None listed
Conditions
Brief summary
Occiput-posterior (OP) fetal position, when the baby is 'back-to-back' with the mother, is associated with operative birth, severe perineal-trauma, birth injury and neonatal intensive care admission. Use of semi-prone posture (Sims) may help babies rotate anteriorly to birth safely and naturally. Current evidence about maternal posture for OP position is uncertain, and there is little evidence on semi-prone posture. We hypothesise that when the mother adopts a semi-prone (Sims) posture, lying on the same side as the fetal spine, the fetal spine gravitates anteriorly, allowing easier descent through the pelvis with improved birth outcomes including reduced operative birth. A randomised trial of semi-prone (Sims) posture for women with an OP fetal position, is proposed. The aim is to assess the acceptability and efficacy of semi-prone (Sims) posture compared to free posture, for increasing the rate of spontaneous vaginal birth.
Interventions
Use of semi-prone (Sims) posture, lying on the same side as the fetal spine (ipsilateral). The lower leg is straight, the upper leg is flexed at 90 degrees, the abdomen rests on the bed and the body is tilted forwards. The posture is adopted for ideally 40 minutes or more per hour every hour, from start of intervention at at least 6 cm cervical dilatation, till birth (approx 7-12 hours or less). Upright or forward leaning postures may be used for up to 20 minutes per hour every hour till birth t
Use of semi-prone (Sims) posture, lying on the same side as the fetal spine (ipsilateral). The lower leg is straight, the upper leg is flexed at 90 degrees, the abdomen rests on the bed and the body is tilted forwards. The posture is adopted for ideally 40 minutes or more per hour every hour, from start of intervention at at least 6 cm cervical dilatation, till birth (approx 7-12 hours or less). Upright or forward leaning postures may be used for up to 20 minutes per hour every hour till birth to aid comfort and mobility. The intervention is supervised by the midwife in attendance. Strategies to monitor adherence include clinical observation using a posture tracking record completed hourly with a tick against what proportion of time the intervention was used (0-19 mins; 20-39 mins; 40-60 mins). A wrist band will be placed on the same side that the participant is to lie, to help them remember their allocated intervention.
Sponsors
Auckland University of Technology
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age at least 16 years, live singleton pregnancy of at least 37 weeks’ gestation, cephalic presentation, cervical dilatation of at least 6 cm, and OP malposition confirmed by portable ultrasound scan. Includes consultations for prolonged labour, oxytocin augmentation or epidural anaesthesia.
Exclusion criteria
Major fetal anomalies, uterine anomalies (defined as bicornuate uterus, uterine septum defect, or large fibroid of at least 5cm), and being unable to adopt the intervention posture.
Outcome results
None listed