RCOG World Congress 2023

A National Survey of Clinicians’ Opinions of Rotational Vaginal Births

Background:

Malposition of the fetal head, defined as occiput transverse (OT) or occiput posterior (OP) positions, occurs in approximately 5% of deliveries. At full cervical dilatation, fetal malposition is associated with an increased need for assisted delivery, and a higher risk of severe perineal trauma (1). Three different rotational methods can be employed to aid vaginal birth in cases of malposition in the second stage of labour. These methods are manual rotation, rotational ventouse, or (Kielland’s) rotational forceps.

At present, no randomised controlled trial has been completed to generate evidence comparing the outcomes of the three rotational methods. Standards of practice and competence in performing rotational deliveries have not been clarified. The variability in current practice may affect the accoucheur’s choice of rotational method.

Objectives:

1)To understand obstetricians’ opinions and methods used during rotational assisted vaginal birth in the UK

2)To ascertain if a randomised controlled trial of rotational methods in the UK would be acceptable

Study Design:

•An online survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK.

•Responses were received from 252 Consultant Obstetricians between August – September 2018

•The 11 questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to a randomised controlled trial of rotational methods and outcome measures

•Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis

Results:

1) The majority of respondents were competent in manual rotation (88%)

2) Manual rotation is the preferred first rotational method in both OT and OP positions

3) The decision for which rotational method to use first is case-dependent

4) Over half of respondents do not routinely use intrapartum ultrasound (52%)

5) Most Obstetricians were willing to recruit to a RCT of manual vs instrumental rotation (62%)

Conclusion:

•There is a wide range of practice in rotational vaginal births in the UK

•A randomised controlled trial to investigate the impact of different rotational methods would be feasible and desirable

•ROTATE, a randomised controlled trial of manual versus instrumental rotation of the fetal head at full cervical dilatation, is currently underway in the UK

References:

1) Burd J, Gomez J, Berghella V, et al. Prophylactic rotation for malposition in the second stage of labor: a systematic review and meta-analysis of randomized controlled trials. American Journal of Obstetrics and Gynecology MFM 2022; Volume 4, Issue 2, 100554.

RCOG World Congress 2023

A National Survey of Clinician’s Opinions of Rotational Vaginal Births

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