Original Articles

The Impact of Maternal Position in Labor on Occiput-Posterior Position of Fetus and Pregnancy Outcomes in Pregnant Women Without Epidural Analgesia

Abstract

Objective: Fetal occiput posterior (OP) position is associated with more maternal and neonatal complications. This study aimed to investigate the effect of maternal position during labor on fetal OP position and pregnancy outcomes.
Materials and methods: This randomized clinical trial study included 180 primigravida women in labor with a single fetus and approved OP position. Participants were randomly allocated into three groups: semi-prone position (n=45), knee-chest position (n=45), and supine position (n=90). All participants were placed in the defined positions 15-30 min in labor until delivery. Data collected using Visual Analogue Scale and researcher made checklist. The ANOVA, Tukey post hoc, and the chi-square test were used to analyze.
Results: Among all participants who had OP, after intervention 16.3% in the semi-prone position, 14/3 % in the knee-chest position, and 33.7% of the control groups remained with OP at birth (X3=7/87, P=0.019). The rate of natural delivery was significantly higher in the semi-prone position and knee-chest position. The duration of active phase of labor and low back pain were significantly reduced in the semi-prone and knee-chest position compared to the control groups (P<0.05). There were no differences in the duration of the third stage of labor, APGAR score, and the rate of neonatal addition to neonatal intensive care unit, using oxytocin, and perineal tears (P>0.05).
Conclusion: The semi-prone and knee-chest positions increase the spontaneous rotation of occiput to the anterior position, vaginal delivery rates as well as a reduction in duration of active phase of labor and low back pain after delivery.

1. Tao H, Wang R, Liu W, Zhao Y, Zou L. The value of intrapartum ultrasound in the prediction of persistent occiput posterior position: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;238:25-32.
2. Simic M, Cnattingius S, Petersson G, Sandström A, Stephansson O. Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC Pregnancy Childbirth. 2017 21;17(1):72.
3. Gimovsky, A.C. (2021). The Role of Intrapartum Sonography in Persistent Occiput Posterior Position and Prolonged Labor. In: Malvasi, A. (eds) Intrapartum Ultrasonography for Labor Management. Springer, Cham; 2021. 183-91. https://doi.org/10.1007/978-3-030-57595-3_16
4. Lee N, Munro V, Oliver K, Flynn J. Maternal positioning with flexed thighs to correct foetal occipito-posterior position in labour: A systematic review and meta-analysis. Midwifery. 2021;99:103008.
5. Desbriere R, Blanc J, Le Dû R, Renner JP, Carcopino X, Loundou A, d'Ercole C. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. Am J Obstet Gynecol. 2013;208(1):60.e1-8.
6. Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli GB. Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. Biomed Res Int. 2014;2014:638093.
7. Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG. 2016;123(13):2199-2207.
8. Levy AT, Weingarten S, Ali A, Quist-Nelson J, Berghella V. Hands-and-knees posturing and fetal occiput anterior position: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2021;3(4):100346.
9. Simkin P, Hanson L, Ancheta R. The labor progress handbook: early interventions to prevent and treat dystocia.4th edition. John Wiley & Sons; 2017.
10. Bueno-Lopez V, Fuentelsaz-Gallego C, Casellas-Caro M, Falgueras-Serrano AM, Crespo-Berros S, Silvano-Cocinero AM, et al. Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial. Birth. 2018;45(4):385-392.
11. Menichini D, Mazzaro N, Minniti S, Ricchi A, Molinazzi MT, Facchinetti F, et al. Fetal head malposition and epidural analgesia in labor: a case-control study. J Matern Fetal Neonatal Med. 2022;35(25):5691-5696.
12. Le Ray C, Lepleux F, De La Calle A, Guerin J, Sellam N, Dreyfus M, et al. Lateral asymmetric decubitus position for the rotation of occipito-posterior positions: multicenter randomized controlled trial EVADELA. Am J Obstet Gynecol. 2016;215(4):511.e1-7.
13. Yang XJ, Sun Y. Comparison of caesarean section and vaginal delivery for pelvic floor function of parturients: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;235:42-48.
14. Hodnett ED, Stremler R, Halpern SH, Weston J, Windrim R. Repeated hands-and-knees positioning during labour: a randomized pilot study. PeerJ. 2013;1:e25.
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IssueVol 17, No 2 (June 2023) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jfrh.v17i2.12871
Keywords
Fetal Occiput Posterior Maternal Position Labor Epidural Analgesia Pregnancy Outcomes
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How to Cite
1.
Bahmaei H, Mousavi P, Haghighizadeh MH, Iravani M. The Impact of Maternal Position in Labor on Occiput-Posterior Position of Fetus and Pregnancy Outcomes in Pregnant Women Without Epidural Analgesia. J Family Reprod Health. 2023;17(2):86-92.