Persistent Occiput Posterior Position During Labor
Conditions
Keywords
occiput-posterior, occipitoposterior, labour
Brief summary
Aim: To evaluate the efficiency of the modified Sims position versus maternal free positions in the rotation of persistent foetal occipito-posterior position intrapartum in pregnant women with epidural anaesthesia. Design: An open, randomised, controlled and parallel clinical trial will be conducted at the Delivery Room of the Area Materno-Infantil, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Method: Fifty-six pregnant women with persistent foetal occipito-posterior position will be selected. Each woman will be assigned to a control or experimental group via an opaque envelope at a 1:1 ratio. The control group will deliver in free intrapartum positions, and the experimental group in a modified Sims position. Correction of foetal position is the key study variable, and delivery type the secondary variable. Statistical analyses will be made with the SPSS v.20 program.
Detailed description
Aim: To evaluate the efficiency of the modified Sims position versus maternal free positions in the rotation of persistent foetal occipito-posterior position intrapartum in pregnant women with epidural anaesthesia. Background: There is a theoretical basis for the possible effects of maternal positions on foetal positions. Despite all the studies published in recent years, conclusive trials providing significant scientific evidence are lacking. Design: An open, randomised, controlled and parallel clinical trial will be conducted at the Delivery Room of the Area Materno-Infantil, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Method: Fifty-six pregnant women with persistent foetal occipito-posterior position will be selected. Each woman will be assigned to a control or experimental group via an opaque envelope at a 1:1 ratio. The control group will deliver in free intrapartum positions, and the experimental group in a modified Sims position. Correction of foetal position is the key study variable, and delivery type the secondary variable. Statistical analyses will be made with the SPSS v.20 program. Discussion: If the modified maternal Sims position proved to correct persistent foetal occipito-posterior positions and being a non-invasive, low-cost, non-prejudicial method for both mother and foetus, maternal and foetal morbidity problem would be reduced
Interventions
PROCEDUREmaternal modified sims position
Maternal Modified Sims position during at least 40 minutes for each 60 minutes
PROCEDUREmaternal free positions
At least 40 minutes each hour during labour
Sponsors
University of Barcelona
Hospital Universitari Vall d'Hebron Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* adult pregnant women (\>18 years of age) * persistent posterior foetal position diagnosed during labour through two vaginal examinations two hours apart. * at-term gestations (37 to 42 weeks) * women in labour with epidural anaesthesia
Exclusion criteria
* multiple gestations * previous severe foetal malformation diagnosed * macrosomic foetus diagnosed by ultrasound in the 3rd trimester (\> percentile 95), or IUGR (\< percentile 10) * women with contraindicated vaginal delivery owing to previous vaginal surgeries * women with severe heart diseases * diabetic pregnant women (types I, II and gestational) * hypertension problems during labour * myopathies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rotation | During labour | the foetal head's capacity to rotate 145º clockwise until the minor fontanelle is situated under the pubic bone, expressed as yes or no, depending on whether there is rotation or not. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| rotating to OA | During labour | length of time taken by the foetal head to reach OA expressed in minutes from the start of the intervention |
| Delivery mode | The first two hours after delivery | eutocic: vaginal delivery, foetal head expulsion in vertex position, spontaneous |
Other
| Measure | Time frame | Description |
|---|---|---|
| epidural anaesthesia | During labour | doses of epidural anaesthesia required, concentration and ml. |
| episiotomy | The first two hours after delivery | whether performed or not to gain a major opening from the soft parts of the birth canal. |
| uterine dynamics | During labour | assessed by frequency and intensity according to Monteviedo unit calculation |
| reason to end labour earlier | The first two hours after delivery | cause that occurs on ending labour before it concludes spontaneously. Reasons may be foetal: risk of loss of foetal wellbeing, or maternal: pelvic foetal disproportion or stopped labour |
| maternal comfort during labour | The first two hours after delivery | MACKEY SATISFACTION CHILDBIRTH RATING SCALE validated in Spanish |
| tear | The first two hours after delivery | trauma occurring spontaneously by the foetal head passing through the vaginal cavity and/or perineum: |
| first stage in minutes | During labour | timed in minutes, from 3cm with cervix shortened until complete diltation. |
| second stage in minutes | The first two hours after delivery | timed from complete dilation to foetal head expulsion |
Countries
Spain
Contacts
Primary ContactVanessa Bueno, Midwife
Outcome results
None listed