Evaluation of the Impact of Rotating Posterior and Transverse Presentations At 2 Hours of Full Dilation

Civil Hospices of Lyon

Status: Active, not recruiting

Conditions: Fetus in Posterior or Transverse Position; Manual Rotation ; Obstetrics ; Delivery Room Practice

Treatments: Device: Mode of delivery

Study type: Observational

Funder types: Other

Identifiers

NCT06886854

24-5373

Details and patient eligibility

About

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.

Enrollment: 1,000 estimated patients

Sex: Male

Ages: 15 to 50 years old

Volunteers: No Healthy Volunteers

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

Trial design

1,000 participants in 1 patient group

Success of the rotation

Description:

Patients in labor with a fetus in posterior or transverse position at 2 hours of full dilation, verified by ultrasound. Manual rotation by an obstetrician after confirming effective analgesia, an empty bladder, and normal fetal heart rate. Success of the manual rotation

Treatment:

Device: Mode of delivery