Cochrane · systematic review · CD014615
Maternal postures for fetal malposition in labour for improving the health of mothers and their infants
Barrowclough, JA, Lin, L, Kool, B, et al. · Cochrane Database of Systematic Reviews · 2022 · 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
28
current version
GRADE rated
17
No studies
3
Included studies
NR
No studies 3 · 10.7%Ungraded 8 · 28.6%Very low 11 · 39.3%Low 6 · 21.4%Moderate 0 · 0%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
Hands and knees posture compared to other postures for fetal malposition in labour ‐ maternal outcomes
Population: fetal malposition in labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Operative birth (composite outcome defined as caesarean section, instrumental vaginal birth) Hands and knees posture vs other postures | RR 1.14 [0.87, 1.5] | 3 studies · 721 participants | Low Downgraded: risk of bias, imprecision |
Epidural use Hands and knees posture vs other postures | RR 0.74 [0.41, 1.31] | 2 studies · 282 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Caesarean section Hands and knees posture vs other postures | RR 1.34 [0.96, 1.87] | 3 studies · 721 participants | Low Downgraded: risk of bias, imprecision |
Instrumental vaginal birth Hands and knees posture vs other postures | RR 1.04 [0.57, 1.9] | 3 studies · 721 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Severe perineal tears (3rd degree or higher, as defined by trialists) Hands and knees posture vs other postures | RR 0.88 [0.03, 22.3] | 2 studies · 586 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Postpartum haemorrhage (as defined by trialists) Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Maternal satisfaction (as defined by trialists using standardised tools available) Hands and knees posture vs other postures | RR 1.02 [0.68, 1.54] | 3 studies · 350 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Hands and knees posture compared to other postures for fetal malposition in labour ‐ infant outcomes
Population: fetal malposition in labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Serious neonatal morbidity (composite outcome defined as death, admission to neonatal intensive care, neonatal encephalopathy, or as defined by trialists) Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Death (stillbirth or death of liveborn infant) Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Apgar scores < 7 at 5 minutes Hands and knees posture vs other postures | RR 0.71 [0.21, 2.34] | 2 studies · 586 participants | Very low Downgraded: risk of bias, imprecision |
Admission to neonatal intensive care Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Neonatal encephalopathy (as defined by trialists) Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Need for respiratory support Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Neonatal jaundice requiring phototherapy Hands and knees posture vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Lateral postures compared to other postures for fetal malposition in labour ‐ maternal outcomes
Population: fetal malposition in labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Operative birth (composite outcome defined as caesarean section, instrumental vaginal birth) Lateral postures vs other postures | RR 0.72 [0.43, 1.19] | 4 studies · 871 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Epidural use Lateral postures vs other postures | no estimate extracted | 0 studies · 0 participants | Ungraded |
Caesarean section Lateral postures vs other postures | RR 0.78 [0.44, 1.39] | 4 studies · 871 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Instrumental vaginal birth Lateral postures vs other postures | RR 0.73 [0.39, 1.36] | 4 studies · 871 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Severe perineal tears (3rd degree or higher, as defined by trialists) Lateral postures vs other postures | RR 0.66 [0.17, 2.48] | 3 studies · 609 participants | Very low Downgraded: risk of bias, imprecision |
Postpartum haemorrhage (as defined by trialists) Lateral postures vs other postures | RR 0.9 [0.48, 1.7] | 1 study · 322 participants | Very low Downgraded: risk of bias, imprecision |
Maternal satisfaction (as defined by trialists using standardised tools available) Lateral postures vs other postures | RR 0.96 [0.84, 1.09] | 2 studies · 451 participants | Low Downgraded: risk of bias, imprecision |
Lateral postures compared to other postures for fetal malposition in labour ‐ infant outcomes
Population: fetal malposition in labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Serious neonatal morbidity (composite outcome defined as death, admission to neonatal intensive care, neonatal encephalopathy, or as defined by trialists) Lateral postures vs other postures | RR 1.41 [0.64, 3.12] | 3 studies · 752 participants | Very low Downgraded: risk of bias, imprecision |
Death (stillbirth or death of liveborn infant) Lateral postures vs other postures | no estimate extracted | 1 study · 210 participants | Very low Downgraded: risk of bias, imprecision |
Apgar scores less than seven at five minutes Lateral postures vs other postures | RR 0.25 [0.03, 2.24] | 1 study · 322 participants | Very low Downgraded: risk of bias, imprecision |
Admission to neonatal intensive care Lateral postures vs other postures | RR 1.41 [0.64, 3.12] | 2 studies · 542 participants | Very low Downgraded: risk of bias, imprecision |
Neonatal encephalopathy (as defined by trialists Lateral postures vs other postures | no estimate extracted | NR | No studies |
Need for respiratory support Lateral postures vs other postures | no estimate extracted | NR | No studies |
Neonatal jaundice requiring phototherapy Lateral postures vs other postures | no estimate extracted | NR | No studies |