Abstract：
BACKGROUND: Malposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland\'s) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies.
OBJECTIVE: To gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods.
METHODS: A survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis.
RESULTS: 252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland\'s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior.
CONCLUSIONS: There is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.
OBJECTIVE: To gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods.
METHODS: A survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis.
RESULTS: 252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland\'s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior.
CONCLUSIONS: There is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.
摘要：
背景：胎头错位，定义为枕骨横向或后部位置，发生在大约5%的新生儿中。在宫颈完全扩张时，胎儿位置不正与阴道旋转分娩的风险增加有关.有三种不同的旋转方法：手动旋转，旋转室或旋转（Kielland\'s）镊子。在缺乏有力证据的情况下，目前还不知道这三种方法中哪一种最有效，对父母和婴儿最安全。
目的：为了更深入地了解轮产的观点和偏好，探索比较不同轮产方法的随机试验的可接受性和可行性。
方法：英国母胎医学会通过电子邮件向产科医生发送了一项调查，以及英国正在进行研究的产科医生和活跃的学者。问题集中在感知能力上，首选轮换方法，位置（剧院或劳动室），愿意招募到RCT，及其结果度量。已结束的问题之后是自由文本选项，以允许进一步评论。自由文本答案经过了主题分析。
结果：252名顾问产科医生回答。大多数人表示他们有能力执行手动轮换（88.1％）。一半的人感到熟练使用Kielland的旋转镊子（54.4％）。大多数产科医生认为熟练使用旋转腹腔（76.2％）。在枕骨横向和后部位置的情况下，手动旋转是首选的第一种旋转方法。许多人认为首先尝试哪种旋转方法的决定取决于案例。三分之二的产科医生通常会在手术室进行轮产（67.9％）。超过一半（52％）不常规使用产时超声检查。大多数（62.7％）愿意招募到比较手动和仪器旋转的随机对照试验。如果一半以上（57.2％）的人愿意招募相同的RCT，如果他们是最资深的轮流阴道分娩监督大三学生的医生。
结论：在英国进行阴道轮换分娩的实践范围很广。研究不同轮换方法对结果的影响的RCT是可行和可取的，特别是在研究活跃的医院。
目的：为了更深入地了解轮产的观点和偏好，探索比较不同轮产方法的随机试验的可接受性和可行性。
方法：英国母胎医学会通过电子邮件向产科医生发送了一项调查，以及英国正在进行研究的产科医生和活跃的学者。问题集中在感知能力上，首选轮换方法，位置（剧院或劳动室），愿意招募到RCT，及其结果度量。已结束的问题之后是自由文本选项，以允许进一步评论。自由文本答案经过了主题分析。
结果：252名顾问产科医生回答。大多数人表示他们有能力执行手动轮换（88.1％）。一半的人感到熟练使用Kielland的旋转镊子（54.4％）。大多数产科医生认为熟练使用旋转腹腔（76.2％）。在枕骨横向和后部位置的情况下，手动旋转是首选的第一种旋转方法。许多人认为首先尝试哪种旋转方法的决定取决于案例。三分之二的产科医生通常会在手术室进行轮产（67.9％）。超过一半（52％）不常规使用产时超声检查。大多数（62.7％）愿意招募到比较手动和仪器旋转的随机对照试验。如果一半以上（57.2％）的人愿意招募相同的RCT，如果他们是最资深的轮流阴道分娩监督大三学生的医生。
结论：在英国进行阴道轮换分娩的实践范围很广。研究不同轮换方法对结果的影响的RCT是可行和可取的，特别是在研究活跃的医院。
