Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?

Barasinski, Chloé; Lémery, D.; Vendittelli, Françoise

doi:10.1016/j.gyobfe.2016.07.004

Cited by 19 publications

(20 citation statements)

References 28 publications

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“…6 11 Only one trial included multiparous women 6. A recent review points out that co-interventions varied between studies,16 as did the mother’s position during the second stage of labour. One study left position to the woman’s choice;6 two others mandated a specific position: dorsal decubitus position in one11 and semirecumbent in the other 5.…”

Section: Background and Significancementioning

confidence: 99%

“…One study left position to the woman’s choice;6 two others mandated a specific position: dorsal decubitus position in one11 and semirecumbent in the other 5. Globally, the quality of the randomisation was not good 16. One study reported using sealed envelopes,6 one failed to specify the kind of envelope used,11 and the last one did not specify the mode of randomisation 5.…”

Section: Background and Significancementioning

confidence: 99%

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Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial—the EOLE study protocol

Barasinski

Vendittelli

2016

BMJ Open

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IntroductionThe scientific data currently available do not allow any definitive conclusion to be reached about what type of pushing should be recommended to women during the second stage of labour. The objective of this trial is to assess and compare the effectiveness of directed open-glottis pushing versus directed closed-glottis pushing. Secondary objectives are to assess, according to the type of pushing: immediate maternal and neonatal morbidity, intermediate-term maternal pelvic floor morbidity, uncomplicated birth, and women's satisfaction at 4 weeks post partum.Methods and analysisThis multicentre randomised clinical trial compares directed closed-glottis pushing (Valsalva) versus directed open-glottis pushing during the second stage of labour in 4 hospitals of France. The study population includes pregnant women who received instruction in both types of pushing, have no previous caesarean delivery, are at term and have a vaginal delivery planned. Randomisation takes place during labour once cervical dilation ≥7 cm. The principal end point is assessed by a composite criterion: spontaneous delivery without perineal lesion (no episiotomy or spontaneous second-degree, third-degree or fourth-degree lacerations). We will need to recruit 125 women per group. The primary analysis will be by intention-to-treat analysis, with the principal results reported as crude relative risks (RRs) with their 95% CIs. A multivariate analysis will be performed to take prognostic and confounding factors into account to obtain adjusted RRs.Ethics and disseminationThis study was approved by a French Institutional Review Board (Comité de Protection des Personnes Sud Est 6:N°AU1168). Results will be reported in peer-reviewed journals and at scientific meetings. This study will make it possible to assess the effectiveness of 2 types of directed pushing used in French practice and to assess their potential maternal, fetal and neonatal effects. Findings from the study will be useful for counselling pregnant women before and during labour.Trial registration numberAgence national de sécurité du médicament et des produits de santé (ANSM): 150099B-22 and IDRCB: 2014-A01920-47. ClinicalTrials.gov: NCT02474745. Pre-result stage.

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Section: Background and Significancementioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial—the EOLE study protocol

Barasinski

Vendittelli

2016

BMJ Open

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“…O puxo dirigido é estimulado independentemente da vontade de puxar. A mulher é solicitada a inspirar profundamente no início da contração e a utilizar a apneia expiratória durante um período de 10 a 30 segundos, associada ao esforço com contração abdominal e diafragmática (com a glote fechada) numa frequência de três a quatro puxos em cada contração (Álvarez-Burón e Arnedillo-Sánchez, 2010; Barasinski et al, 2016).…”

Section: Puxo Dirigido Durante O Parto (Manobra De Valsalva)unclassified

“…Segundo Barasinski et al (2016), o puxo dirigido, também chamado de "manobra de Valsalva", é amplamente utilizado nos países ocidentais, mas a origem desta prática obstétrica é obscura e provavelmente foi desenvolvida com a disseminação dos partos fórcipes, mas sem dados científicos convincentes para apoiá-lo. De acordo com o MS, embora sem registros oficiais, ainda é uma prática muito comum na assistência à mulher no trabalho de parto.…”

Section: Puxo Dirigido Durante O Parto (Manobra De Valsalva)unclassified

“…A Diretriz Nacional de Assistência ao Parto recomenda apenas os puxos espontâneos no período expulsivo em mulheres sem analgesia, evitando os puxos dirigidos, exceto quando a dilatação cervical for completa, com 10 cm, depois de 1 hora nesta condição ou se a cabeça fetal estiver visível (Brasil, 2016 dos estudos e as diferenças entre os protocolos não justificam uma recomendação de um determinado tipo de puxo (Barasinski et al, 2016).…”

Section: Práticas E Desfechos Maternos Identificados Nas Entrevistas unclassified

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Implementação das práticas baseadas em evidências na assistência ao parto normal

Côrtes¹

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Aos meus pais, Benedito e Berenisse, por acreditarem sempre em meu crescimento pessoal e profissional, por me incentivarem a estudar e orgulharem-se de nossas vitórias.A minha eterna esposa, Francisca Maciel Côrtes, pelo imensurável amor, dedicação, paciência e compreensão nos momentos árduos dessa jornada, por incentivar e apoiar incondicionalmente todos os meus projetos de vida.Aos meus filhos Édrey, Eduardo e Thaís pela compreensão; ao Emanuel, meu caçula, como pedido formal de desculpa pelos inúmeros "vai pra lá, filho", que lhe proferi nos momentos de minha necessidade de reclusão e introspecção.Aos meus irmãos pelas lições constantes de amor fraterno, união, honestidade e espírito de luta.A DEUS como gratidão pela vida e por iluminar meus caminhos com sabedoria, permitindo a concretização deste sonho. AGRADECIMENTOS ESPECIAISÀ

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The dynamic change of the anteroposterior diameter of the levator hiatus under Valsalva maneuver at term and labor outcome

Brunelli

Prete

Casadio

et al. 2020

Neurourology and Urodynamics

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The aim of the present study was to evaluate the correlation between the proportional change of anteroposterior diameter (APD) of levator hiatus from rest to maximum Valsalva maneuver in nulliparous women at term and labor outcome. Methods: We prospectively recruited nulliparous women at term before the onset of labor. Women underwent a two-dimensional transperineal ultrasound, measuring the APD of the levator hiatus at rest and under maximum Valsalva's maneuver. APD change from rest to maximum Valsalva was described both in terms of absolute figures and proportional change. Correlation of APD change with the mode of delivery and with labor durations was assessed. Results: Overall, 486 women were included in the analysis. No significant association between change in APD and the mode of delivery. We found a significant negative correlation between change of APD from rest to Valsalva and the duration of active second stage both in terms of absolute change (Pearson's r = −0.138, P = .009) and in terms of proportional change (Pearson's r = −0.154, P = .004). Survival outcomes based on Cox-regression model showed that APD was independently associated with the duration of active second stage of labor after adjusting for epidural analgesia, maternal age

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Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?

Abstract: The low methodological quality of the studies and the differences between the protocols do not justify a recommendation of a particular pushing technique. Further studies appear necessary to study outcomes with each of these techniques.

Cited by 19 publications

References 28 publications

Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial—the EOLE study protocol

Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial—the EOLE study protocol

Implementação das práticas baseadas em evidências na assistência ao parto normal

The dynamic change of the anteroposterior diameter of the levator hiatus under Valsalva maneuver at term and labor outcome

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