Main author

(year) country

Technique

Rate of Successful rotations

Shaffer (2006)

USA

No technique described, but in Shaffer 2011, which is based on the same study material, the technique was described.

74%

Le Ray (2007) France

When the uterus is relaxed, the operator places two fingers or the entire hand (right hand for left OP and OT-position and left hand for right OP and OT-position) behind the fetal ear.

During contraction, while the patient is pushing, the operator uses the pressure of the fingers to rotate the anterior fetal head, moving the occiput relative toward the anterior pelvic girdle.

Continuously monitored fetal heart rate throughout the procedure.

90.3%

Reichman (2008)

Israel

The DR technique accounted for 97% of the rotations. The rest of the rotations were based on the MR technique.

DR entails exerting pressure with the tip of the fingers to rotate the posterior fontanelle upward, toward the symphysis pubis after placing the tips of the index and middle fingers onto the edge of the part of the anterior parietal bone that overlaps the occipital bone, the posterior fontanelle.

MR involves placing the whole hand in the birth canal, positioning the fingers under the lateral posterior parietal bone and the thumb on the anterior parietal bone. The head is then rotated.

93.3 %

Shaffer (2011)

USA

One of two techniques:

The first technique comprises placing the tips of the index and middle fingers onto the edge of the

anterior parietal bone that overlaps the occipital bone, followed by rotation of the posterior fontanelle upwards towards the symphysis during a contraction or maternal expulsive efforts.

The second technique involves cradling the occiput with the fingers under the lateral posterior parietal bone, with the thumb on the anterior parietal bone. Then slightly elevate using gentle pressure, rotate to OA and flex the foetal occiput.

74%

Le Ray (2013)

France

When the uterus is relaxed, the operator places two fingers or the entire hand (right hand for left OP and OT position and left hand for right OP and OT position) behind the foetal ear.

During contraction, while the patient is pushing, the operator uses the pressure of the fingers to rotate the anterior foetal head, moving the occiput relative toward the anterior pelvic girdle.

Continuous monitoring of the foetal heart rate throughout the procedure.

90.1%

Sen (2013)

Japan

No technique described.

47%

Graham

(2014) Australia

DR fingers placed on the lambdoid sutures, rotating towards the pubic symphysis during contraction and with expulsive effort over three contractions. Flexion force was applied, to correct any deflexion. The head of the foetus was then held in OA position for further one to two contractions.

60%