In the world of medicine, every new study holds the promise of transforming the way we approach health challenges.
Today, we delve into an intriguing research project taking place in Australian hospitals.
Brace yourself as we explore the potential effectiveness of manual rotation in reducing adverse outcomes during transverse arrest.
With a sample size of 416 participants, primary outcomes of interest encompass operative delivery and serious morbidity/mortality.
Keep reading to uncover the fascinating details of this approved study, as data collection unfolds at various time points.
transverse arrest
Transverse arrest refers to a situation during labor where the baby’s head is in a transverse (sideways) position instead of the usual cephalic (head down) position.
This can lead to difficulties in delivery and may require intervention to prevent adverse outcomes.
In this study conducted in hospitals in Australia with a high volume of deliveries, the intervention being evaluated is manual rotation, which involves manipulating the baby’s position when the woman is at full cervical dilatation.
The primary outcome measure is the rate of operative delivery, and secondary outcomes include rates of caesarean section and serious maternal and neonatal morbidity and mortality.
The study aims to assess the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest.
Key Points:
- Transverse arrest is when the baby’s head is sideways during labor instead of the usual head down position.
- It can result in difficulties during delivery and may require intervention.
- A study conducted in Australian hospitals is evaluating manual rotation as an intervention.
- The primary outcome measure is the rate of operative delivery.
- Secondary outcomes include rates of caesarean section and serious maternal and neonatal morbidity and mortality.
- The study aims to determine the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest.
transverse arrest – Watch Video
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Pro Tips:
1. Transverse arrest refers to a rare position during childbirth when the baby’s shoulder gets trapped behind the mother’s pubic bone.
2. Historically, transverse arrest was considered one of the most dangerous complications during childbirth due to the risk of injury or death for both the baby and the mother.
3. Renaissance physician and obstetrician, Ambroise Paré, introduced a technique known as “échancrure” in the 16th century to successfully resolve cases of transverse arrest.
4. Transverse arrest is more common in women who have a narrow pelvis or when the baby is in an abnormal position, such as breech (feet-first) or side lying.
5. Nowadays, transverse arrest is rarely encountered thanks to advancements in medical technology, including ultrasound scans, which allow for early detection and appropriate intervention to reposition the baby before birth.
Study Location And Participant Criteria
The study on transverse arrest will be conducted in hospitals in Australia that have a high volume of deliveries, with at least 2,000 deliveries per year. This ensures a large and diverse sample size for the study.
The participants in the study will include pregnant women who meet certain inclusion criteria. These criteria include:
- being at least 18 years old
- having a singleton pregnancy
- being at least 37 weeks gestation
- planning a vaginal birth
- having a cephalic presentation
- having confirmed occiput transverse position
These criteria ensure that the participants are eligible for the study and have a specific condition that the intervention aims to address.
Exclusion Criteria For The Study
The study has both inclusion and exclusion criteria. The aim of the exclusion criteria is to identify potential confounding factors and ensure participant safety. These criteria include clinical suspicion of cephalopelvic disproportion, previous caesarean section, brow or face presentation, pathologic CTG (cardiotocography), fetal scalp abnormalities, chorioamnionitis, intrapartum hemorrhage, maternal diabetes, suspected fetal bleeding disorder, and major fetal abnormalities. By excluding these factors, the study aims to focus on the specific condition of transverse arrest and its potential interventions.
Description Of The Intervention (Manual Rotation)
The intervention being studied is manual rotation, which is performed by experienced obstetricians or midwives. This intervention is performed when the woman is at full cervical dilatation and the fetal position is occiput transverse. The technique used for manual rotation will be at the discretion of the operator and may involve applying pressure to the lambdoid suture or flexion and rotation of the fetal head.
This intervention aims to address the transverse arrest and potentially reduce the need for operative delivery.
- Manual rotation is performed by experienced obstetricians or midwives
- It is done when the woman is at full cervical dilatation and the fetal position is occiput transverse
- Techniques used for manual rotation may involve applying pressure to the lambdoid suture or flexion and rotation of the fetal head
“This intervention aims to address the transverse arrest and potentially reduce the need for operative delivery.”
Comparison To Standard Practice
The comparator in this study is the standard practice of waiting until full dilatation is reached before performing any intervention. This means that in the control group, no intervention will be performed to address the transverse arrest until the woman has reached full cervical dilatation.
By comparing the results of the intervention group to the control group, the study aims to evaluate the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest. This comparison is crucial in determining the potential benefits of the intervention.
- The comparator in this study is the standard practice of waiting until full dilatation is reached before performing any intervention.
- No intervention will be performed in the control group until the woman has reached full cervical dilatation.
- The study aims to evaluate the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest.
- Comparing the intervention group to the control group is crucial in determining the potential benefits of the intervention.
“By comparing the results of the intervention group to the control group, the study aims to evaluate the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest.”
Primary Outcome Measure
The primary outcome measure in this study is the rate of operative delivery, which includes vacuum extraction, forceps delivery, or caesarean section. This outcome measure is important as it reflects the need for medical interventions to assist in the delivery process.
By comparing the rate of operative delivery between the intervention and control groups, the study aims to determine if manual rotation can reduce the need for these interventions and potentially improve the birth outcomes for women with transverse arrest.
- The study focuses on the rate of operative delivery as the primary outcome measure.
- The outcome measure includes vacuum extraction, forceps delivery, or caesarean section.
- Medical interventions are often necessary to facilitate the delivery process.
