Fetal malposition: using manual rotation to improve delivery outcomes

Abstract

Backgound: Fetal malposition in labour is a major risk factor for both caesarean section and instrumental delivery. Manual rotation, in the second stage of labour, represents one promising method of reducing operative delivery. Objectives: To review the literature on the efficacy of manual rotation for fetal malposition in the second stage of labour, assess current clinical practice and explore the feasibility of undertaking a randomised controlled trial of prophylactic manual rotation for reducing operative delivery. Methodology Meta-analysis of randomised controlled trials (RCT) using Cochrane. National Survey of Midwives and Obstetricians to determine current management. Pilot blinded RCT re feasibility of undertaking a trial. Design of a multi-centred blinded RCT to reduce operative delivery. Results: Obstetricians and midwives use manual rotation infrequently but are confidence in its efficacy. An RCT is feasible. Occiput transverse position is associated with increased rates of operative delivery. Intrapartum consent improves recruitment. There is a need for a birth mannequin to facilitate clinicians training in performing manual rotation, which has been designed. Two randomised controlled trials are in progress. Conclusions: Multiple research projects have been performed, which have led to the development of two RCT protocols and two multi-centred randomised controlled trials (one is NHMRC funded) are currently in progress.