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. 2022 Aug 31;8(8):CD014615.
doi: 10.1002/14651858.CD014615.

Maternal postures for fetal malposition in labour for improving the health of mothers and their infants

Jennifer A Barrowclough  1   2 , Luling Lin  1 , Bridget Kool  3 , G Justus Hofmeyr  4 , Caroline A Crowther  1
Affiliations

Maternal postures for fetal malposition in labour for improving the health of mothers and their infants

Jennifer A Barrowclough et al. Cochrane Database Syst Rev. .

Abstract

Background: Fetal malposition (occipito-posterior and persistent occipito-transverse) in labour is associated with adverse maternal and infant outcomes. Whether use of maternal postures can improve these outcomes is unclear. This Cochrane Review of maternal posture in labour is one of two new reviews replacing a 2007 review of maternal postures in pregnancy and labour.

Objectives: To assess the effect of specified maternal postures for women with fetal malposition in labour on maternal and infant morbidity compared to other postures. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (13 July 2021), and reference lists of retrieved studies.

Selection criteria: We included randomised controlled trials (RCTs) or cluster-RCTs conducted among labouring women with a fetal malposition confirmed by ultrasound or clinical examination, comparing a specified maternal posture with another posture. Quasi-RCTs and cross-over trials were not eligible for inclusion.

Data collection and analysis: Two review authors independently assessed trials for inclusion, risk of bias, and performed data extraction. We used mean difference (MD) for continuous variables, and risk ratios (RRs) for dichotomous variables, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

Main results: We included eight eligible studies with 1766 women. All studies reported some form of random sequence generation but were at high risk of performance bias due to lack of blinding. There was a high risk of selection bias in one study, detection bias in two studies, attrition bias in two studies, and reporting bias in two studies. Hands and knees The use of hands and knees posture may have little to no effect on operative birth (average RR 1.14, 95% CI 0.87 to 1.50; 3 trials, 721 women; low-certainty evidence) and caesarean section (RR 1.34, 95% CI 0.96 to 1.87; 3 trials, 721 women; low-certainty evidence) but the evidence is uncertain; and very uncertain for epidural use (average RR 0.74, 95% CI 0.41 to 1.31; 2 trials, 282 women; very low-certainty evidence), instrumental vaginal birth (average RR 1.04, 95% CI 0.57 to 1.90; 3 trials, 721 women; very low-certainty evidence), severe perineal tears (average RR 0.88, 95% CI 0.03 to 22.30; 2 trials, 586 women; very low-certainty evidence), maternal satisfaction (average RR 1.02, 95% CI 0.68 to 1.54; 3 trials, 350 women; very low-certainty evidence), and Apgar scores less than seven at five minutes (RR 0.71, 95% CI 0.21 to 2.34; 2 trials, 586 babies; very low-certainty evidence). No data were reported for the hands and knees comparisons for postpartum haemorrhage, serious neonatal morbidity, death (stillbirth or death of liveborn infant), admission to neonatal intensive care, neonatal encephalopathy, need for respiratory support, and neonatal jaundice requiring phototherapy. Lateral postures The use of lateral postures may have little to no effect on reducing operative birth (average RR 0.72, 95% CI 0.43 to 1.19; 4 trials, 871 women; low-certainty evidence), caesarean section (average RR 0.78, 95% CI 0.44 to 1.39; 4 trials, 871 women; low-certainty evidence), instrumental vaginal birth (average RR 0.73, 95% CI 0.39 to 1.36; 4 trials, 871 women; low-certainty evidence), and maternal satisfaction (RR 0.96, 95% CI 0.84 to 1.09; 2 trials, 451 women; low-certainty evidence), but the evidence is uncertain. The evidence is very uncertain about the effect of lateral postures on severe perineal tears (RR 0.66, 95% CI 0.17 to 2.48; 3 trials, 609 women; very low-certainty evidence), postpartum haemorrhage (RR 0.90, 95% CI 0.48 to 1.70; 1 trial, 322 women; very low-certainty evidence), serious neonatal morbidity (RR 1.41, 95% CI 0.64 to 3.12; 3 trials, 752 babies; very low-certainty evidence), Apgar scores less than seven at five minutes (RR 0.25, 95% CI 0.03 to 2.24; 1 trial, 322 babies; very low-certainty evidence), admissions to neonatal intensive care (RR 1.41, 95% CI 0.64 to 3.12; 2 trials, 542 babies; very low-certainty evidence) and neonatal death (stillbirth or death of liveborn) (1 trial, 210 women and their babies; no events). For the lateral posture comparisons, no data were reported for epidural use, neonatal encephalopathy, need for respiratory support, and neonatal jaundice requiring phototherapy. We were not able to estimate the outcome death (stillbirth or death of liveborn infant) due to no events (1 trial, 210 participants). AUTHORS' CONCLUSIONS: We found low- and very low-certainty evidence which indicated that the use of hands and knees posture or lateral postures in women in labour with a fetal malposition may have little or no effect on health outcomes of the mother or her infant. If a woman finds the use of hands and knees or lateral postures in labour comfortable there is no reason why they should not choose to use them. Further research is needed on the use of hands and knees and lateral postures for women with a malposition in labour. Trials should include further assessment of semi-prone postures, same-side-as-fetus lateral postures with or without hip hyperflexion, or both, and consider interventions of longer duration or that involve the early second stage of labour.

