Persistent Occipito-Posterior: Outcomes following digital rotation. The “POPOUT” Pilot Study
In singleton pregnancies of at least 37 weeks gestational age with an occipito-posterior position early in the second stage of labour, does manual rotation reduce the incidence of operative operative delivery rate (forceps/ vontouse/ caesarean section).
Royal Prince Alfred Women and Babies
30 participants
Dec 3, 2010
Interventional
Conditions
Summary
In most labours, the baby is delivered head first, face downwards. When the baby is facing upwards, the labour may be more difficult, and assisted deliveries including suction cup, forceps, and caesarean section are more likely. When the mother is fully dilated, it is possible to perform an internal examination and to physically rotate the baby to the downwards (anterior) position, but it is unknown if this procedure reduces the chances of an assisted delivery. We plan to run a study looking at whether performing a procedure to turn the baby will reduce the risk of assisted delivery
Eligibility
Inclusion Criteria4
- At least 37 completed weeks of gestation
- · Planned vaginal delivery Cephalic presentation
- · Full cervical dilatation
- ·Fetal position confidently assessed as occipito-posterior on vaginal examination, and confirmed by ultrasound in labour ward
Exclusion Criteria12
- ·Clinical suspicion of cephalopelvic disproportion
- · Previous caesarean section·Brow or face presentation
- · “Pathologic” CTG according to Royal College of Obstetrics and Gynecology (RCOG) classification plus either baseline >160 beats per minute or reduced variability
- ·Fetal scalp pH < 7.25 (if taken)
- ·Suspected fetal compromise
- ·Known anatomical fetal abnormality
- ·Known or suspected chorioamnionitis
- ·Any condition requiring immediate delivery
- ·Any condition requiring elective caesarean section
- ·Intrapartum haemorrhage
- ·Temperature > 38oC in the first stage of labour
- ·Suspected fetal bleeding diaphesis
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Interventions
With an empty bladder, a vaginal examination is performed. If intact, the obstetric membranes are ruptured. The patient is asked to bear down. For the left occipito-posterior (OP) position, the right index finger is applied to the right lambdoid suture, exerting constant pressure with the aim of rotating the fetus in an anti-clockwise direction. For the right OP position, the left index finger is used and the fetus rotated in a clockwise direction (28). On the basis of our clinical experience we would aim to rotate the fetus into the occipito-anterior (OA) position over 2 to 3 contractions, then hold the presenting part in this position over another 2 contractions while the woman bears down, to reduce the chances of reversion back to the OP position. The overall expected duration of study is 3 years.
Locations(1)
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ACTRN12609000833268