title: Persistent occiput posterior: OUTcomes following digital rotation: a pilot randomised controlled trial.
abstract: OBJECTIVE
  To determine the feasibility of a multicentre randomised controlled trial (RCT) to investigate whether digital rotation of the fetal head from occiput posterior (OP) position in the second stage of labour reduces the risk of operative delivery (defined as caesarean section (CS) or instrumental delivery).
  
  
  METHODS
  We conducted the study between December 2010 and December 2011 in a tertiary referral hospital in Australia. A transabdominal ultrasound was performed early in the second stage of labour on women with cephalic, singleton pregnancies to determine the fetal position. Those women with a fetus in the OP position were randomised to either a digital rotation or a sham procedure. In all other ways, participants received their usual intrapartum care. Data regarding demographics, mode of delivery, labour, post natal period and neonatal outcomes were collected.
  
  
  RESULTS
  One thousand and four women were consented, 834 achieved full dilatation, and 30 were randomised. An additional portable ultrasound scan and a blinded 'sham' digital rotation were acceptable to women and staff. Operative delivery rates were 13/15 in the digital rotation (four CS and nine instrumental) and 12/15 in the sham (three CS and nine instrumental) groups, respectively.
  
  
  CONCLUSIONS
  A large double-blinded multicentre RCT would be feasible and acceptable to women and staff. Strategies to improve recruitment such as consenting women with an effective epidural in active labour should be considered. This would be the first RCT to answer a clinically important question which could significantly affect the operative delivery rate in Australia and internationally.
authors.affiliation: RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Graham
authors.forename: Hala
authors.initials: H
authors.lastname: Phipps
authors.forename: Jon A
authors.initials: JA
authors.lastname: Hyett
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Ludlow
authors.forename: Adam
authors.initials: A
authors.lastname: Mackie
authors.forename: Anthony
authors.initials: A
authors.lastname: Marren
authors.forename: Bradley
authors.initials: B
authors.lastname: De Vries
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000628:therapy*; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal
keywords: Caesarean section; instrumental delivery; manual rotation; occiput posterior position; operative delivery