Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial

Abstract

ObjectiveTo evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position.DesignRandomised controlled trial.SettingGeneva University Hospitals, Switzerland.PopulationA total of 439 women with a fetus in the occiput posterior position during the first stage of labour.MethodsThe women in the intervention group were invited to take a hands and knees position for at least for 10 minutes. Women allocated to the control group received the usual care. For both groups, 15 minutes after randomisation, women completed a short questionnaire to report their perceived pain and the comfort of their position.Main outcome measuresThe rotation of the fetal head in occiput anterior position confirmed by ultrasonography 1 hour after randomisation.ResultsOne hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of 209 (12%) in the control group. This difference was not statistically significant (relative risk 1.50; 95% CI 0.93–2.43; P = 0.13). The change in the evaluation of comfort between the randomisation and 15 minutes after showed an improvement in 70 and 39 women, no change in 82 and 78 women and a decrease in 56 and 86 women in the intervention and control groups, respectively (P = 0.02).ConclusionsThis study could not demonstrate a benefit of the hands and knees position to correct the occiput posterior position of the fetus during the first stage of labour, but the women reported an increase in their comfort level.Tweetable abstractHands and knees position does not facilitate rotation into occiput anterior but increases the comfort level of women.

Re: Maternal positioning to correct occiput posterior fetal position during the first stage of the labour: a randomised controlled trial

“…We conducted this study 1 to validate our usual therapeutic approach, consisting of corticosteroid infiltration in patients with pudendal neuralgia (neuropathic pain of the pudendal nerve) due to entrapment syndrome (nerve compression). Unexpectedly, in contrast with our clinical impressions, this protocol (multicentre, randomised, doubleblind, controlled study on 201 patients) failed to demonstrate the superiority of the combination of corticosteroid plus local anaesthetic compared with local anaesthetic alone.…”

“…The authors mention health risks to surrogate mothers as complications of the technique. 1 Of note, recently in Europe there has been a heated debate about surrogacy legislation, with some politicians proposing to make it a crime universally. European legislation is currently divided in countries where this practice is banned (e.g.…”

<br /><br />LIBERDADE DE MOVIMENTOS E POSIÇÕES NO PRIMEIRO ESTÁDIO DO TRABALHO DE PARTO<br /> FREEDOM OF MOVEMENT AND POSITION IN THE FIRST STAGE OF LABOR

“…(25) . (2016) Tabela 1 -Síntese dos estudos da revisão da literatura Contudo, a avaliação do efeito da deambulação associado à rotura artificial da bolsa de águas e ao uso de ocitocina, não demonstrou significância estatística em relação à duração da fase ativa.…”

“…As mulheres envolvidas num ensaio clínico também referiram maior alívio do desconforto relacionado com a adoção de posturas verticais, especificamente a posição de mãos e joelhos. Porém, o mesmo estudo não conseguiu justificar o benefício dessa posição na correção da estática fetal para a variedade (25) .…”

Positions during the first stage and the passive second stage of labor: A survey of French midwives

“…These fetal positions, which may be more frequent among women with epidural analgesia (Lieberman et al, 2005), can cause several different maternal complications, including both cesarean and operative vaginal deliveries, and third-and fourth-degree lacerations (Fitzpatrick et al, 2001). Nonetheless, recent randomized clinical trials have not succeeded in finding a particular maternal position that facilitates rotation of the fetal head (Desbrière et al, 2013;Guittier et al, 2016;Le Ray et al, 2016). In view of the lack of convincing data, all studies recommend that the woman be offered the freedom to choose her position.…”