Cesarean Delivery Affecting Fetus, Labor Complication, Labor Dystocia
Conditions
Keywords
fetal malposition, occiput posterior, occiput transverse
Brief summary
The goal of this randomized trial is to test if changing a person's position in labor can increase the chances of delivering their baby vaginally. Specifically, it aims to answer the questions: * In fetuses who are facing upwards (occiput posterior, OP) or sideways (occiput transverse, OT) during labor, does changing the patient's position during active labor to a side-lying posture with a peanut ball increase the chances of them having a successful, spontaneous vaginal delivery? * Does changing the patient's position in active labor affect the position of the baby at the time of delivery? * Do intentional position changes in labor impact patient-perceived autonomy during their labor and delivery experience? Participants will: * Receive an ultrasound during labor to determine the position of their baby * Be asked to adopt a specific position in labor (side-lying with peanut ball) if they are randomized to the study group * Receive additional ultrasounds during labor to assess their baby's position * Fill out a questionnaire about their labor experience following the delivery of their baby
Detailed description
In this randomized trial, the investigators aim to evaluate the effects of early ultrasound diagnosis and active management of fetal malposition during the first stage of labor. Specifically, the investigators will compare the modified Sims (side-lying) position ipsilateral to fetal spine with the addition of a peanut ball versus free maternal position choice in occiput posterior (OP) or occiput transverse (OT) fetuses diagnosed by ultrasound during active labor, defined as greater than 6cm cervical dilation. The primary outcome will be operative delivery rates, defined as either cesarean delivery or instrumental vaginal delivery with vacuum or forceps. The investigators will also assess rates of spontaneous rotation to occiput anterior (OA) position at complete dilation and at delivery, as well as the impact of the position changes on the patient's labor experience and their perceived autonomy.
Interventions
BEHAVIORALMaternal position change to side-lying lateral with peanut ball
Participants will be assisted into a position lying on their side, specifically the same side as the fetal spine diagnosed by ultrasound. An inflated peanut ball will be positioned between the legs to open the pelvis. They will be asked to maintain the position for 60 minutes.
BEHAVIORALFree maternal position
Participants will be asked to adopt any position of their choosing and to maintain it for 60 minutes. They will be asked to not use a peanut ball during the 60 minute study period.
Sponsors
Women and Infants Hospital of Rhode Island
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Intervention group (side-lying position with peanut ball) versus control group (free position choice, no peanut ball)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Maternal age \>18 * Term gestation (\>37 weeks) * Singleton pregnancy * Spontaneous or induced active labor (cervical dilation 6-9cm) * Epidural anesthesia * Cephalic fetal presentation, OP/OT position diagnosed by bedside ultrasound * Continuous external fetal monitoring * Ability to consent
Exclusion criteria
* Multiple gestations * Unanesthetized labor * Known fetal anomalies * Known intrauterine fetal demise * Inability to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Operative Delivery Rate | Enrollment in active labor through delivery, on average 12 hours | The combined rate of cesarean and instrumental vaginal deliveries in each study group |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rotation at Delivery | Enrollment in active labor through delivery, on average 12 hours | The percent of fetuses that rotate to facing downwards (occiput anterior, OA) at the time of delivery in each study group |
| Duration of Active Second Stage | Onset of second stage of labor to delivery, up to 4 hours | The mean amount of time spent pushing during the second stage of labor in each group (measured in minutes) |
| Estimated Blood Loss | Time of delivery to 24 hours postpartum | The mean amount of blood loss incurred at delivery in each study group (measured in mL) |
| Rotation at Complete Dilation | Enrollment in active labor through delivery, on average 12 hours | The percent of fetuses that rotate to facing downwards (occiput anterior) at the time of complete cervical dilation (10cm) in each study group |
| Score on Labor Agentry Scale | Time of delivery to discharge from hospital, on average 2 days | The mean score on the validated Labor Agentry Scale (LAS) in each study group, which measures the degree that the participant felt in control during their labor process. Possible total scores for the Labor Agentry Scale range from 10 (rarely felt in control) to 70 (almost always felt in control). |
| Apgar Scores | Time of delivery to 5 minutes postpartum | Mean Apgar Score at 1 and 5 minutes for fetuses delivered in each study group |
| Neonatal Intensive Care Unit (NICU) Admission | Time of delivery to up to 6 weeks postpartum | Rates of NICU admission following delivery in each study group |
| Degree of Laceration following Delivery | Time of delivery to admission to postpartum unit, on average 2 hours | The percent of each degree of vaginal laceration (first, second, third, fourth) sustained during vaginal delivery in each study group |
Countries
United States
Contacts
Primary ContactKathryn M Anderson, MD
Backup ContactAlexis Gimovsky, MD
Outcome results
None listed