When an Intervention During Labor Turns Heads

Fetal head position changes during the first and second stages of labor. Although persistence of posterior or transverse occiput at delivery is associated with adverse perinatal outcomes, no consensus has emerged for management of the malpositioned fetus. Researchers evaluated outcomes at two university hospitals in France, one with a strategy of attempted manual rotation of the malpositioned fetus at full dilation and the other with a strategy of changing maternal position to encourage spontaneous rotation without manual intervention.

In the “rotation hospital,” manual rotation was attempted in 79% of 220 fetuses with posterior or transverse occiput at full dilation, and 90% of these attempts were successful. In the “nonrotation hospital,” …