Digital/Manual Rotation Reduces Need for C-Section


RENO, NEV. — Digital or manual rotation of fetuses in the persistent occipitoposterior position reduces the need for instrumental deliveries and cesarean section, reported O. Reichman, M.D., and colleagues at Shaare Zedek Medical Center, Jerusalem.

In a prospective, nonrandomized study, the investigators studied 61 women with a fetus in the occipitoposterior position who had completed half of the normal second stage of labor. The first group of 30 women was allowed to continue labor without intervention. The second group of 31 women underwent digital or manual rotation, the authors wrote in a poster presented at the annual meeting of the Society for Maternal-Fetal Medicine.

There were no significant differences in demographic characteristics between the two groups.

The digital maneuver entails first placing the tips of the index and middle fingers onto the edge of the part of the anterior parietal bone that overlaps the occipital bone in the area of the posterior fontanelle. Next, the clinician exerts pressure with the tips of the fingers to rotate the posterior fontanelle upward and toward the symphysis pubis.

With manual rotation, the clinician inserts the entire hand into the birth canal. He or she first positions the fingers under the lateral posterior parietal bone and the thumb on the anterior parietal bone, and then rotates the fetus's head.

Only 8 of the women in the no-rotation group (27%), compared with 24 in the rotation group (77%), experienced a spontaneous delivery, a significant difference.

A significantly greater percentage of the women in the no-rotation group underwent vacuum extraction (50% vs. 23%) and cesarean section (23% vs. 0%).

In addition, digital/manual rotation was associated with a significantly shorter second stage of labor. As a group, women who underwent digital/manual rotation had a significantly shorter mean hospital stay (3.5 days) than did women in the no-rotation group (4.4 days).

Previous epidemiologic studies have estimated the prevalence of the occipitoposterior position to be about 5%. Among such pregnancies, there is a high incidence of cesarean section, instrumental delivery, third- and fourth-degree perineal tear, postpartum hemorrhage, and puerperal infection.

Although the poster did not mention any adverse events that may have been associated with digital/manual rotation, the authors suggested that the maneuver be considered in cases of occipitoposterior malposition.

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