Management of occiput posterior position in the second stage of labour: a survey of obstetric practice in Australia and New Zealand

Background Issues in the management of the occipito posterior (OP) position have been the subject of clinical controversy over decades. Manual rotation has the potential to reduce operative delivery for fetal malposition. Aim To determine the current obstetric practice with regard to manual rotation in the management of the second stage of labour. Methods Survey mailed to all members and fellows of the Australian and New Zealand College of Obstetricians and Gynaecologists. Results Of 1805 surveyed, 60% responded, of whom 68% were currently practising obstetrics. Ninety-seven per cent of respondents thought that manual rotation at full dilatation was a valid intervention, 85% stated that manual rotation was acceptable prior to instrumental delivery, and 70% thought that manual rotation was acceptable without assisted delivery. Only 41% of practising obstetricians had performed a manual rotation in the last year, and only 9% had performed more than five. Obstetricians would routinely perform manual rotation for OP position if it reduced operative delivery from 68% to a median of 50%. Conclusion Manual rotation is currently performed by only a minority of obstetricians in Australia and New Zealand, yet is considered to be an acceptable procedure by the vast majority. The survey confirmed that obstetricians would be willing to perform prophylactic manual rotation if this was known to reduce the operative delivery rate, suggesting that there is a scope to introduce this procedure into widespread clinical practice.