Re: 100 lbs wieght gain, o.p. multip
From: Efrain Ramirez (eramirezt@coqui.net)
Sat Oct 20 18:09:43 2007
Obstetrics & Gynecology 2007;110:873-879
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL ARTICLES
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Manual Rotation in Occiput Posterior or Transverse Positions
Risk Factors and Consequences on the Cesarean Delivery Rate
Camille Le Ray, MD, Pauline Serres, Thomas Schmitz, MD, Dominique
Cabrol, MD, PhD and François Goffinet, MD, PhD
>From Maternité Cochin Port Royal, Paris, France.
ABSTRACT
OBJECTIVE: To identify the risk factors for failure of manual rotation
in patients with occiput posterior or transverse positions during labor
and to study the cesarean rate according to the success of the rotation.
METHODS: Case-control study comparing failure and success of manual
rotation. Cases were all fetuses for whom rotation failed. We used
computerized randomization (without matching) to select one control with
a successful rotation during the same period for each case with a failed
rotation. Maternal, neonatal, and obstetric risk factors for failed
rotation were studied with bivariable and multivariable analyses. Mode
of delivery was analyzed according to success of the rotation.
RESULTS: During the study period, manual rotations were performed in 796
patients. The procedure failed in 77 (9.7%) women. Attempted rotation
before full dilatation tripled the risk of failure in comparison with
rotation at full dilatation (adjusted odds ratio 3.4, 95% confidence
interval 1.3–8.6), and rotation for failure to progress quadrupled that
risk in comparison with prophylactic rotation (adjusted odds ratio 3.3,
95% confidence interval 1.2–8.5). Failure of manual rotation was
associated with a higher cesarean delivery rate than was success (58.8%
compared with 3.8%, P<.001). All women with unsuccessful manual
rotations who delivered vaginally delivered in the occiput posterior
position, and all women with successful manual rotation delivering
vaginally delivered in the occiput anterior position.
CONCLUSION: Manual rotation may be an effective technique for reducing
the cesarean delivery rate in patients with an occiput posterior or
transverse position during labor. The success or failure of attempted
manual rotation depends upon obstetric conditions, including the
indication for rotation and cervical dilatation.
LEVEL OF EVIDENCE: II
Ef
At Fri, 19 Oct 2007, Ronald Ainsworth wrote:
>
>Had one like that last night. First baby was 6# 7oz.
>I induced her this time at 40wk 2d, amniotomy. She
>moved steadily to complete, but the nurse didn't wake
>me up until 1:30AM when she had been pushing for 1-1/2
>hours and was getting fatigued. When I checked her
>she was obviously OP at +3 and the anterior vaginal
>wall was coming down in front of the head, but she was
>complete. First attempt to manually rotate was
>unsuccessful, tried again in the opposite direction
>and it rotated and delivered in the next two pushes.
>No shoulder dystocia, but this one was 10# even,
>3-1/3# bigger than her first. She could never had it
>posterior, I was fortunate to rotate it. Garry would
>probably have put on Kiellands. I would have 15 years
>ago.
>
>Ron
>--- "Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C."
><johnprov@sympatico.ca> wrote:
>
>> 27 y.o. G2 P1 preious low forceps at 38 weeks baby
>> was only 6lbs 9 oz;
>> Induced today at 39weeks B.P. 150/100 got to 8-9 cm
>> but o.p. and
>> cervix does not want to go away for 2hrs despite
>> augment going to give
>> it 1 more hour and call it a day, 100lb wieght gain
>> is a concern.
>>
>> --
>> Take care, John
>>
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"I can accept failure, but I can't accept not trying." - Michael Jordan
