Transverse position. Using rotation to aid normal birth-OUTcomes following manual rotation (the TURN-OUT trial): a randomized controlled trial.

Cesarean Section Extraction, Obstetrical Female Humans Labor Presentation Obstetric Labor Complications Pregnancy Ultrasonography, Prenatal
abdominal ultrasound cesarean delivery digital rotation fetal malposition instrumental delivery manual rotation occiput transverse position operative delivery 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:
01 2022
Historique:
received: 13 08 2021
revised: 10 09 2021
accepted: 10 09 2021
pubmed: 21 9 2021
medline: 1 2 2022
entrez: 20 9 2021
Statut: ppublish

Résumé

The fetal occiput transverse position in the second stage of labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation in the second stage of labor is considered a safe and easy to perform procedure that has been used to prevent operative deliveries. This study aimed to determine the efficacy of prophylactic manual rotation in the management of the occiput transverse position for preventing operative delivery. We hypothesized that among women who are at ≥37 weeks' gestation with a baby in the occiput transverse position early in the second stage of labor, manual rotation compared with a "sham" rotation will reduce the rate of operative delivery. A double-blinded, parallel, superiority, multicenter, randomized controlled clinical trial in 3 tertiary hospitals was conducted in Australia. The primary outcome was operative (cesarean, forceps, or vacuum) delivery. Secondary outcomes were cesarean delivery, serious maternal morbidity and mortality, and serious perinatal morbidity and mortality. Outcomes were analyzed by intention to treat. Proportions were compared using χ Here, 160 women with a term pregnancy and a baby in the occiput transverse position in the second stage of labor, confirmed by ultrasound, were randomly assigned to receive either a prophylactic manual rotation (n=80) or a sham procedure (n=80), which was less than our original intended sample size. Operative delivery occurred in 41 of 80 women (51%) assigned to prophylactic manual rotation and 40 of 80 women (50%) assigned to a sham rotation (common risk difference, -4.2% [favors sham rotation]; 95% confidence interval, -21 to 13; P=.63). Among more experienced proceduralists, operative delivery occurred in 24 of 47 women (51%) assigned to manual rotation and 29 of 46 women (63%) assigned to a sham rotation (common risk difference, 11%; 95% confidence interval, -11 to 33; P=.33). Cesarean delivery occurred in 6 of 80 women (7.5%) in the manual rotation group and 7 of 80 women (8.7%) in the sham group. Instrumental (forceps or vacuum) delivery occurred in 35 of 80 women (44%) in the manual rotation group and 33 of 80 women (41%) in the sham group. There was no significant difference in the combined maternal and perinatal outcomes. The trial was terminated early because of limited resources. Planned prophylactic manual rotation did not result in fewer operative deliveries. More research is needed in the use of manual rotation from the occiput transverse position for preventing operative deliveries.

Sections du résumé

BACKGROUND
The fetal occiput transverse position in the second stage of labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation in the second stage of labor is considered a safe and easy to perform procedure that has been used to prevent operative deliveries.
OBJECTIVE
This study aimed to determine the efficacy of prophylactic manual rotation in the management of the occiput transverse position for preventing operative delivery. We hypothesized that among women who are at ≥37 weeks' gestation with a baby in the occiput transverse position early in the second stage of labor, manual rotation compared with a "sham" rotation will reduce the rate of operative delivery.
STUDY DESIGN
A double-blinded, parallel, superiority, multicenter, randomized controlled clinical trial in 3 tertiary hospitals was conducted in Australia. The primary outcome was operative (cesarean, forceps, or vacuum) delivery. Secondary outcomes were cesarean delivery, serious maternal morbidity and mortality, and serious perinatal morbidity and mortality. Outcomes were analyzed by intention to treat. Proportions were compared using χ
RESULTS
Here, 160 women with a term pregnancy and a baby in the occiput transverse position in the second stage of labor, confirmed by ultrasound, were randomly assigned to receive either a prophylactic manual rotation (n=80) or a sham procedure (n=80), which was less than our original intended sample size. Operative delivery occurred in 41 of 80 women (51%) assigned to prophylactic manual rotation and 40 of 80 women (50%) assigned to a sham rotation (common risk difference, -4.2% [favors sham rotation]; 95% confidence interval, -21 to 13; P=.63). Among more experienced proceduralists, operative delivery occurred in 24 of 47 women (51%) assigned to manual rotation and 29 of 46 women (63%) assigned to a sham rotation (common risk difference, 11%; 95% confidence interval, -11 to 33; P=.33). Cesarean delivery occurred in 6 of 80 women (7.5%) in the manual rotation group and 7 of 80 women (8.7%) in the sham group. Instrumental (forceps or vacuum) delivery occurred in 35 of 80 women (44%) in the manual rotation group and 33 of 80 women (41%) in the sham group. There was no significant difference in the combined maternal and perinatal outcomes. The trial was terminated early because of limited resources.
CONCLUSION
Planned prophylactic manual rotation did not result in fewer operative deliveries. More research is needed in the use of manual rotation from the occiput transverse position for preventing operative deliveries.

Identifiants

DOI: 10.1016/j.ajogmf.2021.100488 PMID: 34543751
pubmed: 34543751
pii: S2589-9333(21)00183-X
doi: 10.1016/j.ajogmf.2021.100488
pii:
doi:

Banques de données

ANZCTR
['ACTRN12613000005752']

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

100488

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Auteurs

Bradley de Vries (B)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Hala Phipps (H)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan). Electronic address: bradley.devries@health.nsw.gov.au.

Sabrina Kuah (S)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

John Pardey (J)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Geoff Matthews (G)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Joanne Ludlow (J)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Rajit Narayan (R)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Stanley Santiagu (S)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Rachel Earl (R)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Chris Wilkinson (C)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Wendy Carseldine (W)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Jane Tooher (J)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Kevin McGeechan (K)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

Jon A Hyett (JA)

From the Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia (Drs de Vries, Phipps, Tooher, and Hyett); Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (Dr de Vries); Discipline of Obstetrics, Gynecology and Neonatology, The University of Sydney, New South Wales, Australia (Drs Phipps and Ludlow); Women's and Children's Hospital, Adelaide, South Australia, Australia (Drs Kuah, Matthews, Earl, and Wilkinson); Nepean Hospital, Penrith, New South Wales, Australia (Dr Pardey); RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (Drs Ludlow, Narayan, Santiagu, Tooher, and Hyett); Ultrasound Care, Sydney, New South Wales, Australia (Dr Ludlow); Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia (Dr Carseldine); Faculty of Medicine and Health, The University of Sydney School of Public Health, The University of Sydney, New South Wales, Australia (Dr McGeechan).

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie obstétrique › Accouchement (procédure) › Césarienne › Transverse position. Using rotation to aid...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie obstétrique › Accouchement (procédure) › Extraction obstétricale › Transverse position. Using rotation to aid...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Transverse position. Using rotation to aid...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Travail obstétrical › Présentation foetale › Transverse position. Using rotation to aid...
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Transverse position. Using rotation to aid...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Transverse position. Using rotation to aid...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic gynécologique et obstétrique › Diagnostic prénatal › Échographie prénatale › Transverse position. Using rotation to aid...