title: Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position.
abstract: OBJECTIVE
  To examine mode of delivery and perinatal outcomes in women with occiput posterior (OP) or transverse (OT) position in the second stage of labour with a trial of manual rotation compared to expectant management.
  
  
  METHODS
  A retrospective cohort study was designed to examine mode of delivery and perinatal morbidity in women who underwent a trial of manual rotation (n = 731) compared to expectant management (n = 2527) during the second stage of labour with the fetus in OP/OT position. Chi-square test was used to compare categorical outcomes and multivariable logistic regression models were used to control for potential confounders.
  
  
  RESULTS
  Compared to expectant management, women with manual rotation were less likely to have: caesarean delivery (CD) [adjusted odds ratio (aOR) 0.12; 95% confidence interval (CI) 0.09-0.16], severe perineal laceration [aOR 0.64; (0.47-0.88)], postpartum haemorrhage [aOR 0.75; (0.62-0.98)], and chorioamnionitis [aOR 0.68; (0.50-0.92)]. The number of rotations attempted to avert one CD was 4. In contrast, women who had a trial of rotation had an increased risk of cervical laceration [aOR 2.46; (1.1-5.4)].
  
  
  CONCLUSIONS
  Compared with expectant management, a trial of manual rotation with persistent fetal OP/OT position is associated with a reduction in CD and adverse maternal outcomes.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Clinical and Policy Perinatal Research, University of California, San Francisco, CA 94143-0705, USA.
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: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D002821:Chorioamnionitis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D007748:Labor Stage, Second; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D014710:Version, Fetal