title: Manual rotation of the fetal occiput: predictors of success and delivery.
abstract: OBJECTIVE
  The purpose of the study was to define predictors of successful rotation and rate of cesarean delivery after manual rotation of the fetal occiput from occiput posterior or transverse position.
  
  
  METHODS
  A retrospective cohort study comprised patients who underwent a trial of manual rotation of the fetal occiput from occiput posterior or occiput transverse position. Successful rotation was defined as delivery in the occiput anterior position. We examined maternal, fetal, and labor characteristics as predictors of both fetal position at delivery and cesarean delivery.
  
  
  RESULTS
  Multiparity (odds ratio, 2.5; 95% CI, 1.5-3.8) and maternal age < 35 years (odds ratio, 2.0; 95% CI, 1.1-3.4) were associated with successful manual rotation of the fetal occiput. After successful rotation, the cesarean delivery rate was 2%, compared with 34% if the rotation failed (P < .001). Asian ethnicity, nulliparity, age > 35 years, labor induction, and epidural usage were associated with higher rates of cesarean delivery.
  
  
  CONCLUSIONS
  After successful manual rotation of the fetal occiput, women had lower cesarean delivery rates than women with unsuccessful rotations. Multiparity and maternal age of < 35 years were associated with more successful rotations.
authors.affiliation: Division of Perinatal Medicine & Genetics, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94143-0132, USA. shafferb@obgyn.ucsf.edu
authors.forename: Brian L
authors.initials: BL
authors.lastname: Shaffer
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.forename: Juan E
authors.initials: JE
authors.lastname: Vargas
authors.forename: Russell K
authors.initials: RK
authors.lastname: Laros
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006257:Head / Q000196:embryology*; D006801:Humans; D007746:Labor Presentation; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012399:Rotation; D016896:Treatment Outcome; D014710:Version, Fetal