Abstract:
Maternal Posture for Fetal Malposition in Labour for Improving the Health of Mothers and Their Infants – A Cochrane Systematic Review
Barrowclough Jennifer¹ Kool Bridget², Hofmeyr G Justus³, Crowther Caroline¹
1The Liggins Institute, University of Auckland, Auckland, New Zealand
2Faculty of Medical Health Sciences Administration, University of Auckland, Auckland, New Zealand
3Effective Care research Unit, University of Witwatersrand, Walter Sisulu, South Africa
Email: j.barrowclough@auckland.ac.nz
Background: Fetal malposition occurs in 25% of labours. 70% of persistent malposition result in an instrumental birth associated with increased maternal and neonatal morbidity. Studies of maternal posture to facilitate anterior fetal rotation are reported but have not been systematically reviewed. The aim was to undertake such a systematic review.
Methods: A Cochrane systematic review of maternal posture in labour for fetal malposition of randomised controlled trials within the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov and the WHO ICTRP. Participants: women in labour with fetal malposition. Interventions: maternal postures compared with standard care or alternative maternal postures. Postures: maternal side lying symmetrical and asymmetrical to fetus/or with extreme hip flexion, hands and knees, standing, lying flat, squatting and others. Outcomes included: mode of birth, persistent occipito-posterior/transverse (POP/T) position, labour duration, neonatal encephalopathy, 5 minute Apgar score <7, admission neonatal intensive care. Trials were assessed for risk of bias and quality of evidence using GRADE. Subgroup analyses were planned for parity, body mass index, birth weight, and fetal position left or right.
Results: A search of literature has located 10 eligible trials (date of search 30/10/19). Data synthesis used RevMan 2014 with any significant heterogeneity explored using sensitivity analyses.
Conclusions: These findings can be used by women, their care givers and by clinical practice guideline developers to improve health for women with a fetal malposition in labour and their infants.