Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta-analysis

J Adv Nurs. 2020 Dec;76(12):3293-3306. doi: 10.1111/jan.14587. Epub 2020 Oct 3.


Aims: To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour.

Background: Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent.

Design: A meta-analysis of randomized controlled trials.

Data sources: The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019.

Review methods: We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta-analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour.

Results: Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR] = 0.74, 95% CI 0.59-0.93), shortened the active pushing phase (mean difference [MD] = -8.16 min, 95% CI -16.29 to -0.02), decreased the rate of severe perineal trauma (RR = 0.35, 95% CI 0.14-0.87) and episiotomy (RR = 0.52, 95% CI 0.29-0.92), but significantly increased the rate of second-degree perineal trauma (RR = 1.45, 95% CI 1.10-1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage.

Conclusions: Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence.

Impact: This meta-analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.

目的: 评估在第二产程中,与卧位相比,直立体位对未使用硬膜外镇痛的产妇的预后的影响。 背景: 从生理角度讲,直立体位具有许多优势。许多研究报告了第二产程期间直立体位的基本益处和风险,但结果却不尽相同。 设计: 随机对照试验的荟萃分析。 数据来源: 从各数据库成立至2019年6月17日,对Cochrane Library、PubMed、Embase、CINAHL和ProQuest等数据库进行了系统化检索。 审查方法: 使用科克伦协作网的工具进行质量评价,并使用Review Manager 5.3软件进行荟萃分析。主要预后指标是器械性阴道分娩和第二产程的持续时间。 结果: 总的来说,包括了12项研究,涉及4314名妇女。直立体位显著降低了器械性阴道分娩率(风险比[RR]=0.74,95%置信区间0.59-0.93),缩短了主动推宫阶段(平均差 [MD]=−8.16分钟, 95%置信区间−16.29 to −0.02),降低了严重会阴创伤发生率(RR=0.35, 95%置信区间0.14-0.87)和会阴切开术(RR=0.52, 95%置信区间0.29-0.92),但显著增加了二度会阴创伤的发生率(RR=1.45, 95%置信区间.10-1.90)。但在第二产程的持续时间或产后出血方面没有显著差异。 结论: 直立位有利于改善孕产妇预后。有几项结果应予以谨慎考虑。研究人员需要明确直立体位的定义,并在未来进行大规模、稳健的研究,以提供更有力的证据。 影响: 本荟萃分析探讨了产时护理中的一个关键问题,并阐明了直立体位在第二产程中的益处和可能存在的风险。鼓励助产士和产科医生根据产妇的喜好和产程进展采用直立体位,但应采取措施防止会阴创伤。.

Keywords: childbirth; maternal health; meta-analysis; nursing; systematic review; upright position.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Analgesia, Epidural*
  • Delivery, Obstetric
  • Female
  • Humans
  • Labor Stage, Second
  • Midwifery*
  • Patient Positioning
  • Pregnancy