Manual rotation in labour: a systematic review and meta-analysis of randomized controlled trials

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      Fetal malposition in second stage of labour increases the risk of negative maternal and fetal outcomes. Several randomized controlled trials (RCTS) have been undertaken on the efficacy of manual rotation (MR) as a way to mitigate these risks.


      To evaluate if prophylactic MR of occiput posterior (OP) or occiput transverse (OT) position undertaken during 2nd stage of labour results in an increased rate of spontaneous vaginal birth (SVB).


      Searches of electronic databases were performed and we included all RCTs evaluating MR of infants in the OP or OT position in labor until July 2021. Authors of original studies were contacted for additional data. The primary outcome was the rate of SVB. Meta-analysis was performed using the random effects model of DerSimonian and Laird to produce relative risk or mean difference (MD) with 95% confidence interval.


      A total of 643 records were screened. Six studies were included with 1,002 patients. All included studies compared rotation of OP (5 studies) or OT (2 studies) position in the 2nd stage to either no rotation or a sham rotation procedure. There was no difference in the rate of SVD with MR (RR 1.07, 95% CI 0.95, 1.20) nor in any other maternal or fetal outcomes. In a planned subgroup analysis of OP only, there was a 12.8-minute decrease in the length of the second stage in the MR group (MD -12.80, 95% CI -22.61, -2.99). There were no other significant differences in maternal or fetal outcomes in the OP subgroup and no differences in the OT subgroup.


      MR of the OP position early in the 2nd stage of labor is associated with a significant 12.8 minutes decrease in the length of the 2nd stage of labor, compared to no MR, with no changes in any other maternal or fetal outcomes.
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