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https://ciane.net/id=3032

Created on : 23 Nov 2018
Modified on : 25 Nov 2018

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Bibliographical entry (without author) :

The Swedish Birth Seat Trial. Thesis. Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden.

Author(s) :

Li Thies-Lagergren

Year of publication :

2013

URL(s) :

https://openarchive.ki.se/xmlui/handle/10616/41433

Résumé (français)  :

Contexte : Les preuves de la sécurité des positions de naissance verticales en relation avec la perte de sang maternel et les résultats périnéaux ne sont pas concluantes. On sait peu de choses sur l’impact des positions verticales sur l’utilisation de l’ocytocine synthétique pour l’augmentation du travail ou sur le point de savoir si une position verticales au deuxième stade du travail peut réduire le nombre d’accouchements par voie vaginale instrumentaux. De plus, les préférences et les expériences des femmes en matière d’accouchement au deuxième stade du travail nécessitent une enquête.

Objectifs : étudier l’efficacité de l’utilisation d’un siège de naissance en ce qui concerne les résultats maternels et infantiles, ainsi que les expériences vécues par les femmes en matière de position dans la deuxième phase du travail.

Méthodes : dans un essai contrôlé randomisé, les résultats chez les enfants et les mères ont été étudiés lors de la première affectation des mères à un groupe expérimental (siège de naissance) ou à un groupe témoin (toute position sauf le siège de la naissance). L’analyse a été effectuée en intention de traiter dans les papiers I et II (n = 1002). Les résultats ont été analysés selon l’analyse de traitement dans le papier III (n = 950). Une étude de suivi a été réalisée à l’aide d’un questionnaire et les réponses de 289 femmes affectées au groupe expérimental ont été incluses (IV).

Résultats : La naissance sur le siège de la naissance a eu pour résultat un deuxième stade du travail plus court et une utilisation moins fréquente d’oxytocine synthétique pour l’augmentation du travail, mais n’a pas réduit le nombre d’accouchements par voie vaginale instrumentale (I-III). Il y avait un risque accru de perte de sang post-partum chez les femmes qui ont accouché et sur les femmes qui ont reçu de l’ocytocine synthétique au premier stade, indépendamment de la position de naissance (I & III). Il n’y avait pas de différences dans les degrés de lacérations périnéales (I & III) et les femmes qui ont accouché sur un siège de naissance étaient moins susceptibles de subir une épisiotomie (III). Il n’y avait pas de risque accru d’œdème périnéal dans le groupe des sièges de naissance (I et III). Aucun résultat indésirable pour le nouveau-né n’a été identifié (II). En dépit de la randomisation, les femmes qui ont accouché sur le siège de naissance ont déclaré qu’elles avaient elles-mêmes pris la décision quant à leur position à la naissance et qu’elles estimaient avoir eu la possibilité de prendre la position de leur choix. Les femmes qui ont accouché sur le siège de naissance ont déclaré plus souvent se sentir puissantes, protégées et confiantes (IV).

Conclusions : L’accouchement sur un siège de naissance a réduit la durée du deuxième stade du travail. Le nombre d’accouchements vaginaux instrumentaux n’a pas été réduit. Aucune issue défavorable chez la mère ou le bébé, sauf une perte de sang accrue chez les femmes qui ont accouché sur le siège ; cette découverte n’a eu aucune incidence sur le taux d’hémoglobine 8 à 12 semaines après l’accouchement. Une position de naissance verticale, lorsqu’elle est choisie par la femme, pourrait donner un sentiment d’autonomisation, ce qui conduit à une plus grande satisfaction lors de l’accouchement. Une position debout pendant la deuxième phase du travail, facilitée par un siège de naissance, peut être recommandée comme intervention non médicale aux femmes nullipares en bonne santé.

Abstract (English)  :

Background: Evidence for the safety of upright birth positions in relation to maternal blood
loss and perineal outcomes is inconclusive. Little is known about the impact of upright
positions on the use of synthetic oxytocin for augmentation of labour or whether an upright
birth position in the second stage of labour can reduce the number of instrumental vaginal
deliveries. In addition women’s preferences for and experiences of birth positions in the
second stage of labour require investigation.

Aims: to investigate the efficacy of the use of a birth seat in relation to maternal and infant
outcomes, and to investigate women’s experiences of birth position in the second stage of
labour.

Methods: in a randomised controlled trial maternal and infant outcomes were investigated
when first time mothers were allocated either to an experimental group (birth seat) or to a
control group (any position except for the birth seat). Analysis was according to the intention
to treat principal in paper I & II (n = 1002). Outcomes were analysed according the ontreatment analysis in paper III (n = 950). A follow-up study was carried out using a
questionnaire and answers from 289 women who were allocated to the experimental group
were included (IV).

