PROphylactic Manual RotatIon in the Second stagE of Labor

This is a randomized controlled trial to determine whether prophylactic manual rotation for fetuses identified to have persistent occiput posterior or occiput transverse presentation (POP/OTP) at the initiation of the second stage of labor in nulliparous individuals reduces rates of operative delivery, second stage of labor duration, and resultant adverse clinical outcomes compared to standard management of the second stage of labor.

Inclusion Criteria: * Pregnant * Age 18 years or greater * English-speaking * Nulliparous * Singleton gestation * Planning a vaginal birth * Have neuraxial anesthesia * Term gestation (≥37 weeks' gestation) * Ruptured membranes * Complete cervical dilation * Cephalic presenting fetus * Fetus presenting with occiput posterior or occiput transverse position confirmed by ultrasound Exclusion Criteria: * Pregnancies with intrauterine fetal demise * Pregnancies affected by major fetal anomaly * Maternal or fetal contraindication to vaginal delivery, including operative vaginal delivery * Fetal malpresentation, including brow or face presentation * Category III fetal heart rate tracing at time of randomization * Duration of pushing already exceeding 15 minutes in the second stage of labor * Lack of other inclusion criteria as described above