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Conflict of interest statement

Jennifer Barrowclough: reports receiving a student scholarship from the Liggins Institute, University of Auckland, funds from Shundi Group Ltd, and funds from Work Force New Zealand education grant.

Caroline Crowther: has declared no conflict of interest.

Bridget Kool: has declared no conflict of interest

Luling Lin: has declared no conflict of interest.

Justus Hofmeyr: reports being an Associate Editor for Cochrane Pregnancy Childbirth, and reports no involvement in the editorial processing of this review. Reports receiving consulting fees and royalties unrelated to this topic.

Figures

1
1
Applying the Cochrane Pregnancy and Childbirth Trustworthiness Screening Tool
2
2
Study flow diagram
3
3
Figure 3. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
4
4
Figure 4. Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 1: Operative birth (composite outcome defined as caesarean section, instrumental vaginal birth)
1.2
1.2. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 2: Fetal malposition (OP/OT) after the intervention
1.3
1.3. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 3: Duration of labour
1.4
1.4. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 4: Oxytocin augmentation
1.5
1.5. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 5: Pain score (as defined by trialists using standardised tools available)
1.6
1.6. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 6: Pain score (as defined by trialists using standardised tools available
1.7
1.7. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 7: Improved comfort
1.8
1.8. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 8: Epidural use
1.9
1.9. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 9: Occipito‐posterior/transverse position at birth
1.10
1.10. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 10: Caesarean section
1.11
1.11. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 11: Instrumental vaginal birth
1.12
1.12. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 12: Episiotomy
1.13
1.13. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 13: Severe perineal tears (3rd degree or higher, as defined by trialists)
1.14
1.14. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 14: Maternal satisfaction (as defined by trialists using standardised tools available)
1.15
1.15. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 15: Maternal satisfaction (as defined by trialists using standardised tools available)
1.16
1.16. Analysis
Comparison 1: Hands and knees posture versus other postures, Outcome 16: Apgar scores less than seven at five minutes
2.1
2.1. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 1: Operative birth (composite outcome defined as caesarean section, instrumental vaginal birth)
2.2
2.2. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 2: Fetal malposition (OP/OT) after the intervention
2.3
2.3. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 3: Duration of labour
2.4
2.4. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 4: Oxytocin augmentation
2.5
2.5. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 5: Pain score (as defined by trialists using standardised tools)
2.6
2.6. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 6: Occipito‐posterior/transverse position at birth
2.7
2.7. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 7: Caesarean section
2.8
2.8. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 8: Instrumental vaginal birth
2.9
2.9. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 9: Episiotomy
2.10
2.10. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 10: Severe perineal tears (3rd degree or higher, as defined by trialists)
2.11
2.11. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 11: Postpartum haemorrhage (as defined by trialists)
2.12
2.12. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 12: Maternal satisfaction (as defined by trialists using standardised tools available)
2.13
2.13. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 13: Serious neonatal morbidity (composite outcome defined as death, admission to neonatal intensive care, neonatal encephalopathy or as defined by trialists)
2.14
2.14. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 14: Apgar scores less than seven at five minutes
2.15
2.15. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 15: Admission to neonatal intensive care
2.16
2.16. Analysis
Comparison 2: Any lateral posture versus other postures, Outcome 16: Birth trauma (as defined by trialists)
3.1
3.1. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 1: Operative birth (composite outcome defined as caesarean section, instrumental vaginal birth)
3.2
3.2. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 2: Fetal malposition (OP/OT) after the intervention
3.3
3.3. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 3: Duration of labour
3.4
3.4. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 4: Oxytocin augmentation
3.5
3.5. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 5: Occipito‐posterior/transverse position at birth
3.6
3.6. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 6: Caesarean section
3.7
3.7. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 7: Instrumental vaginal birth
3.8
3.8. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 8: Episiotomy
3.9
3.9. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 9: Severe perineal tears (3rd degree or higher, as defined by trialists)
3.10
3.10. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 10: Serious neonatal morbidity (composite outcome defined as death, admission to neonatal intensive care, neonatal encephalopathy or as defined by trialists)
3.11
3.11. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 11: Admission to neonatal intensive care
3.12
3.12. Analysis
Comparison 3: Lateral posture on same side as fetus versus other postures, Outcome 12: Birth trauma (as defined by trialists)
4.1
4.1. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 1: Operative birth (composite outcome defined as caesarean section, instrumental vaginal birth)
4.2
4.2. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 2: Fetal malposition (OP/OT) after the intervention
4.3
4.3. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 3: Duration of labour
4.4
4.4. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 4: Pain score (as defined by trialists using standardised tools)
4.5
4.5. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 5: Occipito‐posterior/transverse position at birth
4.6
4.6. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 6: Caesarean section
4.7
4.7. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 7: Instrumental vaginal birth
4.8
4.8. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 8: Episiotomy
4.9
4.9. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 9: Severe perineal tears (3rd degree or higher, as defined by trialists)
4.10
4.10. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 10: Postpartum haemorrhage (as defined by trialists)
4.11
4.11. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 11: Maternal satisfaction (as defined by trialists using standardised tools available)
4.12
4.12. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 12: Serious neonatal morbidity (composite outcome defined as death, admission to neonatal intensive care, neonatal encephalopathy or as defined by trialists)
4.13
4.13. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 13: Apgar scores less than seven at five minutes
4.14
4.14. Analysis
Comparison 4: Contralateral (opposite side to fetus) posture versus other postures, Outcome 14: Admission to neonatal intensive care
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References

