Maternal Position Effects On The Perinatal Outcomes In The Second Stage Of Labor

Objective: To evaluate the effects of no-supine position, such as lateraland hands-and-knees position, on perinatal outcomes during second stage oflabor, like episiotomies, perineal lacerations, perineal edema, blood lose after2hours of labor, meconium-stained liquor, fetal heart rate patterns andneonatal asphyxia.Methods: This prospective controlled trial included633primiparadeliveried in the Fourth Hospital of Hebei Medical University betweenJanuary2013and March2014, who were laboring with a head presentationfetus at20-36years old,37-41+6weeks’ gestation, without epiduralanaesthesia and other serious complication. A group of317women whochoose the lateral or hands-and-knees position, and a control group of316women who choose supine position. Application of SPSS13.0statisticalsoftware, Maternal and neonatal outcomes were compared with the use ofStudent t tests, Mann-Whitney U rank sum test, chi-squared, and Fisher exacttest,and a probability value of0.05was used to indicate statistical significance.Risk ratios and95%confidence intervals were calculated.Results:1In primigravid women the use of any no-supine position compared withsupine positions, there was a significant reduction in episiotomies (5.36%vs23.42%, χ2=41.91, P=0.000, OR=0.19,95%CI0.11-0.32），an increase in firstdegree perineal lacerations (85.18%vs65.19%, χ2=33.88，P=0.000,OR=3.07,95%CI2.08-4.52), fewer perineal edema (13.56%vs21.20%, χ2=6.43,P=0.011, OR=0.58,95%CI0.38-0.89)，the second degree perineal lacerationswas no significant difference, there was no intact perineum，third or fourthdegree perineal lacerations.2The rate of meconium-stained liquor was fewer（20.82%vs33.23%, χ2=12.36，P=0.000, OR=0.53,95%CI0.37-0.76) in the group of no-supineposition. Though the duration of second stage of labor was longer, and anincreasing rates of prolonged second stage of labor, and a greater of blood loseafter2hours of labor in the no-supine position group, there have a significantdifferences(P<0.05), however, there were non-significant in operative vaginaldelivery, using of oxytocin in the second stage of labor or neonatal asphyxia.3The group of no-supine position has grater normal fetal heart rate patterns(82.34%vs65.82%, χ2=22.48，P=0.000, OR=2.42,95%CI1.67-3.51); fewerearly deceleration (10.09%vs17.09%, χ2=6.59, P=0.010, OR=0.55,95%CI0.34-0.87)；fewer variable deceleration (2.84%vs6.65%, χ2=5.08，P=0.024,OR=0.41，95%CI0.19-0.91)；fewer late deceleration (3.15%vs7.59%,χ2=6.14, P=0.013, OR=0.39,95%CI0.19-0.84)；the tachycardia between thegroups was no significant differences(P>0.05). Though the neonatal asphyxiawere five in the no-supine position group and six in the supine position group,there were no significant differences(P>0.05).Conclusion: The findings of this study suggest several possible benefitsfor no-supine position, lateral or hands-and-knees position, which may reducethe episiotomies and perineal edema,, decline perineal lacerations, abnormalfetal heart rate patterns and meconium-stained liquor. No-supine position mayhave a longer second stage of labor, however, it was not increased the risk offetal distress, operative vaginal delivery or neonatal asphyxia. Blood lose after2hours of labor is more in no-supine position in this study, but it needsadvanced study.