Bueno-Lopez Vanessa, Fuentelsaz-Gallego Carmen, Casellas-Caro Manel, Falgueras-Serrano Ana Maria, Crespo-Berros Silvia, Silvano-Cocinero Ana Maria, Alcaine-Guisado Carolina, Zamoro Fuentes Manuela, Carreras Elena, Terré-Rull Carmen
Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Nursing Healthcare Research, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Birth. 2018 Dec;45(4):385-392. doi: 10.1111/birt.12347. Epub 2018 Mar 14.
Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position.
This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction.
In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035).
The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.
分娩时胎儿枕后位与更疼痛且产程延长相关，同时母婴发病率增加。本研究的目的是评估在硬膜外镇痛且胎儿为持续性枕后（POP）位的女性中，在胎儿脊柱侧采用改良截石位是否能增加枕前位的旋转。
这是一项开放、随机对照临床试验。纳入120例胎儿为POP位的分娩女性。通过阴道指检进行诊断，并经超声扫描确认。女性被随机分为自由体位组或胎儿脊柱侧改良截石位组。主要结局是旋转至枕前位，次要结局是分娩方式、产后会阴状况、围产期结果和产妇满意度。
在采用截石位分娩的孕妇中，POP位胎儿有50.8%旋转至枕前位，而在自由体位组中，旋转发生率为21.7%（P = 0.001）。截石位组的阴道分娩率高于自由体位组（84.7%对68.3%，P = 0.035）。
改良截石位是一种对POP旋转有效的产妇体位干预措施，可降低剖宫产率。它是一种简单且无创的干预措施，可重复实施，孕妇耐受性良好。
