Table 1 Main characteristics of included studies
From: Maternal position during the first stage of labor: a systematic review
Study | Methods | Participants | Interventions | Outcome | Notes | Allocation Concealment |
|---|---|---|---|---|---|---|
FLYNN [2] (UK, 1978) | Random Generation: not stated Allocation Concealment Method: not stated ("Participants were. randomly allocated") | 68 women who expressed an interest in ambulation during labor. | Ambulant group: the intention was to keep the woman ambulant. Recumbent group: the intention was to keep the woman in a recumbent position. | Length of first stage of labor; Labor augmentation; Mode of delivery; and Apgar Score at 5th minute Others (time spent ambulant, contraction frequency and contraction amplitude, basal uterine tone, dose of intravenous or epidural analgesic, Apgar score at 1st minute) | There was no sampling calculation. | B |
McMANUS [8] (UK, 1978) | Random Generation: not stated Allocation Concealment by envelopes | 40 women with 38 weeks' gestation or more, singleton, with cervical score (Calder, 1974) greater than 5, cephalic presentation and induced labor. | Upright group: the women were encouraged to be up and about. Recumbent group: The women were nursed in the lateral position. | Labor augmentation; Mode of delivery; Analgesia; and Apgar score at 5th minute Others (Induction delivery interval, number of PGE2 tablets, dose of analgesic, Apgar score at 1st minute, Apgar score less than 4, number of women with fetal distress) | There was no sampling calculation. Induced labor | A |
READ [9] (USA, 1980) | Random Generation: not stated Allocation Concealment Method: not stated ("patients were prospectively randomized") | 14 women in active labor who demonstrated failure to progress over one or more hours, and whose contractions would require augmentation. | Ambulatory group: after the diagnosis of protracted labor, women of this group underwent a 2 h period of walking or standing in an upright position. | Mode of delivery; Apgar score at 5th minute. Others (labor progress characteristics (dilation and station, Apgar score at 1st minute) | There was no sampling calculation. All patients had ruptured membranes. Protracted labor | B |
HEMMINKI [10] (Finland, 1983) | Random Generation: not stated Allocation Concealment by sealed envelopes. | 627 low risk women who had spontaneous onset of labor, with intact membranes and who were sent from the reception ward to the delivery room during the study period. | Ambulant group: the women were asked by the midwife to be upright or ambulant, but with no obligation and being allowed to rest in the bed whenever they wanted. Control group: the women received the hospital's standard treatment, which means that after arriving in the delivery room they lay in bed, usually on their sides. | Length of labor (first and second stage); Labor augmentation; Mode of delivery; Apgar score at 5th minute; and Analgesia Others (episiotomy, well-being of the fetus, shoulder dystocia, Apgar score at 1st minute, Apgar score less than 7 at 5th minute, days in the hospital, admission to a special care unit, stillbirth and neonatal death) | There was no sampling calculation. Amniotomy was delayed in the study group (co-intervention). | A |
HEMMINKI [11] (Finland, 1985) | Random Generation: not stated Allocation Concealment was conducted separately for primipara and multipara by sealed envelopes. | 57 women with protracted labor. | Ambulant group: women were encouraged to be upright or ambulant. Oxytocin group: women received the standard treatment provided by the hospital. | Length of labor; Mode of delivery; Apgar score at 5th minute; Women's experiences (maternal comfort). Others (episiotomy, strength of contractions before pushing) | There was no sampling calculation. Protracted labor | A |
ANDREWS [12] (USA, 1990) | Random Generation: not stated Allocation Concealment Method: not stated ("Participants were randomly assigned") | 40 women "All participants were nulliparous, experiencing a medically uncomplicated pregnancy, with a single vertex fetus in anterior position, spontaneous onset of labor at 38 to 42 weeks' gestation, adequate pelvis measurement, and intact amniotic membranes at the beginning of the phase of maximum slope" (from 4 to 9 cm of dilatation). | Upright position group: the intention was to keep the woman in an upright position. Supine position group: the intention was to keep the woman in a supine position. The women were free to choose several variations within each position group. | Length of the phase of maximum slope during the first stage of labor (4 to 9 cm of dilation); Maternal Confort Score; Analgesic dose; Apgar scores at 1 and 5 minutes. | No sampling calculation. The information on the variability of Apgar scores is not presented (The SD was assumed to be approximately one quarter of the range of the values presented). | B |
ALLAHBADIA [13] (India, 1992) | Random Generation: not stated Allocation Concealment Method: not stated ("All patients were selected at random") | 200 women with 37 weeks' gestation or more, with adequate pelvis, vertex presentation and no medical, surgical or obstetric disease. | Ambulatory Group: women were 'kept' ambulatory during the first stage of labor and encouraged to adopt the squatting position during the second stage. | Length of labor (first and second stage); Mode of delivery; Incidence of complications (prolonged first stage, prolonged second stage, maternal injuries, perinatal mortality and morbidity) | No sampling calculation. No mention about the beginning of labor (if it was spontaneous or induced). The information on the variability of labor is scarce. | B |
BLOOM [14] (USA, 1998) | Random Generation: not stated Allocation Concealment Method: not stated ("The women enrolled in the study were randomly assigned") | 1067 women in spontaneous labour with uncomplicated pregnancies between 36 and 41 weeks' gestation, having regular uterine contractions with cervical dilatation of 3 to 5 cm and fetuses in the cephalic presentation. | Walking Group: women were encouraged to walk but were instructed to return to their beds when they needed intravenous or epidural analgesia or when the second stage of labor began. Usual Care Group: women were permitted to assume their choice of supine, lateral or sitting position during labor. | Length of labor (first and second stage); Labor augmentation; Mode of delivery; Analgesia. Others (episiotomy, shoulder dystocia, dose of analgesic, neonatal condition at birth (Apgar score less than 4 at 5th minute, umbilical artery pH<7.0, intubation in delivery room), stillbirth and neonatal death) | No sampling calculation. Women in the control group could assume sitting positions during labor. (Contamination). | B |
MIQUELUTTI [15] (Brazil, 2006) | Random Generation: computer generated random sequence (Excel 2003) Allocation Concealment by sealed and opaque envelopes. | 107 nulliparous women with uncomplicated singleton pregnancies between 37 and 41 weeks, cephalic, with cervical dilation between 3 to 5 cm. | Study group: the women were encouraged to remain in vertical positions. Control group: the women received usual maternity care. | Length of labor (first and second stage); Mode of delivery; Apgar score at 5th minute; Analgesia; Maternal satisfaction. Others (episiotomy, pain, well-being of the fetus, Apgar score at 1st minute, Apgar score less than 7 at 5th minute) | The sampling calculation was performed. Women in the control group could remain upright if they preferred (Contamination). | A |