Bertholdt Charline, Morel Olivier, Zuily Stéphane, Ambroise-Grandjean Gaëlle
Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Pôle de la Femme, Nancy, France; International Adaptive Diagnosis Imaging, Institut National de la Santé et de la Recherche Médicale U1254, Rue du Morvan, Vandœuvre-lès-Nancy, France.
Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Pôle de la Femme, Nancy, France; International Adaptive Diagnosis Imaging, Institut National de la Santé et de la Recherche Médicale U1254, Rue du Morvan, Vandœuvre-lès-Nancy, France.
Am J Obstet Gynecol. 2022 Jun;226(6):781-793. doi: 10.1016/j.ajog.2021.11.033. Epub 2021 Nov 17.
The primary objective of this systematic review was to assess the association between spontaneous vaginal delivery and manual rotation during labor for occiput posterior or transverse positions. Our secondary objective was to assess maternal and neonatal outcomes.
An electronic search of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Register of Controlled Trials covered the period from January 2000 to September 2021, without language restrictions.
The eligibility criteria included all randomized trials with singleton pregnancies at ≥37 weeks of gestation comparing the manual rotation groups with the control groups. The primary outcome was the rate of spontaneous vaginal delivery. Additional secondary outcomes were rate of occiput posterior position at delivery, operative vaginal delivery, cesarean delivery, postpartum hemorrhage, obstetrical anal sphincter injury, prolonged second stage of labor, shoulder dystocia, neonatal acidosis, and phototherapy. Subgroup analyses were performed according to types of position (occiput posterior or occiput transverse), techniques used (whole-hand or digital rotation), and parity (nulliparous or parous).
The quality of each study was evaluated with the revised Cochrane risk-of-bias tool for randomized trials, known as RoB 2. The meta-analysis used random-effects models depending on their heterogeneity, and risks ratios were calculated for dichotomous outcomes.
Here, 7 of 384 studies met the inclusion criteria and were selected. They included 1402 women: 704 in the manual rotation groups and 698 in the control groups. Manual rotation was associated with a higher rate of spontaneous vaginal delivery: 64.9% vs 59.5% (risk ratio, 1.09; 95% confidence interval, 1.03-1.16; P=.005; 95% prediction interval, 0.90-1.32). This association was no longer significant after stratification by parity or technique used. Manual rotation was associated with spontaneous vaginal delivery only for the occiput posterior position (risk ratio, 1.08; 95% confidence interval, 1.01-1.15). Furthermore, it was associated with a reduction in occiput posterior or transverse positions at delivery (risk ratio, 0.64; 95% confidence interval, 0.48-0.87) and episiotomies (risk ratio, 0.84; 95% confidence interval, 0.71-0.98). The groups did not differ significantly for cesarean deliveries, operative vaginal deliveries, or neonatal outcomes.
Manual rotation increased the rate of spontaneous vaginal delivery.
本系统评价的主要目的是评估分娩时枕后位或枕横位自然阴道分娩与手法旋转之间的关联。次要目的是评估母婴结局。
对PubMed、EMBASE、ClinicalTrials.gov和Cochrane对照试验注册库进行电子检索，涵盖2000年1月至2021年9月期间，无语言限制。
纳入标准包括所有妊娠≥37周的单胎妊娠随机试验，比较手法旋转组与对照组。主要结局是自然阴道分娩率。其他次要结局包括分娩时枕后位率、阴道助产、剖宫产、产后出血、产科肛门括约肌损伤、第二产程延长、肩难产、新生儿酸中毒和光疗。根据胎位类型（枕后位或枕横位）、使用的技术（全手旋转或指旋转）和产次（初产妇或经产妇）进行亚组分析。
采用修订后的Cochrane随机试验偏倚风险工具（称为RoB 2）评估每项研究的质量。荟萃分析根据其异质性使用随机效应模型，并计算二分结局的风险比。
在此，384项研究中有7项符合纳入标准并被选中。它们包括1402名女性：手法旋转组704名，对照组698名。手法旋转与自然阴道分娩率较高相关：64.9%对59.5%（风险比，1.09；95%置信区间，1.03 - 1.16；P = 0.005；95%预测区间，0.90 - 1.32）。按产次或使用的技术分层后，这种关联不再显著。手法旋转仅与枕后位的自然阴道分娩相关（风险比，1.08；95%置信区间，1.01 - 1.15）。此外，它与分娩时枕后位或枕横位的减少（风险比，0.64；95%置信区间，0.48 - 0.87）和会阴切开术（风险比，0.84；95%置信区间，0.71 - 0.98）相关。两组在剖宫产、阴道助产或新生儿结局方面无显著差异。
手法旋转增加了自然阴道分娩率。
