Maternal position during the second stage of labor and maternal-neonatal outcomes in nulliparous women: a retrospective cohort studyAJOG Global Reports at a Glance

Alessandra Familiari, MD; Caterina Neri, MD; Elvira Passananti, MD; Giulia Di Marco, MD; Francesca Felici, MD; Elisa Ranieri; Maria Elena Flacco, MD, PhD; Antonio Lanzone, MD, PhD

AJOG Global Reports (Feb 2023)

Maternal position during the second stage of labor and maternal-neonatal outcomes in nulliparous women: a retrospective cohort studyAJOG Global Reports at a Glance

Alessandra Familiari, MD,
Caterina Neri, MD,
Elvira Passananti, MD,
Giulia Di Marco, MD,
Francesca Felici, MD,
Elisa Ranieri,
Maria Elena Flacco, MD, PhD,
Antonio Lanzone, MD, PhD

Affiliations

Alessandra Familiari, MD: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone); Corresponding author: Alessandra Familiari, MD.
Caterina Neri, MD: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone)
Elvira Passananti, MD: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone)
Giulia Di Marco, MD: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone)
Francesca Felici, MD: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone)
Elisa Ranieri: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone)
Maria Elena Flacco, MD, PhD: Department of Medical Sciences, University of Ferrara, Ferrara, Italy (Dr Flacco); Local Health Unit, University of Pescara, Pescara, Italy (Dr Flacco)
Antonio Lanzone, MD, PhD: Departments of Obstetrics and Gynaecology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy (Drs Familiari, Neri, Passananti, Di Marco, and Felici, XX Ranieri, and Dr Lanzone)

Journal volume & issue: Vol. 3, no. 1
p. 100160

Abstract

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BACKGROUND: The existing evidence is insufficient to draw conclusions about the association between maternal position in labor and obstetrical outcomes. OBJECTIVE: This study aimed to evaluate the effects of different maternal positions during the second stage of labor among women with and those without epidural analgesia on important obstetrical outcomes including perineal damage. STUDY DESIGN: In this retrospective cohort study, we collected data of women who delivered vaginally over a 2-year period. The associations between maternal and gestational characteristics and several obstetrical outcomes were analyzed. We considered perineal damage as the primary outcome. Secondary outcomes were the incidence of operative vaginal births, duration of fetal descent, intrapartum blood loss, and 1-minute and 5-minutes Apgar scores. RESULTS: A total of 2240 nulliparous, at-term pregnancies were included. Of those, 76.9% gave birth in a supine position and 23.1% gave birth in alternative positions. The results showed that regardless of the use of epidural analgesia, nonsupine positions in the second stage of labor are associated with a significant reduction in the risk of both episiotomy and perineal damage to any degree (P<.0001) and to a reduction in the duration of fetal descent (Spearman rho, 9.17; confidence interval, 3.07–15.32; P=.003). No statistically significant differences were found in the 1-minute and 5-minutes Apgar score between the 2 groups. CONCLUSION: Our results show that nonsupine positions in the second stage of labor and at the time of birth are associated with a significant increase in having an intact perineum and a reduction in any perineal trauma and in the need for an episiotomy regardless of the use of epidural analgesia.

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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