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Persistent Occiput Posterior: OUT comes following digital rotation: A pilot randomised controlled trial
Author(s) -
Graham Kathryn,
Phipps Hala,
Hyett Jon A.,
Ludlow Joanne P.,
Mackie Adam,
Marren Anthony,
De Vries Bradley
Publication year - 2014
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12192
Subject(s) - medicine , randomized controlled trial , occiput , caesarean section , fetal head , demographics , referral , obstetrics , physical therapy , surgery , pregnancy , fetus , nursing , genetics , demography , sociology , biology
Aim 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. Conclusion 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.

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