Fetus in Posterior or Transverse Position; Manual Rotation ; Obstetrics ; Delivery Room Practice
Conditions
Brief summary
During labor, 20% of fetuses present in a posterior or transverse position. Among them, 90% rotate spontaneously during labor. For the remaining 10%, maintaining a posterior or transverse position leads to longer labor, increased instrumental deliveries, more cesarean sections, and more severe perineal tears. Obstetricians can intervene by manually rotating the fetus to an anterior position. Several studies have shown the benefits of this technique, but they were all conducted at full dilation or one hour after full dilation. This timing does not allow enough time for the fetus to rotate spontaneously. Additionally, manual rotation can be poorly tolerated by the patient, especially if pain management is insufficient. Our study aims to demonstrate the benefits of manual rotation two hours after full dilation. This delay allows 90% of fetuses to rotate spontaneously, and it could help harmonize obstetrical practices.
Interventions
DEVICEMode of delivery
Retrieval of delivery data, typically recorded by midwives - retrieval of data per delivery and post-delivery - Consultation of medical data on labor duration, labor onset method, estimated fetal weight, etc. Data collected for each delivery, identical in both groups.
Sponsors
Hospices Civils de Lyon
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
MALE
Age
15 Years to 50 Years
Inclusion criteria
* \- Patient delivering at Hospices Civils de Lyon (XR, HFME, LS?) * Low-pitched voice agreement * Mobile fetal cephalic presentation * Transverse or posterior presentation confirmed by ultrasound * 2 hours of complete dilation * Agreement for 3 hours by OB-GYN * Normal fetal heart rate * Epidural anesthesia in place * Bladder catheterized
Exclusion criteria
* \- Multiparous uterus with scars * Breech presentation * Fetus \> 5000 g * Patient refusal * Inadequate analgesia * Fetal hypoxia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of eutocic deliveries | Collected at the time of delivery. | Collection of delivery data recorded by the midwife: eutocic delivery, instrumental extraction by vacuum, instrumental extraction by forceps, instrumental extraction by spatula, emergency cesarean section (green, orange, or red code). |
Countries
France
Outcome results
None listed