Left Occipitoposterior: Understanding the Causes, Symptoms, and Treatments
– This article describes a randomised clinical trial being conducted to evaluate the effects of different positions on the outcome of occipitoposterior (OP) position during labor.
– The study will compare the hands and knees position with expectant management (no intervention).
– The study will only include nulliparous and multiparous women during the first stage of labor with a cervical dilatation between 2 to 9 cm, a singleton pregnancy at term (≥ 37 weeks’ gestation), and an OP position diagnosed by ultrasound.
– Women under 18 years old, with limited understanding of French, or who have attempted hands and knees positions previously during labor are excluded from the study.
– Randomisation will be performed using a web-based system and the ratio for hands and knees versus expectant management is 1:1.
– The study interventions involve women in the hands and knees position group choosing one of six positions described by Dr. de Gasquet.
– There are six fitted positions that can be used, with three important points to be observed: resting on the knees and hands if necessary, thrusting the abdomen forward, and keeping the back stretched.
– A pillow can be used for comfort, and the woman can choose to place her abdomen on a cushion or leave it unsupported.
– All midwives in the delivery room have been trained in managing the OP position using specific hand and knee positions.
– In the expectant management arm, women will receive usual care and have the option to adopt a hands and knees’ position after one hour. The position of the woman during this hour will be recorded.
– Participants in both groups will complete a questionnaire on perceived pain and comfort, and fetal head position will be verified one hour after randomization or at delivery.
– The primary outcome measure is fetal head in anterior position.
– The study aims to compare different maternal positions during labor and their impact on fetal head rotation.
– The study will assess the effectiveness of various positions on fetal head rotation, comfort of maternal positions, pain perception, duration of labor stages, mode of delivery, perineal status, and neonate outcomes.
– Data analysis will be performed using statistical tests such as t-tests, chi-square tests, and non-parametric tests.
– A sample size of 438 women is needed to show a statistically significant difference in the incidence of the main outcome measure.
– The study estimates that around 300 eligible women per year will be proposed for study entry, and the required sample size could be reached in around 35 months.
– The study is expected to be completed in June 2014.
– The study protocol has been approved by the institutional ethics committee, and safety considerations for mothers and fetuses will be closely monitored.
– The study ensures that women have the right to withdraw consent without impacting the quality of care or staff attitude.
– Data will be kept confidential and participants will be identified with a number.
– The study results will be reported anonymously.