbidity. Analysis was by intention to treat. Proportions were compared using chi-square tests adjusted for stratification variables using the Mantel-Haenszel method or the Fisher exact test. Planned subgroup analyses by operator experience and by manual rotation technique (digital or whole-hand rotation) were performed. Operative delivery occurred in 79 of 127 women (62%) assigned to prophylactic manual rotation and 90 of 127 women (71%) assigned to sham rotation (common risk difference, 12; 95% confidence interval, -1.7 to 26; P=.09). Among more experienced operators or investigators, operative delivery occurred in 46 of 74 women (62%) assigned to manual rotation and 52 of 71 women (73%) assigned to a sham rotation (common risk difference, 18; 95% confidence interval, -0.5 to 36; P=.07). Cesarean delivery occurred in 22 of 127 women (17%) in both groups. Instrumental delivery (forceps or vacuum) occurred in 57 of 127 women (45%) assigned to prophylactic manual rotation and 68 of 127 women (54%) assigned to sham rotation (common risk difference, 10; 95% confidence interval, -3.1 to 22; P=.14). There was no significant difference in the combined maternal and perinatal outcomes. Prophylactic manual rotation did not result in a reduction in the rate of operative delivery. Given manual rotation was associated with a nonsignificant reduction in operative delivery, more randomized trials are needed, as our trial might have been underpowered. In addition, further research is required to further explore the potential impact of operator or investigator experience.

Sections du résumé

BACKGROUND
Persistent occiput posterior position in labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation from the occiput posterior position to the occiput anterior position in the second stage of labor is considered a safe and easy to perform procedure that in observational studies has shown promise as a method for preventing operative deliveries.
OBJECTIVE
This study aimed to determine the efficacy of prophylactic manual rotation in the management of occiput posterior position for preventing operative delivery. The hypothesis was that among women who are at least 37 weeks pregnant and whose baby is in the occiput posterior position early in the second stage of labor, manual rotation will reduce the rate of operative delivery compared with the "sham" rotation.
STUDY DESIGN
A double-blinded, parallel, superiority, multicenter, randomized controlled clinical trial in 4 tertiary hospitals was conducted in Australia. A total of 254 nulliparous and parous women with a term pregnancy and a baby in the occiput posterior position in the second stage of labor were randomly assigned to receive either a prophylactic manual rotation (n=127) or a sham rotation (n=127). The primary outcome was operative delivery (cesarean, forceps, or vacuum delivery). Secondary outcomes were cesarean delivery, combined maternal mortality and serious morbidity, and combined perinatal mortality and serious morbidity. Analysis was by intention to treat. Proportions were compared using chi-square tests adjusted for stratification variables using the Mantel-Haenszel method or the Fisher exact test. Planned subgroup analyses by operator experience and by manual rotation technique (digital or whole-hand rotation) were performed.
RESULTS
Operative delivery occurred in 79 of 127 women (62%) assigned to prophylactic manual rotation and 90 of 127 women (71%) assigned to sham rotation (common risk difference, 12; 95% confidence interval, -1.7 to 26; P=.09). Among more experienced operators or investigators, operative delivery occurred in 46 of 74 women (62%) assigned to manual rotation and 52 of 71 women (73%) assigned to a sham rotation (common risk difference, 18; 95% confidence interval, -0.5 to 36; P=.07). Cesarean delivery occurred in 22 of 127 women (17%) in both groups. Instrumental delivery (forceps or vacuum) occurred in 57 of 127 women (45%) assigned to prophylactic manual rotation and 68 of 127 women (54%) assigned to sham rotation (common risk difference, 10; 95% confidence interval, -3.1 to 22; P=.14). There was no significant difference in the combined maternal and perinatal outcomes.
CONCLUSION
Prophylactic manual rotation did not result in a reduction in the rate of operative delivery. Given manual rotation was associated with a nonsignificant reduction in operative delivery, more randomized trials are needed, as our trial might have been underpowered. In addition, further research is required to further explore the potential impact of operator or investigator experience.

Identifiants

DOI: 10.1016/j.ajogmf.2021.100306 PMID: 33418103
pubmed: 33418103
pii: S2589-9333(21)00001-X
doi: 10.1016/j.ajogmf.2021.100306
pii:
doi:

Banques de données

ANZCTR
['ACTRN12609000833268', 'ACTRN12612001312831']

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

100306

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.

Auteurs

Hala Phipps (H)

Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: hala.phipps@health.nsw.gov.au.

Jon A Hyett (JA)

Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Sabrina Kuah (S)

Women's and Children's Hospital, Adelaide, South Australia, Australia.

John Pardey (J)

Nepean Hospital, Penrith, New South Wales, Australia.

Geoff Matthews (G)

Women's and Children's Hospital, Adelaide, South Australia, Australia.

Joanne Ludlow (J)

Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Ultrasound Care, Sydney, New South Wales, Australia.

Rajit Narayan (R)

Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Stanley Santiagu (S)

Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Rachel Earl (R)

Women's and Children's Hospital, Adelaide, South Australia, Australia.

Chris Wilkinson (C)

Women's and Children's Hospital, Adelaide, South Australia, Australia.

Andrew Bisits (A)

Royal Hospital for Women, Sydney, New South Wales, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.

Wendy Carseldine (W)

Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia.

Jane Tooher (J)

Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Kevin McGeechan (K)

Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia.

Bradley de Vries (B)

Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia.

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Classifications MeSH

questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Persistent occiput posterior position outcomes...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Persistent occiput posterior position outcomes...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Travail obstétrical › Présentation foetale › Persistent occiput posterior position outcomes...
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Persistent occiput posterior position outcomes...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Persistent occiput posterior position outcomes...
questionsmedicales.fr › Phénomènes physiques › Déplacement › Rotation › Persistent occiput posterior position outcomes...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic gynécologique et obstétrique › Diagnostic prénatal › Échographie prénatale › Persistent occiput posterior position outcomes...