References to studies included in this review

Bahmaei 2018 {published data only}
    1. Bahmaei K, Iravani M, Moosavi P, Haghighizadeh MH. Effect of maternal positioning with occipito-posterior fetal position during labor on pain intensity and satisfaction of mothers. Iranian Journal of Obstetrics, Gynecology and Infertility 2018;21(5):66-73. [CENTRAL: CN-01645940] [EMBASE: 623723760]
    1. IRCT2017082111360N3. The efficacy of maternal position in labor to correct occipito-posterior fetal position and delivery outcome. www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2017082111360N3 (first received 13 November 2017). [CENTRAL: CENTRAL: CN-01896062]
Bueno‐Lopez 2018 {published data only}
    1. 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: Issues in Perinatal Care 2018;45(4):385-92. [CENTRAL: CN-01667845] [EMBASE: 624963359] [PMID: ] - PubMed
    1. NCT02209090. Modified intrapartum sims position-related efficiency in correction of persistent foetal OP position [Randomised clinical trial: modified intrapartum maternal sims position-related efficiency in the correction of persistent foetal occipito-posterior position]. clinicaltrials.gov/show/NCT02209090 (first received 2 July 2014). [CENTRAL: CN-02025768]
Desbriere 2013 {published data only}
    1. Desbriere R, Blanc J, Le Du R, Renner JP, Carcopino X, Loundou A, et al. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. American Journal of Obstetrics and Gynecology 2013;208(1):60.e1-8. [CENTRAL: CN-00862750] [PMID: ] - PubMed
Guittier 2016 {published data only}
    1. Guittier MJ, Othenin-Girard V, Gasquet B, Irion O, Boulvain M. Authors' reply re: maternal positioning to correct occiput posterior fetal position during the first stage of the labour: a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2017;124(7):1124. - PubMed
    1. Guittier MJ, Othenin-Girard V, 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: an international journal of obstetrics and gynaecology 2016;123(13):2199-207. [CENTRAL: CN-01264392] [PMID: ] - PMC - PubMed
    1. Guittier MJ, Othenin-Girard V, Irion O, Boulvain M. Maternal positioning to correct occipito-posterior fetal position in labour: a randomised controlled trial. BMC Pregnancy and Childbirth 2014;14(1):83. [CENTRAL: CN-01118251] [EMBASE: 53026418] [PMID: ] - PMC - PubMed
    1. NCT01291355. Maternal positioning and occipitoposterior fetal position. clinicaltrials.gov/show/NCT01291355 (first received 7 February 2011). [CENTRAL: CN-02026525]
    1. Suzuki S. Re: maternal positioning to correct occiput posterior fetal position during the first stage of the labour: a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2017;124(7):1123-4. [EMBASE: 616364611] - PubMed
Le Ray 2016 {published data only}
    1. Blanc-Petitjean P, Le Ray C, Lepleux F, De La Calle A, Dreyfus M, Chantry AA. Factors affecting rotation of occiput posterior position during the first stage of labor. Journal of Gynecology Obstetrics and Human Reproduction 2018;47(3):119-25. [CENTRAL: CN-01627539] [PMID: ] - PubMed
    1. Le Ray C, Lepleux F, De La Calle A, Guerin J, Sellam N, Dreyfus M, et al. Lateral asymmetric decubitus for rotation of occiput posterior position: multicenter randomized controlled trial EVADELA. American Journal of Obstetrics and Gynecology 2016b;214(1 Suppl):S335-S336. [CENTRAL: CN-01134796] [EMBASE: 72164820] - PubMed
    1. 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. American Journal of Obstetrics and Gynecology 2016;215(4):511.e1-7. [CENTRAL: CN-01368865] [PMID: ] - PubMed
    1. NCT01854450. Evaluation of asymmetrical lateral decubitus for rotation of occipitoposterior fetal position [Evaluation of asymmetrical lateral decubitus for rotation of occipitoposterior fetal position during labor: EVADELA multicentre randomized trial]. clinicaltrials.gov/show/NCT01854450 (first received 13 May 2013). [CENTRAL: CN-01542175]
Liu 2018 {published data only}
    1. Liu L-P, Chen J-H, Yang Z-J, Zhu J. Corrective effects of maternal extreme flexure and hip abduction combined with contralateral side-lying on persistent foetal occipito-posterior position. International Journal of Nursing Practice 2018;24(5):e12663. [CENTRAL: CN-01651307] - PubMed
Molina‐Reyes 2014 {published data only}
    1. Molina Reyes C, Munoz Martinez AL, Herrera Cabrerizo B, Berral Gutierrez MA, Moore T, Alcantara Lopez C. Investigation project: the efficacy of the intervention of maternal position during labor to change a persistent occipitoposterior fetal position. Journal of Maternal-fetal & Neonatal Medicine 2010;23(S1):279-80. [CENTRAL: CN-00794281]
    1. Molina Reyes CY, Berral Gutierrez A, Huete Morales D, Martinez Garcia E, Castellano Ibanez FD. Maternal satisfaction in the clinical trial ‘the efficacy of maternal posturing during labor on the prevention of fetal occiput posterior position' [Satisfacción materna en el ensayo clínico "Eficacia de la postura materna en partos con malj fetal occipitoposterior”]. Metas de Enfermeria 2013;16(9):60-7.
    1. Molina-Reyes CY, Martinez-Garcia E, Huete-Morales MD, Munoz-Martinez AL, Maldonado-Molina E, Molina-Cubero L. Maternal comfort and pain reduction for women in labour with fetal occiput-posterior position by using lateral decubitus and hands and knees postures: a randomised clinical trial [Comodidad materna y reduccion del dolor en mujeres con posicion fetal occipitoposterior durante el parto con el uso de las posturas de decubito lateral y manos-rodillas: ensayo clinico aleatorizado]. Matronas Profesion 2013;14(1):3-9. [CENTRAL: CN-02135242]
    1. Molina-Reyes CY, Muňoz-Martínez AL, Martínez-García E, Moore TL, Huete-Morales MD, Burgos-Sánchez JA. Eficacia de la postura materna manos-rodillas para corregir la posición fetal occipitoposterior en el parto. Index de Enfermería 2014;23(1/2):15-20.
Stremler 2005 {published and unpublished data}
    1. Stremler R, Hodnett E, Petryshen P, Stevens B, Weston J, Willan AR. Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Birth (Berkeley, Calif.) 2005;32(4):243-51. [CENTRAL: CN-00553411] [PMID: ] - PubMed
    1. Stremler R. The Labour Position Trial: A Randomized, Controlled Trial of Hands and Knees Positioning for Women Labouring with a Fetus in Occipitoposterior Position [Thesis]. Toronto (Canada): University of Toronto, 2003.