Results: Birth on the birth seat resulted in a shorter second stage of labour and in less use of
synthetic oxytocin for augmentation of labour, but did not reduce the number of instrumental
vaginal deliveries (I-III). There was an increased risk for post-partum blood loss in women
who gave birth on the birth seat and also in women who were given synthetic oxytocin during
the first stage, regardless of birth position (I & III). There were no differences in any degrees
of perineal lacerations (I & III) and women who gave birth on a birth seat were less likely to
have an episiotomy performed (III). There was no increased risk for perineal oedema in the
birth seat group (I & III). No adverse infant outcomes were identified (II). Despite
randomisation, women who gave birth on the birth seat reported to a higher degree that they
themselves had made the decision about birth position and felt that they had been given the
opportunity to take their preferred position. Women who gave birth on the birth seat reported
more often that they felt powerful, protected and self-confident (IV).

Conclusions: Birth on the birth seat reduced the duration of the second stage of labour. The
number of instrumental vaginal births was not reduced. There were no adverse infant or
maternal outcomes except for an increased blood loss in women who gave birth on the birth
seat; this finding was without affecting the haemoglobin level 8-12 weeks postpartum. An
upright birth position, when chosen by the woman, could give a feeling of empowerment,
which leads to greater childbirth satisfaction. An upright position during the second stage of
labour, facilitated by a birth seat, can be recommended as a non-medical intervention to
healthy nulliparous women.

Sumário (português)  :

Fundamentos: A evidência da segurança das posições verticais do parto em relação à perda de sangue materno e desfechos perineais é inconclusiva. Pouco se sabe sobre o impacto das posições verticais sobre o uso de ocitocina sintética para aumentar o trabalho ou se uma posição vertical no segundo estágio do trabalho de parto pode reduzir o número de partos por ano. Rota vaginal instrumental. Além disso, as preferências e experiências das mulheres com o parto de segundo estágio exigem investigação.

Objetivos: Estudar a efetividade do uso da cadeira de parto no que diz respeito aos desfechos maternos e infantis, bem como as experiências das mulheres em termos de sua posição na segunda fase do trabalho. Métodos: em um ensaio clínico randomizado e controlado, os resultados em crianças e mães foram estudados durante a primeira designação de mães para um grupo experimental (assento de parto) ou para um grupo controle (com exceção de qualquer posição). a sede do nascimento). A análise foi realizada por intenção de tratar nos artigos I e II (n = 1002). Os resultados foram analisados ​​de acordo com a análise do tratamento no artigo III (n = 950). Um estudo de acompanhamento foi realizado utilizando um questionário e as respostas de 289 mulheres designadas para o grupo experimental foram incluídas (IV).

Resultados: Nascimento na sede do parto resultou em um segundo estágio de trabalho mais curto e uso menos freqüente de ocitocina sintética para aumentar o trabalho, mas não reduziu número de partos vaginais instrumentais (I-III). Houve um aumento do risco de perda de sangue pós-parto em mulheres que deram à luz e mulheres que receberam ocitocina sintética de primeira fase, independentemente da posição de nascimento (I e III). Não houve diferenças no grau de laceração perineal (I e III) e as mulheres que deram à luz ao nascer tiveram menor probabilidade de serem submetidas à episiotomia (III). Não houve aumento do risco de edema perineal no grupo da cadeira de parto (I e III). Nenhum resultado adverso para o neonato foi identificado (II). Apesar da randomização, as mulheres que deram à luz no local de nascimento relataram que elas próprias tomaram a decisão sobre sua posição de nascimento e que sentiram que tiveram a oportunidade de assumir a posição de sua mãe. escolha. As mulheres que deram à luz no local de nascimento relataram sentir-se mais poderosas, protegidas e confiantes (IV).

Conclusões: O parto em uma cadeira de parto reduziu a duração do segundo estágio do trabalho de parto. O número de partos vaginais instrumentais não foi reduzido. Nenhum resultado adverso na mãe ou bebê, exceto aumento da perda de sangue em mulheres que deram à luz no assento; este achado não teve impacto sobre o nível de hemoglobina 8 às 12 semanas pós-parto. Uma posição de nascimento vertical, quando escolhida pela mulher, poderia dar uma sensação de empoderamento, o que leva a uma maior satisfação durante o parto. A posição de pé durante a segunda fase do trabalho de parto, facilitada por uma cadeira de parto, pode ser recomendada como uma intervenção não médica para mulheres nulíparas saudáveis.

Resumen (español)  :

Full text (public) :

Comments :

Argument (français) :

Une position verticale pendant le deuxième stade du travail, facilitée par un siège de naissance, peut être recommandée comme intervention non médicale chez les femmes nullipares en bonne santé.

Argument (English):

An upright position during the second stage of labour, facilitated by a birth seat, can be recommended as a non-medical intervention to healthy nulliparous women.

Argumento (português):

Uma postura ereta durante o segundo estágio do trabalho de parto, facilitada por uma cadeira de parto, pode ser recomendada como uma intervenção não médica a mulheres nulíparas saudáveis.

Argumento (español):

Keywords :

➡ duration of labour ; position during labor ; psychology ; postpartum hemorrhage

Author of this record :

Bernard Bel — 23 Nov 2018
➡ latest update : Bernard Bel — 25 Nov 2018

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