Valley Women's Health, Provo, UT (Dr Broberg); Utah Valley Hospital, Intermountain Healthcare, Provo, UT (Dr Broberg).
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR (Dr Caughey).
Am J Obstet Gynecol MFM. 2021 Mar;3(2):100327. doi: 10.1016/j.ajogmf.2021.100327. Epub 2021 Feb 2.
Women whose fetuses are in the occiput posterior head position at the time of delivery are known to have longer second stages of labor and more complicated deliveries including more operative deliveries (cesarean, forceps, or vacuum-assisted delivery) and more third- and fourth-degree lacerations than those whose fetuses are in the occiput anterior position.
We hypothesized that rotating the fetus at the start of the second stage might decrease these complications.
At Utah Valley Regional Medical Center, we randomized term (37 weeks or beyond), nulliparous patients with epidurals and a singleton fetus in the occiput posterior position to either attempted early manual rotation to occiput anterior or to a control group managed expectantly. The control group could later be rotated if indicated by the clinical setting. The primary outcome was the length of the second stage of labor. Dichotomous outcomes were compared utilizing the chi-square test, and continuous outcomes were compared utilizing the Student t test or Wilcoxon rank sum test. The sample size estimate was for 64 patients to be randomized (32 in each group) to show a difference of 36 minutes of pushing time between the 2 groups.
We randomized 65 patients (33 to early manual rotation and 32 to control). When we examined a variety of baseline obstetrical characteristics, we found no statistically different values for the 2 groups. The early manual rotation group had a shorter median second stage of labor (65 minutes vs 82 minutes; P=.04).
Early manual rotation of the occiput posterior fetus led to a shorter second stage of labor in this small randomized trial. Future larger randomized trials are needed to validate these findings.
分娩时胎儿处于枕后位的女性，其第二产程较长，分娩较复杂，包括更多的剖宫产、产钳或真空辅助分娩，以及更多的三度和四度裂伤，而胎儿处于枕前位的女性则较少。
我们假设在第二产程开始时转动胎儿可能会减少这些并发症。
在犹他谷地区医疗中心，我们对有硬膜外麻醉且胎儿为枕后位的足月（37 周或以上）初产妇进行随机分组，一组尝试早期手动旋转至枕前位，一组为对照组，期待治疗。如果临床情况需要，对照组可以稍后进行旋转。主要结局是第二产程的长度。二分类结局采用卡方检验比较，连续结局采用 Student t 检验或 Wilcoxon 秩和检验比较。样本量估计为 64 例患者随机分组（每组 32 例），以显示两组推挤时间差 36 分钟。
我们随机分配了 65 例患者（早期手动旋转 33 例，对照组 32 例）。当我们检查各种基线产科特征时，我们发现两组没有统计学上的差异值。早期手动旋转组的中位第二产程较短（65 分钟比 82 分钟；P=0.04）。
在这项小型随机试验中，早期手动旋转枕后位胎儿导致第二产程缩短。未来需要更大规模的随机试验来验证这些发现。