References to studies excluded from this review

Andrews 1981 {published data only}
    1. Andrews CM. Nursing intervention to change a malpositioned fetus. Advances in Nursing Science 1981;3:53-66. [CENTRAL: CN-00230276] - PubMed
Kariminia 2004 {published data only}
    1. Kariminia A, Chamberlain ME, Keogh J, Shea A. Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth. BMJ 2004;328(7438):490. - PMC - PubMed
    1. Kariminia A, Keogh J, Chamberlain M. The effect of hands and knees exercise on the incidence of OP position at birth. In: Perinatal Society of Australia and New Zealand 7th Annual Congress; 2003 March 9-12; Tasmania, Australia. 2003. [CENTRAL: CN-00433437]
Zhang 2017 {published data only}
    1. Zhang H, Huang S, Guo X, Zhao N, Lu Y, Chen M, et al. A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery 2017;50:117-24. [CENTRAL: CN-01600517] [EMBASE: 621962182] [PMID: ] - PubMed

References to studies awaiting assessment

Lu 2001 {published data only}
    1. Lu JX, Li HX, Shu BL. Clinical observation of lateral-prostrate position preventing persistent OP/OT position. Journal of Nursing Science 2001;16(3):136-7. [CENTRAL: CN-00601229]
Ou 1997 {published data only}
    1. Ou X, Chen X, Su J. Correction of occipito-posterior position by maternal posture during the process of labor. Zhonghua Fu Chan Ke za Zhi [Chinese Journal of Obstetrics and Gynecology] 1997;32(6):329-32. [CENTRAL: CN-00150937] [PMID: ] - PubMed
Wu 2001 {published data only}
    1. Wu X, Fan L, Wang Q. Correction of occipito-posterior by maternal postures during the process of labor. Zhonghua Fu Chan Ke za Zhi [Chinese Journal of Obstetrics and Gynecology] 2001;36(8):468-9. [CENTRAL: CN-00406800] [PMID: ] - PubMed

