Manual Rotation May Be Ineffective


Prophylactic manual rotation to avoid operative delivery may not be effective, according to a recent Cochrane meta-analysis.

Little is known about the efficacy of manually turning a baby early during the second stage of labor, leaving questions about its value in preventing a c-section or other type of operative delivery.

The editors of the Cochrane Pregnancy and Childbirth Group concluded that there is insufficient evidence to determine the usefulness of prophylactic manual rotation. They found just one small pilot study and noted that a second study is ongoing.

Key Points:

- There is no scientific evidence supporting the commonly used procedure of manually turning a fetus during the second stage of labor.

- A Cochrane review suggests more studies be conducted to better assess the efficacy of the practice.

The results of their findings were published last month.

The single study involved 30 women from Australia who were candidates for manual rotation, with half of the women placed in the manual rotation group and half in a control group. The study reported that while there were no adverse events, there were also no clear differences between groups in the delivery ultimately requiring a c-section or other operative delivery, such as vacuum-assisted delivery or forceps use. In nearly all cases, the women ended up having an operative delivery. Operative delivery occurred in 13 of 15 women in the manual rotation group and 12 of 15 women in the control group.

The Cochrane editors believe further research could help to better establish the scientific evidence surrounding the use of the commonly performed maneuver. While manual rotation is perceived as safe, it’s unclear whether it's effective, they said. Still, they noted, “Manual rotation has the potential to prevent operative delivery and caesarean section, and reduce obstetric and neonatal complications.”

In attempting the meta-analysis, the reviewers searched the Cochrane Pregnancy and Childbirth Group’s Trials Register, the Australian and New Zealand Clinical Trials Registry,, Current Controlled Trials, and the WHO International Clinical Trials Registry Platform, previous reviews and, references of retrieved studies. Still, just the one small pilot study was found.

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