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

Abstract 

Objective

Our purpose was to study prospectively the efficacy of digital rotation in reducing the prevalence of persistent occipito-posterior position (POP) and its consequences.

Study design

Sixty-one women with a singleton pregnancy were enrolled prospectively between July 2003 and July 2004. They were in the second stage of labor with the fetal head engaged in the occipito-posterior position. During the first period of the study women were allowed to continue labor without intervention (group I); during the second period, digital rotation was performed (group II).

Results

In group I 15% of the fetuses were delivered in the occipito-anterior position and 27% underwent spontaneous vaginal delivery, as opposed to 93% and 77%, respectively, when the procedure was performed—an increase in spontaneous vaginal delivery among the group undergoing rotation of more than 50% (p<0.0001). Cesarean section was performed in 23% and vacuum in 50% when the procedure was not performed (group I) in contrast to 0% and 23%, respectively, in the group undergoing rotation (0.0001).

Conclusion

Digital rotation should be considered when managing the labor of a fetus in the occipito-posterior position. The maneuver successfully rotates the fetus reducing the need for cesarean section, instrumental delivery, and other complications associated with POP.

Keywords: Occipito-posterior, Digital/manual rotation, Obstetric outcome