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

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https://afar.info/id=1122

Created on : 01 Apr 2005
Modified on : 28 Oct 2018

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Bibliographical entry (without author) :

Supine position compared to other positions during the second stage of labor: a meta-analytic review. J Psychosom Obstet Gynaecol. 2004 Mar;25(1):35-45.

Author(s) :

De Jonge A, Teunissen TA, Lagro-Janssen AL.

Year of publication :

2004

URL(s) :

https://www.researchgate.net/publication/8338914_S…
https://doi.org/10.1080/01674820410001737423

Résumé (français)  :

L’utilisation en routine de la position lithotomique pendant la deuxième phase du travail peut être considérée comme une intervention en soi dans le déroulement physiologique de l’accouchement. Le but de cette étude est de déterminer si cette pratique est justifiée et peut être conservée. Neuf essais randomisés contrôlés et une étude de cohorte ont été analysés. Une méta-analyse montre qu’il y a plus d’extractions instrumentales et d’épisiotomies en position lithotomique. Les pertes de sang et taux d’hémarrogie post-partum sont plus faibles, mais il n’est pas certain que cette différence soit réelle ou due à un biais d’observation [?observed difference]. Bien qu’hétérogènes, les données indiquent que les femmes ressentent plus de douleur en position lithotomique et qu’elles préfèrent d’autres positions pour accoucher.

Nous avons identifié de nombreux problèmes méthodologiques dans ces études, et nous remettons en question la pertinence des études randomisées contrôlées pour l’étude de ce sujet. Une étude de cohorte serait plus appropriée, associée à une méthode qualitative pour étudier les expériences des femmes. Des mesures de laboratoire objectives devraient être utilisées pour examiner les différences de perte sanguine.

En conclusion, les résultats ne justifient pas de continuer à utiliser la position lithotomique en routine pendant le second stade du travail.

Abstract (English)  :

The routine use of the supine position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish whether the continuation of this intervention is justified. Nine randomized controlled trials and one cohort study were included. A meta-analysis indicated a higher rate of instrumental deliveries and episiotomies in the supine position. A lower estimated blood loss and lower rate of postpartum hemorrhage were found in the supine position, however it is not clear whether this is a real or only an observed difference. Heterogenous, non-pooled data showed that women experienced more severe pain in the supine position and had a preference for other birthing positions.

Many methodological problems were identified in the studies and the appropriateness of a randomized controlled trial to study this subject is called into question. A cohort study is recommended as a more appropriate methodology, supplemented by a qualitative method to study women’s experiences. Objective laboratory measurements are advised to examine the difference in blood loss.

In conclusion, the results do not justify the continuation of the routine use of the supine position during the second stage of labor.

Sumário (português)  :

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Argument (français) :

Méta-analyse comparant l’accouchement en position couchée à d’autres positions pendant la seconde phase du travail. En position couchée, plus d’extractions instrumentales, d’épisiotomies, et de douleur ; moindre satisfaction maternelle. Plus de pertes de sang en position non allongée (60 ml, statistiquement significatif) sans augmentation des transfusions. Il n’y a pas de différence significative pour les résultats sur le foetus. Etudes prises en compte : fiches AFAR 1159, 1160, 1127, 1161, 1165, 1162, 1113, 1158, 2043, 1163

Argument (English):

High quality meta-analysis comparing supine with other positions for the second stage of labor. The only significant results are, supine vs others : more instrumental deliveries and more episiotomies, more pain and less satisfaction. None of the foetal outcomes shows any significant difference.

Argumento (português):

Meta-análise comparando o nascimento propenso a outras posições durante a segunda fase do trabalho de parto. Em decúbito dorsal, não há mais extrações instrumentais, episiotomias e dor; menor satisfação materna. Mais perda de sangue na posição não estendida (60 ml, estatisticamente significante) sem transfusão aumentada. Não há diferença significativa para os resultados no feto.

Keywords :

➡ alternative birth ; duration of labour ; ethics ; evidence-based medicine/midwifery ; physiology ; position during labor ; psychology ; perineal/vaginal tears ; pain ; postpartum hemorrhage ; deontology ; fetal distress ; episiotomy ; instrumental delivery ; active management of labor

Author of this record :

Cécile Loup — 01 Apr 2005
➡ latest update : Bernard Bel — 28 Oct 2018

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#1127   de Jong PR, Johanson RB, Baxen P, Adrians VD, van der Westhuisen S, Jones PW. (1997). Randomised trial comparing the upright and supine positions for the second stage of labour. Br J Obstet Gynaecol. 1997 May;104(5):567-71. ➡ https://afar.info/id=1127
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