Abstract
To evaluate the association between the upright and supine maternal positions for birth and the incidence of obstetric anal sphincter injuries (OASIs). Retrospective cohort study analyzed the data of 1,728 pregnant women who vaginally delivered live single cephalic newborns with a birth weight of 2,500 g. Multiple regression analyses were used to investigate the effect of the supine and upright positions on the incidence of OASIs after adjusting for risk factors and obstetric interventions. In total, 239 (13.8%) births occurred in upright positions, and 1,489 (86.2%) in supine positions. Grade-III lacerations occurred in 43 (2.5%) patients, and grade-IV lacerations occurred in 3 (0.2%) women. Supine positions had a significant protective effect against severe lacerations, odds ratio [95% confidence interval]: 0,47 [0.22-0.99], adjusted for the use of forceps 4.80 [2.15-10.70], nulliparity 2.86 [1.44-5.69], and birth weight 3.30 [1.56-7.00]. Anesthesia (p < 0.070), oxytocin augmentation (p < 0.228), shoulder dystocia (p < 0.670), and episiotomy (p < 0.559) were not associated with the incidence of severe lacerations. Upright birth positions were not associated with a lower rate of perineal tears. The interpretation of the findings regarding these positions raised doubts about perineal protection that are still unanswered.
Highlights
The best maternal position adopted during the pelvic phase to avoid perineal damage is an issue that is still controversial, depending on a set of multifactorial predictors and specific subgroups of analysis.[1,2,3] High rates of obstetric anal sphincter injuries (OASIs) among women giving birth in the lithotomy position were reported in a population-based study[1] in Sweden on term non-instrumental births without episiotomy
Upright birth positions were not associated with a lower rate of perineal tears
The present study reports the frequency and the profile of births occurred in upright positions in a teaching maternity
Summary
The best maternal position adopted during the pelvic phase to avoid perineal damage is an issue that is still controversial, depending on a set of multifactorial predictors and specific subgroups of analysis.[1,2,3] High rates of obstetric anal sphincter injuries (OASIs) among women giving birth in the lithotomy position were reported in a population-based study[1] in Sweden on term non-instrumental births without episiotomy. We compared the rate of OASIs found in the present study with that of our previous report.[6]
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