A comprehensive Cochrane review of six randomized controlled trials involving 1002 women evaluated whether prophylactic manual rotation during labor improves delivery outcomes for fetal malposition. Across studies enrolling women with occiput posterior or occiput transverse fetal positions, manual rotation was compared with expectant management. The findings suggest that manual rotation may result in little to no difference in operative delivery, caesarean section, instrumental delivery, severe perineal trauma, or postpartum hemorrhage, with no maternal or perinatal deaths reported.
Due to concerns about bias, particularly lack of blinding, and imprecision in several trials, the certainty of evidence remained low. Subgroup analyses showed no consistent benefit across fetal positions or parity groups, leaving overall effectiveness uncertain. The authors conclude that more robust, well-designed trials are needed to determine whether prophylactic manual rotation can meaningfully reduce operative deliveries and improve maternal or neonatal outcomes.