Effects of a Lateral Position With Hip Flexion and Femoral Internal Rotation During the Second Stage of Labor in Nulliparous Women Receiving Epidural Analgesia

Second Affiliated Hospital of Wenzhou Medical University230 enrolled

Overview

This randomized clinical study evaluated the effects of a lateral position with hip flexion and femoral internal rotation during the second stage of labor in nulliparous women receiving epidural labor analgesia. Participants were assigned to either an observation group using the modified lateral position or a control group using the conventional lateral position. The study compared second-stage labor duration, additional obstetric interventions, maternal outcomes, perineal outcomes, and neonatal outcomes between the two groups.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

230

Conditions

Delivery, Obstetric Labor, Obstetric

Interventions

Participants adopted a modified lateral position during the second stage of labor. The position involved lateral positioning facing the side opposite to the fetal back, hip flexion, knee flexion, and 30°-40° femoral internal rotation with midwife assistance. The position was used during uterine contractions with guided bearing-down efforts and was alternated with a semi-recumbent position according to the study protocol.

Conventional Lateral PositionBEHAVIORAL

Participants adopted the conventional lateral position during the second stage of labor under routine intrapartum care and midwife assistance. During uterine contractions, participants performed bearing-down efforts in the lateral position, followed by intervals of rest and semi-recumbent positioning according to the study protocol.

Eligibility

Sex: FEMALEMin age: 22 YearsMax age: 34 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Nulliparous women. * Age 22 to 34 years. * Singleton pregnancy. * Cephalic presentation confirmed by ultrasonography after 37 weeks of gestation. * Gestational age of 37 to 41 weeks. * Estimated fetal weight of 2,500 to 3,500 g. * No birth-canal abnormalities on vaginal examination. * Effective epidural labor analgesia during the first stage of labor. * Sufficient cognitive capacity to understand and cooperate with the study procedures. * Ability and willingness to provide written informed consent. Exclusion Criteria: * Organic heart, liver, or kidney disease. * Prenatal indication for cesarean delivery. * Pubic symphysis separation. * Lower-limb disease or impaired mobility. * Precipitous labor. * Second stage of labor lasting less than 30 minutes. * Severe mental illness. * Fetal malformation. * Withdrawal from the study.

Outcomes

Primary Outcomes

Duration of the Second Stage of Labor

Time frame: From full cervical dilatation to delivery of the neonate

Additional Obstetric Interventions During the Second Stage of Labor

Additional obstetric interventions during the second stage of labor, classified as none, forceps-assisted vaginal birth, cesarean delivery during the second stage, vaginal birth after manual fetal-head rotation, or vaginal birth with episiotomy as the principal intervention.

Time frame: During the second stage of labor

Secondary Outcomes

Duration of the First Stage of Labor

Duration of the first stage of labor, measured in minutes.

Time frame: From onset of regular uterine contractions to full cervical dilatation

Duration of the Third Stage of Labor

Duration of the third stage of labor, measured in minutes.

Time frame: From delivery of the neonate to delivery of the placenta

Postpartum Blood Loss

Postpartum blood loss, measured in milliliters.

Time frame: Within 2 hours after delivery

Perineal Outcomes

Perineal outcomes classified as intact perineum, episiotomy, first-degree perineal laceration, or second-degree or higher perineal laceration.

Time frame: At delivery