Digital rotation from occipito-posterior to occipito-anterior decreases the need for cesarean section

Eur J Obstet Gynecol Reprod Biol. 2008 Jan;136(1):25-8. doi: 10.1016/j.ejogrb.2006.12.025. Epub 2007 Mar 21.


Objective: Our purpose was to study prospectively the efficacy of digital rotation in reducing the prevalence of persistent occipito-posterior position (POP) and its consequences.

Study design: Sixty-one women with a singleton pregnancy were enrolled prospectively between July 2003 and July 2004. They were in the second stage of labor with the fetal head engaged in the occipito-posterior position. During the first period of the study women were allowed to continue labor without intervention (group I); during the second period, digital rotation was performed (group II).

Results: In group I 15% of the fetuses were delivered in the occipito-anterior position and 27% underwent spontaneous vaginal delivery, as opposed to 93% and 77%, respectively, when the procedure was performed-an increase in spontaneous vaginal delivery among the group undergoing rotation of more than 50% (p<0.0001). Cesarean section was performed in 23% and vacuum in 50% when the procedure was not performed (group I) in contrast to 0% and 23%, respectively, in the group undergoing rotation (0.0001).

Conclusion: Digital rotation should be considered when managing the labor of a fetus in the occipito-posterior position. The maneuver successfully rotates the fetus reducing the need for cesarean section, instrumental delivery, and other complications associated with POP.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Cesarean Section / statistics & numerical data
  • Female
  • Humans
  • Labor Presentation*
  • Labor Stage, Second
  • Obstetric Labor Complications*
  • Pregnancy
  • Prospective Studies
  • Rotation
  • Version, Fetal / methods*