Fetal Occipitoposterior Position During the Labor
Conditions
Keywords
Occipitoposterior position, Maternal posturing, Labor
Brief summary
Maternal posturing is used during labor to facilitate the rotation of occipitoposterior fetal position in anterior. Our study aims to evaluate the efficacy of asymmetrical lateral decubitus for rotation of the fetal head.
Detailed description
The prevalence of fetal occipitoposterior position during labor is 20%. Compared to anterior positions, they are known to be at higher risk of complications (cesarean section, instrumental delivery, severe perineal laceration). Maternal posturing is used during labor to facilitate the rotation of the fetal head in anterior position. Asymmetrical lateral decubitus is used frequently, without having ever been evaluated. Our study aims to evaluate the efficacy of this maternal posturing, through a randomized open trial. We hypothesized that posturing women in asymmetrical lateral decubitus allows increasing frequency of anterior fetal position after 1 hour.
Interventions
OTHERAsymmetrical Lateral Decubitus
After randomization, women are postured in pronounced lateral decubitus (side opposite to the back of the fetus), with the inferior leg in extension, and the superior leg in hyperflexion, during 1 hour (minimum 30 minutes). Then, women are encouraged to take this posture during labor as frequently as possible if the fetus remains in occipitoposterior position
OTHERcontrol
usual obstetrical care
Sponsors
URC-CIC Paris Descartes Necker Cochin
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* women older than 18 years * Gestational age ≥ 37SA, * Ruptured membranes, * single living fetus in cephalic presentation with an occipitoposterior position clinically diagnosed between 2 and 9 cm dilated and confirmed by ultrasound. * Affiliation to a social security scheme (beneficiary or assignee) * Signing the consent
Exclusion criteria
* Fetal presentation other than posterior * Multiple pregnancy, * Breech presentation * History of previous cesarean section * Fetal death in utero, termination of pregnancy * Fetal intrauterine fetal growth restriction \<5e percentile, * Fetal malformation, * Women younger than 18 years old, * Women do not understand French, * Women with psychiatric condition
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fetal head position | 1 hour | fetal head position one hour after randomization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| fetal head position | at diagnosis of full dilatation | Clinical evaluation of the fetal head position at diagnosis of full cervical dilatation confirmed with ultrasound |
| Speed of cervical dilatation | during the first stage of labour | Duration of labor between randomization and full dilatation |
| Mode of delivery and perineal complications | at delivery | Mode of delivery (spontaneous vaginal, instrumental vaginal delivery, cesarean section) and perineal complications (episiotomy, severe perineal tears). |
| feasibility and acceptability of asymmetrical lateral decubitus | during and after labour | quality of fetal heart rate monitoring during maternal posturing Evaluation of maternal satisfaction using self-administered questionnaire |
Countries
France
Outcome results
None listed