Early Diagnosis and Intervention for Fetal Malposition in Active Labor and Its Impact on Mode of Delivery

This study is testing an intervention to correct fetal malposition during active labor — specifically when the baby's head is in an occiput posterior (OP) or occiput transverse (OT) position, meaning the baby is facing forward (sunny-side up) or sideways instead of the ideal backward-facing position. Malposition is a major cause of prolonged, painful labor, failed vaginal delivery, and emergency cesarean sections. Detecting the position with bedside ultrasound and then using physical maneuvers to rotate the baby may reduce these complications. Eligible participants are women over 18 in term (37+ weeks) singleton pregnancies who are in active labor with cervical dilation of 6 to 9 cm, have epidural anesthesia, and have been diagnosed with OP or OT position by ultrasound. Multiple gestations, known fetal anomalies, fetal demise, and inability to consent are exclusion criteria. Participants are randomized to early detection and rotation intervention versus standard care, with the primary outcome being mode of delivery (vaginal versus cesarean). This trial addresses a high-stakes obstetric question — if rotation maneuvers guided by real-time ultrasound can prevent cesareans and reduce labor complications, the implications for maternal care globally would be substantial.