What is the best method to reduce postpartum morbidity among women with prolonged obstructed labor?
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Intrapartum Sims' posturing of the woman on the same side as the fetal spine enhances rotation of the fetal head from occiput posterior (OP) to occiput anterior (OA) and successful vaginal delivery. (SOR: A, based on a systematic review.) Manual rotation of the fetal head from OP/occiput transverse (OT) to OA reduces cesarean section rate, third or fourth degree laceration, postpartum infection, and hemorrhage. (SOR: B, based on a single retrospective cohort study.) Vacuum-assisted vaginal delivery is associated with fewer third or fourth degree lacerations than use of forceps, regardless of head position. (SOR: B, based on a single retrospective cohort study.) In a nonhospital setting, midwife adherence to the World Health Organization (WHO) partograph leads to early hospital referral and reduces incidence of obstructed labor. (SOR: B, based on a single RCT.)
Evidence Based Practice 14(1): 07.