Additional references

Aiken 2015
    1. Aiken AR, Aiken CE, Albery MS, Brocklesby JC, Scott JG. Management of fetal malposition in the second stage of labour: a propensity score analysis. American Journal of Obstetrics and Gynecology 2015;212(3):355 e1-7. [DOI: 10.1016/j.ajog.2014.10.023] - DOI - PMC - PubMed
Akmal 2003
    1. Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound in Obstetrics and Gynecology 2003;21(5):437-40. [DOI: 10.1002/uog.103] - DOI - PubMed
Akmal 2004
    1. Akmal S, Tsoi E, Howard R, Osei E, Nicolaides KH. Investigation of occiput posterior delivery by intrapartum sonography. Ultrasound in Obstetrics and Gynecology 2004;24(4):425-8. [DOI: 10.1111/j.1471-0528.2004.00134.x] - DOI - PubMed
Allman 1996
    1. Allman AC, Genevier ES, Johnson MR, Steer PJ. Head-to-cervix force: an important physiological variable in labour. 2. Peak active force, peak active pressure and mode of delivery. British Journal of Obstetrics and Gynaecology 1996;103(8):769-75. [DOI: 10.1111/j.1471-0528.1996.tb09871.x] - DOI - PubMed
Anderson 1965
    1. Anderson DG. Arrested occiput posterior positions. Clinical Obstetrics and Gynecology 1965;8(4):867-81. [DOI: 10.1097/00003081-196512000-00006] - DOI - PubMed
Andrews 2004
    1. Andrews CM, Andrews EC. Physical theory as a basis for successful rotation of fetal malpositions and conversion of fetal malpresentations. Biological Research for Nursing 2004;6(2):126-40. [DOI: 10.1177/1099800404268318] - DOI - PubMed
Ashwal 2016
    1. Ashwal E, Wertheimer A, Aviram A, Pauzner H, Wiznitzer A, Yogev Y, et al. The association between fetal head position prior to vacuum extraction and pregnancy outcome. Archives of Gynecology and Obstetrics 2016;293(3):567-73. [DOI: 10.1007/s00404-015-3884-x] - DOI - PubMed
Ayers 2001
    1. Ayers S, Pickering AD. Do women get post-traumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001;28:111-8. [DOI: 10.1097/01.grf.0000129919.00756.9c] - DOI - PubMed
Barbier 2007
    1. Barbier A, Poujade O, Fay R, Thiebaugeorges O, Levardon M, Deval B. Is primiparity, the only risk factor for type 3 and 4 perineal injury, during delivery? Gynecologie, Obstetrique and Fertilite 2007;35(2):101-6. [DOI: 10.1016/j.gyobfe.2006.12.017] - DOI - PubMed
Barth 2015
    1. Barth WH. Persistent occiput posterior. Obstetrics and Gynecology 2015;125(3):695-709. [DOI: 10.1097/AOG.0000000000000647] - DOI - PubMed
Blumenthal 1982
    1. Blumenthal NJ, Merrell DA, Langer O. Obstetrics in the very young black South African teenager. South African Medical Journal 1982;61(14):518-20. [www.ncbi.nlm.nih.gov/pubmed/7064033] - PubMed
Boog 2006
    1. Boog G. How to reduce the incidence and complications of occiput posterior positions during delivery? Gynecologie, Obstetrique and Fertilite 2006;34(11):1003-6. [DOI: 10.1016/j.gyobfe.2006.09.007] - DOI - PubMed
Carlisle 2017
    1. Carlisle JB. Data fabrication and other reasons for non-random sampling in 5087 randomised, controlled trials in anaesthetic and general medical journals. Anaesthesia 2017;72(8):944-52. [DOI: ] - PubMed
Cheng 2006a
    1. Cheng YW, Shaffer BL, Caughey AB. Associated factors and outcomes of persistent occiput posterior position: a retrospective cohort study from 1976 to 2001. Journal of Maternal-fetal & Neonatal Medicine 2006;19(6):563-8. [DOI: 10.1080/14767050600682487] - DOI - PubMed
Cheng 2006b
    1. Cheng YW, Shaffer BL, Caughey AB. The association between persistent occiput posterior position and neonatal outcomes. Obstetrics and Gynecology 2006;107(4):837-44. [DOI: 10.1097/01.AOG.0000206217.07883.a2] - DOI - PubMed
Cheng 2006c
