Comparison of 0.1% Ropivacaine and 0.0625% Bupivacaine With Fentanyl as an Adjuvant for Labour Analgesia.

Within this document, we use the term for those giving birth for the purpose of brevity. However, it is important to acknowledge that not all those who give birth identify as women and that this work relates to all people giving birth, irrespective of gender identity. Most vaginal births occur without complication or the requirement of medical intervention when babies are in an occipito-anterior position []. Fetal malposition at full cervical dilatation, defined as the fetal occiput in transverse or posterior positions, occurs in approximately 4% to 5% of all pregnant women []. There are 2 options for managing persistent fetal malposition in the second stage of labor: rotational vaginal birth or cesarean birth at full dilatation. In total, 11% of women with fetal malposition in the first stage of labor will eventually undergo a rotational vaginal birth []. There are 3 different methods of rotational vaginal birth: rotational (Kielland) forceps, rotational vacuum, and manual rotation. Kielland forceps and rotational vacuum are both methods of instrumental rotation. Women are more likely to experience significant perineal trauma following rotational vaginal birth than cesarean birth at full dilatation, including obstetric anal sphincter injury (OASI; 10%) [,]. OASI can cause significant long-term problems, including urinary and anal incontinence, which can gravely impede quality of life []. Until now, evidence gleaned from observational studies has guided practice of rotational vaginal birth, with no multicenter randomized controlled trial (RCT) ever completed comparing outcomes, including the incidence of OASI, between different rotational methods. Compared to cesarean birth at full dilatation, rotational vaginal birth may be associated with risks for mothers and babies, including infection (1%-4%), vaginal wall lacerations (12%-20%), and neonatal trauma (2%-9%) [].