Cochrane · systematic review · CD009124
Pushing/bearing down methods for the second stage of labour
Lemos, A, Amorim, MMR, Dornelas de Andrade, A, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
12
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 2 · 14.3%Very low 7 · 50%Low 2 · 14.3%Moderate 3 · 21.4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Spontaneous pushing compared to directed pushing for the second stage of labour (types of pushing)
Population: women in the second stage of labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of second stage (minutes) Spontaneous pushing vs directed pushing | no estimate extracted | 6 studies · 667 participants | Very low |
Perineal laceration (3rd or 4th degree) Spontaneous pushing vs directed pushing | RR 0.87 [0.45, 1.66] | 1 study · 320 participants | Low Downgraded: imprecision, inconsistency |
Admission to neonatal intensive care Spontaneous pushing vs directed pushing | RR 1.08 [0.3, 3.79] | 2 studies · 393 participants | Very low |
Hypoxic ischaemic encephalopathy Spontaneous pushing vs directed pushing | no estimate extracted | 0 studies · 0 participants | Ungraded |
5‐minute Apgar score < 7 Spontaneous pushing vs directed pushing | RR 0.35 [0.01, 8.43] | 1 study · 320 participants | Very low Downgraded: imprecision, inconsistency |
Duration of pushing (minutes) Spontaneous pushing vs directed pushing | no estimate extracted | 2 studies · 169 participants | Very low Downgraded: imprecision, inconsistency |
Spontaneous vaginal delivery Spontaneous pushing vs directed pushing | RR 1.01 [0.97, 1.05] | 5 studies · 688 participants | Moderate Downgraded: imprecision, inconsistency |
Delayed pushing compared to immediate pushing (all women with epidural) for the second stage of labour (timing of pushing)
Population: women in the second stage of labour with epidural in situ
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of second stage (minutes) Delayed pushing vs immediate pushing (all women with epidural) | no estimate extracted | 11 studies · 3049 participants | Very low |
Perineal laceration (3rd or 4th degree) Delayed pushing vs immediate pushing (all women with epidural) | RR 0.94 [0.78, 1.14] | 7 studies · 2775 participants | Moderate |
Admission to neonatal intensive care Delayed pushing vs immediate pushing (all women with epidural) | RR 0.98 [0.67, 1.41] | 3 studies · 2197 participants | Low Downgraded: imprecision, inconsistency |
Hypoxic ischaemic encephalopathy Delayed pushing vs immediate pushing (all women with epidural) | no estimate extracted | 0 studies · 0 participants | Ungraded |
5‐minute Apgar score < 7 Delayed pushing vs immediate pushing (all women with epidural) | RR 0.15 [0.01, 3] | 3 studies · 413 participants | Very low Downgraded: imprecision, inconsistency |
Duration of pushing (minutes) Delayed pushing vs immediate pushing (all women with epidural) | no estimate extracted | 11 studies · 2932 participants | Very low |
Spontaneous vaginal delivery Delayed pushing vs immediate pushing (all women with epidural) | RR 1.07 [1.03, 1.11] | 12 studies · 3114 participants | Moderate |