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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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https://afar.info/id=1099

Created on : 23 Mar 2005
Modified on : 25 Nov 2018

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Bibliographical entry (without author) :

Position for women during second stage of labour. Cochrane Database Syst Rev. 2004;(1):CD002006.

Author(s) :

Gupta JK, Hofmeyr GJ.

Year of publication :

2004

URL(s) :

http://www.mrw.interscience.wiley.com/cochrane/cls…

Résumé (français)  :

CONTEXTE : Controverse sur les avantages des différentes positions d’accouchement, verticales (assise, tabourets d’accouchements, sièges, quatre pattes), ou allongées.

OBJECTIFS : Déterminer les bénéfices et les risques de différentes positions lors du second stade du travail (i. e. à partir de la dilatation complète du col).

STRATEGIE DE RECHERCHE : Recherche systématique dans Cochrane, groupe “Pregnancy and Childbirth“, 16 avril 2003

CRITERES DE SELECTION : Essais randomisés ou quasi-randomisés, avec suivi adéquat et comparant diverses positions utilisées par les femmes au second stade du travail.

RECUEIL DES DONNEES ET ANALYSE : Nous avons indépendemment évalué la qualité des essais pour les inclure dans cette étude, et extrait les données.

PRINCIPAUX RESULTATS : Les résultats doivent être interprétés avec précaution car la qualité des 19 essais retenus (5764 personnes) était variable. L’utilisation de n’importe quelle position verticale ou en décubitus latéral, comparé au décubitus dorsal ou position lithotomique, était associé à : réduction de la durée du second stade du travail (10 essais : moyenne 4. 29 minutes, intervalle de confiance à 95% 2. 95 à 5. 64 minutes) - ce résultat était en grande partie du aux femmes assignées à utiliser un coussin d’accouchement ; une faible diminution des accouchements instrumentaux (18 essais : risque relatif 0. 84, intervalle de confiance à 0. 95% 0. 73 à 0. 98) ; une diminution des épisiotomies (12 essais : RR 0. 84, IC 95% 0. 79 à 0. 91) ; une augmentation des déchirures du second degré (11 essais : RR 1. 23, IC 95% 1. 09 à 1. 39) ; une augmentation des pertes sanguines supérieures à 500 ml (11 trials : RR 1. 68, IC 95% 1. 32 à 2. 15) ; moins de douleurs sévères rapportées pendant le second stade du travail (1 essai : RR 0. 73, IC 95% 0. 60 à 0. 90) ; moins d’anomalies du rythme cardiaque foetal (1 trial : RR 0. 31, IC 95% 0. 08 à 0. 98).

CONCLUSIONS : Les résultats de cette revue suggèrent que les positions verticales ont plusieurs avantages, et qu’ils augmentent peut-être le risque des pertes sanguines supérieures à 500 ml. Les femmes devraient être encouragées à accoucher dans la position qu’elles trouvent la plus confortable. Jusqu’à ce que les bénéfices et risques des différentes positions d’accouchement aient pu être établis avec une plus grande certitude, par des essais de méthodologie robuste, les femmes devraient pouvoir faire des choix éclairés sur les positions d’accouchement qu’elles souhaiteraient utiliser pour la naissance de leurs bébés.

Abstract (English)  :

BACKGROUND: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down have advantages for women delivering their babies.

OBJECTIVES: To assess the benefits and risks of the use of different positions during the second stage of labour (i.e. from full dilatation of the cervix).

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (16 April 2003).

SELECTION CRITERIA: Trials that used randomised or quasi-randomised allocation and appropriate follow up and compared various positions assumed by pregnant women during the second stage of labour.

DATA COLLECTION AND ANALYSIS: We independently assessed the trials for inclusion and extracted the data.

