The Benefits of Manual Rotation in The Treatment of Occiput Posterior Position: A Case Study of Iraq

The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% of them rotate to the occiput anterior. This research aims to analyze the rate of delivery in the OP position (also called sunny-side-up) concerning the outcome of manual rotation carried out contingent upon the OP position remains persistent. Perinatal outcomes were the secondary goals.

This prospective cohort study was carried out in Obstetrics & Gynecology Clinic (OGC) at Faruk Medical City, Iraq. The study included all women who experienced a singleton pregnancy after 36 weeks, had an effort to rotate the fetus manually and had the fetus remain in the persistent OP position. The primary result was the delivery's occiput position. Perineal injuries, labor length, and the method of delivery have been the secondary outcomes. According to the outcome of manual rotation, two groups were contrasted.

The overall number of women participating was 250, and the manual rotation success rate was 59.1%. The success was strongly correlated with a reduction in the OP position during vaginal, cesarean, operative vaginal delivery, episiotomy, and obstetric anal sphincter injury.

Reduced incidence of OP position at anal sphincter injury during operative vaginal delivery is linked to attempts at manual rotation in the case of persistent OP position.