title: Sonographic evaluation of the fetal spine position and success rate of manual rotation of the fetus in occiput posterior position: A randomized controlled trial.
abstract: BACKGROUND
  To evaluate whether sonographic (US) diagnosis of the fetal spine position could increase the success rate of manual rotation of the fetal occiput (MRFO) in second-stage arrest in persistent occiput posterior position (OPP).
  
  
  METHODS
  In this randomized controlled parallel single-center trial, 58 nulliparous in second-stage arrest of labor with fetus in cephalic presentation and OPP diagnosed by US were randomly assigned to group A where the fetal spine position was not known by the operator or to group B where the operator knew it. The main outcome was the success of MRFO in the two groups. Secondary outcomes were perineal injuries, blood loss, duration of expulsive period, and neonatal APGAR at 5 minutes.
  
  
  RESULTS
  A priori knowledge of the spine position improves the success of the MRFO (41.4% group A versus 82.8% group B, p value < 0.001), the percentage of spontaneous deliveries (27.6% group A versus 69% group B, p value = 0.01), and maternal outcome (intact perineum and blood loss). No differences were detected on the neonatal side.
  
  
  CONCLUSIONS
  MRFO is a safe and useful procedure that should be performed in second-stage arrest in OPP. A better performance was observed when supported by the US knowledge of the spine position. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:472-476, 2017.
authors.affiliation: Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Masturzo
authors.affiliation: Department of Medicine and Surgery (DIMEC), Division of Prenatal Medicine, Sant'Orsola Malpighi Hospital; University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Farina
authors.affiliation: Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
authors.forename: Lorenza
authors.identifier: http://orcid.org/0000-0003-3710-1166
authors.initials: L
authors.lastname: Attamante
authors.affiliation: Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Piazzese
authors.affiliation: Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rolfo
authors.affiliation: Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gaglioti
authors.affiliation: Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy.
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D015203:Reproducibility of Results; D012399:Rotation; D013131:Spine / Q000033:anatomy & histology* / Q000196:embryology*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014710:Version, Fetal / Q000379:methods*
keywords: labor; manual rotation; obstetrics; occiput posterior position; ultrasound