Trial of Prophylactic Manual Rotation of Persistent Occiput Posterior Presentation During the Early Second Stage of Labor to Reduce Operative Delivery: a Prospective Multicenter Randomized Control Trial

Trial of Prophylactic Manual Rotation of Persistent Occiput Posterior Presentation During the Early Second Stage of Labor to Reduce Operative Delivery: a Prospective Multicenter Randomized Control Trial

Superiority multicenter prospective randomized study on operative delivery (instrumental delivery or caesarean section) of prophylactic manual rotation in case of persistent occipital posterior presentation during the second stage of labor compared to expectant management. A 15% reduction of operative delivery (instrumental delivery or caesarean section) is attempt in the prophylactic manual rotation group.

Inclusion Criteria:

• Age ≥ 18 years
• Singleton pregnancy
• Term ≥ 37 weeks of gestation
• Early second stage of labor
• Rupture membranes
• Persistent occiput posterior position confirmed by ultrasound
• Epidural anesthesia
• Patient who agree to participate and sign consent form

Exclusion Criteria:

• Age < 18 years
• Term < 37 weeks of gestation
• Vaginal and instrumental Delivery maternal contraindication
• Antecedent of perineal injury type IV
• Sensitive perineum
• Crohn's disease with vaginal delivery contraindication
• Instrumental fetal contraindication
• Non reassuring fetal heart with impossibility of optimal maternal information
• Known fetal malformation
• Previous ceaserean section
• Non cephalic presentation
• Not affiliated to social security