    1. Cheng YW, Norwitz ER, Caughey AB. The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. American Journal of Obstetrics & Gynecology 2006;195(3):856-62. [PMID: 10.1016/j.ajog.2006.06.017] - DOI - PubMed
Cunningham 2018
    1. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25th edition. New York: McGraw-Hill Education, 2018.
de la Torre 2006
    1. la Torre L, Gonzalez-Quintero VH, Mayor-Lynn K, Smarkusky L, Hoffman MC, Saab A, et al. Significance of accidental extensions in the lower uterine segment during cesarean delivery. American Journal of Obstetrics and Gynecology 2006;194(5):4-6. [DOI: 10.1016/j.ajog.2006.01.026] - DOI - PubMed
Doggett 1967
    1. Doggett TH. Management of the persistent occiput posterior position. Southern Medical Journal 1967;60(5):494-7. [DOI: 10.1097/00007611-196705000-00011] - DOI - PubMed
Dudding 2008
    1. Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Annals of Surgery 2008;247(2):224-37. [DOI: 10.1097/SLA.0b013e318142cdf4] - DOI - PubMed
Eggebo 2015
    1. Eggebo TM, Hassan WA, Salvesen KA, Torkildsen EA, Ostborg TB, Lees CC. Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor. Ultrasound in Obstetrics and Gynecology 2015;46(5):606-10. [DOI: 10.1002/uog.14773] - DOI - PubMed
El‐Mowafi 2017
    1. El-Mowafi DM. Maternal changes due to pregnancy. In: Campana A, editors(s). Obstetrics Simplified. Geneva: GMFR Geneva Foundation For Medical Education and Research, 2017.
Fitzpatrick 2001
    1. Fitzpatrick M, McQuillan K, O'Herlihy C. Influence of persistent occiput posterior position on delivery outcome. Obstetrics and Gynecology 2001;98(6):1027-31. [DOI: 10.1016/s0029-7844(01)01600-3] - DOI - PubMed
Gardberg 1994
    1. Gardberg M, Tuppurainen M. Anterior placental location predisposes for occiput posterior presentation near term. Acta Obstetricia et Gynecologica Scandinavica 1994;73(2):151-2. [DOI: 10.3109/00016349409013418] - DOI - PubMed
Gardberg 1998
    1. Gardberg M, Laakkonen E, Salevaara M. Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries. Obstetrics and Gynecology 1998;91(5 Pt 1):746-9. [DOI: 10.1016/s0029-7844(98)00074-x] - DOI - PubMed
Ghi 2016
    1. Ghi T, Youssef A, Martelli F, Bellussi F, Aiello E, Pilu G, et al. Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery. Ultrasound in Obstetrics and Gynecology 2016;48(4):511-5. [DOI: 10.1002/uog.15808] - DOI - PubMed
Gilboa 2013
    1. Gilboa Y, Kivilevitch Z, Spira M, Kedem A, Katorza E, Moran O, et al. Pubic arch angle in prolonged second stage of labor: clinical significance. Ultrasound in Obstetrics and Gynecology 2013;41(4):442-6. [DOI: 10.1002/uog.12304] - DOI - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed 1 December 2021. Hamilton (ON): McMaster University (developed by Evidence Prime). Available at gradepro.org.
Higgins 2011
    1. Higgins JP, Green S, editor(s. Cochrane Handbook for Systematic Reviews of InterventionsVersion 5.1.0 (updated March 2011). The CochraneCollaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Higgins 2021
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane 2021. Available from www.training.cochrane.org/handbook 2021.
Higgins 2022
    1. Higgins JPT, Eldridge S, Li T (editors) . Chapter 23: Including variants on randomized trials. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022 . Available from www.training.cochrane.org/handbook.
Hodnett 1987
    1. Hodnett ED, Simmons-Tropea DA. The Labour Agentry Scale: psychometric properties of an instrument measuring control during childbirth. Research in Nursing and Health 1987;10(5):301-10. [DOI: 10.1002/nur.4770100503] - DOI - PubMed
