Authors' objectives: The main aim of this review was to ascertain whether there are differences in maternal and/or foetal outcomes at delivery when the woman in labour adopts an upright vs. lying position during the expulsion stage of delivery. Secondary aims: 1) To see whether the differences (if any) in maternal and/or foetal outcomes are affected by the use of epidural anaesthesia; 2) To ascertain the percentage of women receiving epidural anaesthesia who are able to maintain the upright position during the entire expulsion stage of delivery.

Authors' results and conclusions: Ten trials (from 3 systematic reviews) were selected from the first bibliographic search aimed at pinpointing systematic reviews and higher quality clinical trials. The second stage retrieved 179 topic-related papers though none of these were selected as they all failed to meet the inclusion criteria. The quality of the 10 trials varied, with a median of 3.5 points (ranging from 2 to 6 on a 7-point scale). There was also a wide variety in approaches and in how often each of the 18 variables in maternal and foetal outcomes was considered in each study. The percentage of women included who had received epidural anaesthesia was only explicitly mentioned in five of the ten studies. Most comparisons of delivery positions (82%) showed no statistically significant differences in maternal and foetal outcomes. The differences pinpointed referred to seven of the variables studied, but only one of these - perineal trauma- yielded statistically significant differences in outcomes (comparing both positions) in more than one clinical trial. In general, a greater frequency of tears and a lesser rate of episotomy were reported for upright vs. lying down positions. The subjective variables (related particularly to women's satisfaction and preferences) achieved better outcomes in women who had delivered in an upright position. Of note here is that 85% of women stated they would prefer the upright position for their next delivery. Lastly, the information provided in the studies did not enable us to determine the percentage of women receiving epidural anaesthesia able to maintain an upright position during the expulsion stage of delivery. Nor could the most appropriate form of epidural anaesthesia for vertical position deliveries be deduced from the information provided in the papers, given the absence of details.

Authors' recommendations: CONCLUSIONS: No differences between vertical and horizontal positions have been found in terms of maternal or foetal safety, although subjectively women tend to prefer an upright position. This was the case regardless of whether the women included in the clinical trials received epidural anaesthesia or not. There is very little information available on the percentage of women with epidural anaesthesia able to maintain an upright position during the expulsion stage of delivery or on what kinds of anaesthesia and dosage are the most appropriate to facilitate expulsion in an upright delivery. RECOMMENDATIONS: Preferably, healthcare services should move towards providing each woman with the option to choose her own preferred delivery position. This will involve major changes both in infrastructure and in mindset. Also, further studies are required to define the kind and dosage of anaesthesia capable of facilitating upright positions throughout the expulsion stage of delivery.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/fase-expulsiva-del-parto-comparacion-entre-la-posicion-de-la-mujer-vertical-frente-a-horizontal-a-traves-de-los-resultados-maternos-y-fetales/

Year Published: 2006

URL for published report: https://www.aetsa.org/download/publicaciones/antiguas/AETSA_P_2006_13_Parto.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)