Influence of the prone position on a stretcher for pregnant women on maternal and fetal hemodynamic parameters and comfort in pregnancy

Abstract

Objectives:: To analyze the influence of lying in prone position on a specially designed stretcher on the maternal-fetal hemodynamic parameters and comfort of pregnant women.

Methods:: A randomized, controlled trial with 33 pregnant women divided into 2 groups: pregnant group sequence 1 and pregnant group sequence 2. The order of positions used in sequence 1 was Fowler's position, prone position, supine position, left lateral, Fowler's position 2, supine position 2, prone position 2 and left lateral 2. The order of positions used in sequence 2 was Fowler's position, prone position, left lateral, supine position, Fowler's position 2, left lateral 2, prone position 2 and supine position 2. Each woman remained in each position for 6 minutes. For the statistical analyses, we used Wilcoxon's test for 2 paired samples when comparing the prone position with the other positions. The variables are presented in graphs showing the means and 95% confidence intervals. Trial Registration: Clinical Trial No. ISRCTN41359519.

Results:: All the parameters were within the standards of normality. There were no differences between positions in terms of maternal heart rate, diastolic blood pressure, oxygen saturation and fetal heart rate. However, there were significant decreases in respiratory rate and systolic blood pressure in prone position 2 compared with left lateral 2. There was an increase in oxygen saturation in prone position compared with Fowler's position and supine position 2 in both sequences. All the women reported feeling comfortable in the prone position.

Conclusions:: The prone position was considered safe and comfortable and could be advantageous for improving oxygen saturation and reducing the systolic blood pressure and respiratory rate.

Figure 1

A. Lateral view of the prototype of the stretcher that was specifically designed for pregnant women. National Industrial Intellectual Property Institute (INPI Brazil) – BR 10 2014 017147 9 and International - Patent Cooperation Treaty (PCT/BR2015/000103) B. A pregnant woman in the prone position on the stretcherwith cervical support.

Figure 2

A. Supine position with a 15-degree tilt B. Left lateral position with support for the lower limbs C. Fowler’s position, i.e., semi-upright with slightly flexed knees and a 45° support placed behind the back.

Figure 3

Flow chart of the total number of participants in pregnant group sequence 1 (PGS1) and pregnant group sequence 2 (PGS2) according to the order of randomization.

Figure 4

Graphical representation of the heart rates of the pregnant women who performed sequence 1 (A) and sequence 2 (B). Graphical representation of the respiratory rates of the pregnant women who performed sequence 1 (C) and sequence 2 (D).

Figure 5

Graphical representation of the systolic blood pressure of the pregnant women who performed sequence 1 (A) and sequence 2 (B). Graphical representation of the diastolic blood pressure of the pregnant women who performed sequence 1 (C) and sequence 2 (D).

Figure 6

Graphical representation of the oxygen saturation of the pregnant women who performed sequence 1 (A) and sequence 2 (B).

Figure 7

Representation of the fetal heart rates of the fetuses of the pregnant women who performed sequence 1 (A) and sequence 2 (B).