Hodnett 2013
    1. 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. [DOI: 10.7717/peerj.25] [PMID: ] - DOI - PMC - PubMed
Ingemarsson 1980
    1. Ingemarsson E, Ingemarsson I, Solum T, Westgren M. Influence of occiput posterior position on the fetal heart rate pattern. Obstetrics and Gynecology 1980;55(3):301-4. [DOI: 10.1097/00006250-198003000-00006] - DOI - PubMed
Kjaergaard 2008
    1. Kjaergaard H, Olsen J, Ottesen B, Nyberg P, Dykes AK. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study. BMC Pregnancy and Childbirth 2008;8(1):45. [DOI: 10.1186/1471-2393-8-45] - DOI - PMC - PubMed
Kutcipal 1959
    1. Kutcipal RA. The persistent occiput posterior position: a review of 498 cases. Obstetrics and Gynecology 1959;14:296-304. [www.ncbi.nlm.nih.gov/pubmed/14412967] - PubMed
Lee 2021
    1. 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. [DOI: 10.1016/j.midw.2021.103008] - DOI - PubMed
Levy 2021
    1. 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. American Journal of Obstetrics & Gynecology MFM 2021;3(4):100346. [DOI: 10.1016/j.ajogmf.2021.100346] - DOI - PubMed
Lieberman 2005
    1. Lieberman E, Davidson K, Lee-Parritz A, Shearer E. Changes in fetal position during labor and their association with epidural analgesia. Obstetrics and Gynecology 2005;105(5 Pt 1):974-82. [DOI: 10.1097/01.AOG.0000158861.43593.49] - DOI - PubMed
Liljestrom 2018
    1. Liljestrom L, Wikstrom AK, Agren J, Jonsson M. Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study. Acta Obstetricia et Gynecologica Scandinavica 2018;97(5):615-23. [DOI: 10.1111/aogs.13316] - DOI - PubMed
Lydon‐Rochelle 2001
    1. Lydon‐Rochelle MT, Holt VL, Martin DP. Delivery method and self‐reported postpartum general health status among primiparous women. Journal of Paediatric Perinatal Epidemiology 2001;15(3):232-40. [ISSN 0269-5022] - PubMed
Martins 2011
    1. Martins VB, Toledo Florêncio TM, Grillo LP, do Carmo P, Franco M, Martins PA, et al. Long-lasting effects of undernutrition. International Journal of Environmental Research and Public Health 2011;8(6):1817-46. [DOI: 10.3390/ijerph8061817] [PMID: ] - DOI - PMC - PubMed
Menichini 2021
    1. 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. Journal of Maternal-Fetal & Neonatal Medicine 2021 Feb 21 [online publication]:1-10. [DOI: 10.1080/14767058.2021.1890018] - DOI - PubMed
Orlovic 2017
    1. Orlovic M, Carter AW, Marti J, Mossialos E. Estimating the incidence and the economic burden of third and fourth-degree obstetric tears in the English NHS: an observational study using propensity score matching. BMJ Open 2017;7(6):e015463. [DOI: 10.1136/bmjopen-2016-015463] - DOI - PMC - PubMed
Parente 2009
    1. Parente MP, Jorge RM, Mascarenhas T, Fernandes AA, Martins JA. The influence of an occipito-posterior malposition on the biomechanical behavior of the pelvic floor. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2009;144(Suppl 1):166-9. [DOI: 10.1016/j.ejogrb.2009.02.033] - DOI - PubMed
Phipps 2014
    1. Phipps H, Hyett JA, Graham K, Carseldine WJ, Tooher J, Vries B. Is there an association between sonographically determined occipito-transverse position in the second stage of labor and operative delivery? Acta Obstetricia et Gynecologica Scandinavica 2014;93(10):1018-24. [DOI: 10.1111/birt.12094] - DOI - PubMed
Ponkey 2003
    1. Ponkey SE, Cohen AP, Heffner LJ, Lieberman E. Persistent fetal occiput posterior position: obstetric outcomes. Obstetrics and Gynecology 2003;101(5 Pt 1):915-20. [DOI: 10.1016/s0029-7844(03)00068-1] - DOI - PubMed
Randal 1952
