BACKGROUND: Issues in the management of the occipito posterior (OP) position have been the subject of clinical controversy over decades. Manual rotation has the potential to reduce operative delivery for fetal malposition. AIM: To determine the current obstetric practice with regard to manual rotation in the management of the second stage of labour. METHODS: Survey mailed to all members and fellows of the Australian and New Zealand College of Obstetricians and Gynaecologists. RESULTS: Of 1805 surveyed, 60% responded, of whom 68% were currently practising obstetrics. Ninety-seven per cent of respondents thought that manual rotation at full dilatation was a valid intervention, 85% stated that manual rotation was acceptable prior to instrumental delivery, and 70% thought that manual rotation was acceptable without assisted delivery. Only 41% of practising obstetricians had performed a manual rotation in the last year, and only 9% had performed more than five. Obstetricians would routinely perform manual rotation for OP position if it reduced operative delivery from 68% to a median of 50%. CONCLUSION: Manual rotation is currently performed by only a minority of obstetricians in Australia and New Zealand, yet is considered to be an acceptable procedure by the vast majority. The survey confirmed that obstetricians would be willing to perform prophylactic manual rotation if this was known to reduce the operative delivery rate, suggesting that there is a scope to introduce this procedure into widespread clinical practice.
BACKGROUND: Issues in the management of the occipito posterior (OP) position have been the subject of clinical controversy over decades. Manual rotation has the potential to reduce operative delivery for fetal malposition. AIM: To determine the current obstetric practice with regard to manual rotation in the management of the second stage of labour. METHODS: Survey mailed to all members and fellows of the Australian and New Zealand College of Obstetricians and Gynaecologists. RESULTS: Of 1805 surveyed, 60% responded, of whom 68% were currently practising obstetrics. Ninety-seven per cent of respondents thought that manual rotation at full dilatation was a valid intervention, 85% stated that manual rotation was acceptable prior to instrumental delivery, and 70% thought that manual rotation was acceptable without assisted delivery. Only 41% of practising obstetricians had performed a manual rotation in the last year, and only 9% had performed more than five. Obstetricians would routinely perform manual rotation for OP position if it reduced operative delivery from 68% to a median of 50%. CONCLUSION: Manual rotation is currently performed by only a minority of obstetricians in Australia and New Zealand, yet is considered to be an acceptable procedure by the vast majority. The survey confirmed that obstetricians would be willing to perform prophylactic manual rotation if this was known to reduce the operative delivery rate, suggesting that there is a scope to introduce this procedure into widespread clinical practice.
Authors: Abigail R Aiken; Catherine E Aiken; Medhat S Alberry; Jeremy C Brockelsby; James G Scott Journal: Am J Obstet Gynecol Date: 2014-10-18 Impact factor: 8.661
Authors: Hala Phipps; Jon A Hyett; Sabrina Kuah; John Pardey; Joanne Ludlow; Andrew Bisits; Felicity Park; David Kowalski; Bradley de Vries Journal: Trials Date: 2015-03-15 Impact factor: 2.279
Authors: Bradley de Vries; Hala Phipps; Sabrina Kuah; John Pardey; Joanne Ludlow; Andrew Bisits; Felicity Park; David Kowalski; Jon A Hyett Journal: Trials Date: 2015-08-18 Impact factor: 2.279