How Can Manual Rotation Reduce Vacuum, Forceps and Caesarean Deliveries?—A Review of the Evidence

Cathrine Os,Elisabeth Severinsson

doi:10.4236/ojn.2017.71007

Abstract

The aim of this review was to investigate whether manual rotation can be used to reduce vacuum, forceps and caesarean deliveries in women with occiput posterior or occiput transverse positions from 7 cm dilation in labour. A search strategy was developed and relevant papers published between 1946 and January 2015 were identified from electronic databases. Key search terms used were manual and digital rotation, labour presentation, obstetric labour complications, occiput posterior and version foetal. The search revealed 330 papers. A short list of 33 publications of possible relevance was compiled and assessed using the following criteria: primary studies on the effectiveness of manual rotation performed in women with singleton occiput posterior or occiput transverse presentations published in English or the Scandinavian languages. The quality of the included studies was evaluated by means of the critical appraisal tools for quantitative studies. Seven studies were included in the thematic analysis. The results varied but the main finding was that in order to decrease vacuum, forceps and caesarean deliveries by means of manual rotation, it is essential that the procedure is successful. The success rate of manual rotation is dependent on the experience of the healthcare professionals who perform the rotation procedure rather than the technique employed. Predictors of successful manual rotation were used after engagement of the foetal head, at full dilatation and prophylactic use before failure to progress in labour. In conclusion, although the results vary, there is a consensus in all the studies that manual rotation is worth considering and that it can contribute to decreasing vacuum, forceps and caesarean deliveries. The implications for practice are that successful manual rotation can reduce caesarean delivery and increase spontaneous vaginal delivery, but experience is necessary to perform successful rotations. Because there are no risk factors associated with manual or digital rotation when performed after engagement of the head and at full dilatation, they are worth considering. The central role of the midwife in each individual labour makes her important for ensuring that manual rotation can be considered at the right time in labour.

Highlights

Occiput posterior (OP) and Occiput transverse (OT) positions have been associated with difficult labours for centuries [1]
A short list of 33 publications of possible relevance was compiled and assessed using the following criteria: primary studies on the effectiveness of manual rotation performed in women with singleton occiput posterior or occiput transverse presentations published in English or the Scandinavian languages
Seven studies were included in the literature review, none of which was a randomized controlled trial (RCT)

Summary

Introduction

Occiput posterior (OP) and Occiput transverse (OT) positions have been associated with difficult labours for centuries [1]. For this reason, Dr William Smellie conducted and reported the first instrumental rotation from an OP to an Occiput Anterior (OA) in 1745 [2]. The instrumental rotation forceps and instrumental delivery in general have been associated with many serious complications such as the 3rd and 4th degree lacerations, postpartum haemorrhage and neonatal morbidity, despite the fact that with appropriate training, the techniques can be performed safely [6] [7]. Manual rotation (MR) is a procedure where the whole hand is used to manually flex and rotate the foetus from an OP or OT to an OA presentation [8]. MR is the general term and will be used throughout the paper

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