Impact of Trendelenburg Positioning During Active Labor on Mode of Delivery [25M

Abstract

INTRODUCTION: Upright maternal position in labor has been associated with improved obstetrical outcomes. Little is known regarding the impact of alternative maternal positions on maternal and fetal outcomes. The primary aim of this study was to show a decrease in the incidence of cesarean delivery with the use of Trendelenberg position in pregnant women with a prolonged active phase of labor. METHODS: This study is a retrospective chart review of women admitted to the VCU Labor and Delivery Unit from 2013-2015 with a prolonged active phase of labor. A total of 2,816 subjects with a singleton viable pregnancy at term were included in the analysis. In addition to demographic data, information was collected from the medical record regarding maternal history, mode of delivery, and fetal outcomes. RESULTS: Of 2,816 subjects who met inclusion criteria, 768 (29.4%) were placed in Trendelenburg position. Overall, 441 (16.9%) patients in the study had a cesarean section. The rate of cesarean section in the Trendelenburg group was higher (30.7%) than in the non-Trendelenburg group (14.3%), p < 0.001. Apgar scores were lower in the Trendelenberg group than in the non-Trendelenberg group (1 minute 7.7 vs 8.3, 5 min 8.7 vs 8.9, p < 0.001). CONCLUSION: Use of Trendelenburg position during prolonged active labor does not decrease the incidence of cesarean delivery and may be associated with poor fetal outcomes. Prospective, randomized data on the topic of maternal positioning in labor would further elucidate the role, if any, for Trendelenburg position in labor.