    1. Randal JH. The persistent occiput posterior. Journal of Iowa State Medical Society 1952;42:148-51. [www.ncbi.nlm.nih.gov/pubmed/14917902] - PubMed
Review Manager 2014 [Computer program]
    1. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Robinson 1996
    1. Robinson CA, Macones GA, Roth NW, Morgan MA. Does station of the fetal head at epidural placement affect the position of the fetal vertex at delivery? American Journal of Obstetrics and Gynecology 1996;175(4):991-4. [DOI: 10.1016/S0002-9378(96)80039-1] - DOI - PubMed
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from gdt.guidelinedevelopment.org/app/handbook/handbook.html.
Senécal 2005
    1. Senécal J, Xiong X, Fraser WD. Effect of fetal position on second-stage duration and labour outcome. Obstetrics and Gynecology 2005;105(4):763-72. [DOI: 10.1097/01.AOG.0000154889.47063.84] - DOI - PubMed
Sherer 2002
    1. Sherer DM, Miodovnik M, Bradley KS, Langer O. Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor. Ultrasound in Obstetrics and Gynecology 2002;19(3):258-63. [DOI: 10.1046/j.1469-0705.2002.00641.x] - DOI - PubMed
Sokol 1981
    1. Sokol RJ. Occiput posterior position and fetal heart rate patterns. Obstetrics and Gynecology 1981;57(2):266-7. - PubMed
Souka 2003
    1. Souka AP, Haritos T, Basayiannis K, Noikokyri N, Antsaklis A. Intrapartum ultrasound for the examination of the fetal head position in normal and obstructed labor. Journal of Maternal-fetal & Neonatal Medicine 2003;13(1):59-63. [DOI: 10.1080/jmf.13.1.59.63] - DOI - PubMed
Stremler 2003
    1. Stremler RL. The Labour Position Trial: A Randomized, Controlled Trial of Hands and Knees Positioning for Women Labouring with a Fetus in Occipitoposterior Position [Thesis]. Toronto (Canada): University of Toronto, 2003. [search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=109843601&...
Suonio 1986
    1. Suonio S, Saarikoski S, Raty E, Vohlonen I. Clinical assessment of the pelvic cavity and outlet. Archives of Gynecology 1986;239(1):11-6. [DOI: 10.1007/bf02134282] - DOI - PubMed
Sutton 2000
    1. Sutton J. Occiput-posterior positioning and some ideas about how to change it! Practising Midwife 2000;3(6):20-2. [ISSN: 1461-3123] - PubMed
Wijma 1997
    1. Wijma K, Soderquist J, Wijma B. Posttraumatic stress disorder after childbirth: a cross sectional study. Journal of Anxiety Disorders 1997;11:587-97. [DOI: 10.1016/s0887-6185(97)00041-8] - DOI - PubMed
World Health Organization 1996
    1. World Health Organization (WHO). Care in normal birth: a practical guide; 1996. Report of a Technical Working Group. Report No.: WHO/FRH/MSM/96.24. Available at: cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2014/08/WHO_FRH_MSM_9... (accessed prior to 27 July 2022). [WHO/FRH/MSM/96.24]
Zahalka 2005
    1. Zahalka N, Sadan O, Malinger G, Liberati M, Boaz M, Glezerman M, et al. Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of fetal head position in second stage of labour. American Journal of Obstetrics and Gynecology 2005;193(2):381-6. [DOI: 10.1016/j.ajog.2004.12.011] - DOI - PubMed

References to other published versions of this review

Barrowclough 2019
    1. Barrowclough J, Kool B, Hofmeyr GJ, Crowther C . Maternal postures for fetal malposition in labour for improving the health of mothers and their infants. PROSPERO 2021 CRD42021214341 Available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021214341. - PMC - PubMed
Hunter 2007
    1. Hunter S, Hofmeyr GJ, Kulier R. Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No: CD001063. [DOI: 10.1002/14651858.CD001063.pub3] - DOI - PMC - PubMed

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