- The study aims to investigate if manual rotation can lower the need for these interventions.
- Improved birth outcomes are expected for women with transverse arrest.
Secondary Outcome Measures
In addition to the primary outcome measure, the study includes several secondary outcome measures. These measures include the rate of caesarean section, serious maternal morbidity or mortality, and serious perinatal and neonatal morbidity and mortality.
These secondary outcomes provide a more comprehensive understanding of the potential effects of the intervention on both the mother and the baby. By examining these secondary outcomes, the study aims to assess the overall impact of manual rotation on various aspects of birth outcomes.
- Rate of caesarean section
- Serious maternal morbidity or mortality
- Serious perinatal and neonatal morbidity and mortality
Definition Of Prolonged Second Stage Of Labor
Prolonged second stage of labor is defined differently based on parity (whether the woman has given birth before) and the use of epidural analgesia.
For nulliparous women (first-time mothers) without epidural analgesia, a second stage of labor lasting more than three hours is considered prolonged.
For nulliparous women with epidural analgesia, a second stage of labor lasting more than four hours is considered prolonged.
For multiparous women (women who have given birth before) without epidural analgesia, a second stage of labor lasting more than two hours is considered prolonged.
For multiparous women with epidural analgesia, a second stage of labor lasting more than three hours is considered prolonged.
These definitions help to establish a clear criteria for identifying prolonged second stage of labor and its potential impact on birth outcomes.
Additional Outcomes Assessed
The study not only investigates primary and secondary outcomes, but also considers several other important outcomes. These include:
- Length of the second stage of labor
- Time from randomization to delivery
- Estimated blood loss
- Perineal or vaginal trauma requiring suturing
- Length of hospital stay
- Outcomes for operative delivery
These additional outcomes further contribute to a comprehensive understanding of the effects of manual rotation on different aspects of the delivery process and recovery.
Sample Size And Study Aim
The sample size for this study is determined based on power calculations and previous studies. With a sample size of 416 participants, the study aims to have sufficient statistical power to detect meaningful differences between the intervention and control groups.
The study aims to evaluate the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest. By determining the potential benefits of this intervention, the study aims to improve the care and outcomes for women experiencing transverse arrest during childbirth.
- Key points:
- Sample size: 416 participants
- Aim: detect meaningful differences between intervention and control groups
- Focus: effectiveness of manual rotation in reducing adverse outcomes during transverse arrest
“The study aims to improve the care and outcomes for women experiencing transverse arrest during childbirth.”
Data Collection, Informed Consent, And Study Procedures
Data collection for this study will occur at three possible time points: antenatal, latent phase of labor, or active phase of the first stage of labor. This allows for a comprehensive assessment of the participants’ characteristics and outcomes throughout the labor process. Informed consent will be obtained from all participants, and they will be made aware of the potential risks associated with manual rotation. An ultrasound will be performed at full dilatation to confirm the fetal position. The treatment allocation will be recorded on a randomization sheet, and the findings will be recorded by the investigator. The data collected will be stored securely and checked for accuracy. The analysis of the data will be done according to specific guidelines, and subgroup analyses will also be performed based on different techniques of manual rotation and operator ability. To ensure the safety of the trial participants, a Data and Safety Monitoring Committee has been established. Any adverse events will be reported to this committee, and serious complications will be referred to them as well. The study has received approval from the Ethics Review Committee of the Sydney Local Health District in Sydney, Australia, with the protocol number X110410.
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You may need to know these questions about transverse arrest
What is transverse arrest?
Transverse arrest refers to the situation in which the baby’s head fails to rotate and descend from a transverse position, typically occurring at or just above the level of the spines. This condition occurs when the cervix is fully dilated and uterine contractions are sufficient. Deep transverse arrest involves the failure of both rotation and descent of the head, hindering the progress of labor. It is a critical point during childbirth that may require medical intervention to safely deliver the baby.
How do you deliver deep transverse arrest?
In cases of deep transverse arrest (DTA), both manual rotation forceps extraction and vacuum extraction have been found to be safe methods of delivery. Manual rotation involves gently rotating the baby’s position inside the birth canal using forceps, allowing for a successful delivery. This method ensures the safe delivery of the baby while minimizing the risks associated with DTA. On the other hand, vacuum extraction utilizes suction to assist in pulling the baby out, providing a safe and effective option for resolving DTA. Both methods have proven to be successful in facilitating the delivery process and ensuring the well-being of both the baby and the mother.
What is a deep transverse arrest seen in?
Deep transverse arrest is frequently observed in cases of fetal occiput transverse position during childbirth. This phenomenon is commonly linked to caesarean section and instrumental vaginal delivery. Furthermore, when occiput transverse position is unexpectedly identified during the second stage of labor, it is often associated with operative delivery in high-risk populations.
What type of pelvis causes deep transverse arrest?
Deep transverse arrest is primarily caused by a gynecoid pelvis, which exhibits a typically favorable shape for childbirth. Gynecoid pelvis, present in nearly half of all women, allows for sufficient internal rotation, facilitating the movement of the baby’s sagittal suture in the antero-posterior diameter. This ensures a smooth progression through the birth canal. In contrast, platypelloid and android pelvises, which are found in a minority of women, lack the internal space required for proper internal rotation, leading to deep transverse arrest during labor.
Reference source
https://www.sciencedirect.com/science/article/pii/002072929390319R
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-0854-3
https://www.gynecologistmumbai.com/blog/labor-delivery/
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-0854-3