MAIN RESULTS: Results should be interpreted with caution as the methodological quality of the 19 included trials (5764 participants) was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: reduced duration of second stage of labour (10 trials: mean 4.29 minutes, 95% confidence interval (CI) 2.95 to 5.64 minutes) - this was largely due to a considerable reduction in women allocated to the use of the birth cushion; a small reduction in assisted deliveries (18 trials: relative risk (RR) 0.84, 95% CI 0.73 to 0.98); a reduction in episiotomies (12 trials: RR 0.84, 95% CI 0.79 to 0.91); an increase in second degree perineal tears (11 trials: RR 1.23, 95% CI 1.09 to 1.39); increased estimated blood loss greater than 500 ml (11 trials: RR 1.68, 95% CI 1.32 to 2.15); reduced reporting of severe pain during second stage of labour (1 trial: RR 0.73, 95% CI 0.60 to 0.90); fewer abnormal fetal heart rate patterns (1 trial: RR 0.31, 95% CI 0.08 to 0.98).

REVIEWER’S CONCLUSIONS: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss greater than 500 ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time as the benefits and risks of various delivery positions are estimated with greater certainty, when methodologically stringent trials’ data are available, women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies.

Sumário (português)  :

ANTECEDENTES: controvérsia sobre as vantagens dos diferentes posições de parto, verticais (sentado, entregas bancos, cadeiras, quatro guias), ou alongada.

OBJETIVOS: Para determinar os benefícios e riscos de diferentes posições durante a segunda etapa do trabalho (ou seja, a partir de dilatação cervical completa).

ESTRATÉGIA DE BUSCA: Busca sistemática em Cochrane grupo “Gravidez e Parto“, 16 de abril de 2003

CRITÉRIOS DE SELEÇÃO: randomizados ou quasi-randomizado, com acompanhamento adequado e comparando várias posições utilizado por mulheres na segunda etapa do trabalho.

COLETA DE DADOS E ANÁLISE: Avaliamos independentemente a qualidade dos estudos para inclusão neste estudo e extraímos os dados.

PRINCIPAIS RESULTADOS: Os resultados devem ser interpretados com cautela, porque a qualidade dos 19 estudos incluídos (5764 de pessoas) foi variável. O uso de qualquer posição vertical ou posição lateral em relação à posição de litotomia dorsal ou posição supina foi associado com: reduzindo a duração da segunda fase do trabalho de parto (10 testes: média de 4,29 minutos, intervalo de confiança de 95% 2,95 a 5,64 minutos) - este resultado foi em grande parte devido às mulheres designadas para usar uma almofada de parto; uma ligeira diminuição nos partos instrumentais (18 ensaios: risco relativo 0,84, intervalo de confiança 0,95% 0,73 a 0,98); uma diminuição nas episiotomias (12 ensaios: RR 0,84, IC 95% 0,79 a 0,91); um aumento de rupturas de segundo grau (11 ensaios: RR 1,23, IC 95% 1,09 a 1,39); um aumento na perda de sangue superior a 500 ml (11 estudos: RR 1,68, IC 95% 1,32 a 2,15); dor menos intensa relatada durante o segundo estágio do trabalho de parto (1 ensaio: RR 0,73, IC 95% 0,60 a 0,90); menos anormalidades da frequência cardíaca fetal (1 ensaio: RR 0,31, IC 95% 0,08 a 0,98).

CONCLUSÕES: Os resultados desta revisão sugerem que as posições verticais apresentam diversas vantagens, podendo aumentar o risco de perda sanguínea superior a 500 ml. As mulheres devem ser encorajadas a parir na posição que acharem mais confortável. Até que os benefícios e riscos de diferentes posições de entrega possam ser estabelecidos com maior certeza, através de testes metodológicos robustos, as mulheres devem ser capazes de fazer escolhas informadas sobre as posições de entrega que gostariam de ver. use para o nascimento de seus bebês.

Full text (private) :

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Comments :

Argument (français) :

Les positions autres qu’allongées auraient des avantages, mais augmentent peut-être le risque des pertes sanguines supérieures à 500 ml.

Argument (English):

Upright positions may have advantages, but may increase the risk of blood loss greater than 500 ml.

Argumento (português):

Posições não alongadas podem ter vantagens, mas podem aumentar o risco de perda de sangue maior que 500 ml.

Keywords :

➡ evidence-based medicine/midwifery ; position during labor ; perineal/vaginal tears ; postpartum hemorrhage ; fetal distress ; episiotomy ; instrumental delivery ; dilation

Author of this record :

Cécile Loup — 23 Mar 2005
➡ latest update : Bernard Bel — 25 Nov 2018

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