The Library
A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural : clinical effectiveness and an economic evaluation (BUMPES)
Tools
Bick, Debra, Briley, Annette, Brocklehurst, Peter, Hardy, Pollyanna, Juszczak, Edmund, Lynch, Lynn, MacArthur, Christine, Moore, Phillip, Nolan, Mary, Rivero-Arias, Oliver, Sanders, Julia, Shennan, Andrew and Wilson, Matthew J. A. (2017) A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural : clinical effectiveness and an economic evaluation (BUMPES). Health Technology Assessment, 21 (65). pp. 1-176. doi:10.3310/hta21650 ISSN 1366-5278.
|
PDF
WRAP-multicentre-randomised-controlled-trial-position-during-late-stages-labour-nulliparous-women-epidural-Bick-2019.pdf - Published Version - Requires a PDF viewer. Download (69Mb) | Preview |
Official URL: http://dx.doi.org/10.3310/hta21650
Abstract
Background:
Epidural analgesia leads to increased risk of instrumental vaginal delivery (IVD). There is debate about whether or not posture in second-stage labour influences the incidence of spontaneous vaginal birth (SVB).
Objectives:
In nulliparous women with epidural analgesia, does a policy of adopting an ‘upright position’ throughout second-stage labour increase the incidence of SVB compared with a policy of adopting a ‘lying-down’ position?
Design:
Two-arm randomised controlled trial.
Setting:
Maternity units in England and Wales.
Participants:
Nulliparous women aged ≥ 16 years, at ≥ 37 weeks’ gestation with singleton cephalic presentation and intended SVB, in second-stage labour with an epidural providing effective pain relief.
Interventions:
(1) Upright position to maintain the pelvis in as vertical a plane as possible; and (2) lying-down position to maintain the pelvis in as horizontal a plane as possible.
Main outcome measures:
The primary outcome measure was incidence of SVB. Secondary outcomes included augmentation, interventions to maintain blood pressure, duration of labour, episiotomy, genital tract trauma, post-partum haemorrhage, maternal satisfaction, neonatal metabolic acidosis, 5-minute Apgar score of < 4, resuscitation at birth and admission to neonatal unit. At 1 year for (1) women: urinary or faecal incontinence, dyspareunia and health-related quality of life; (2) for infants: major morbidity. A cost–consequences analysis with a time horizon of 1 year after the birth from a NHS perspective.
Results:
Between October 2010 and January 2014, 3236 women were randomised from 41 centres in England and Wales. There was a statistically significant difference in the incidence of SVB between groups, with 35.2% of women achieving a SVB in the upright group, compared with 41.1% in the lying-down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). There was no evidence of differences in most of the secondary maternal or neonatal outcomes, or in long-term outcomes at the 12-month follow-up. No significant overall cost differences were observed between upright and lying-down positions for mothers or their babies.
Limitations:
Measurement of adherence was challenging in this unmasked trial, and adherence could be influenced by midwives’ beliefs about the allocated positions. If adherence was poor, this would have diluted the difference between the two groups.
Conclusions:
There is clear evidence of the benefit of adopting a lying-down position in second-stage labour in nulliparous women with epidural analgesia, with no apparent disadvantages in either short- or long-term outcomes for mother or baby, and this is cost neutral for the NHS.
Future work:
Questions remain about whether or not other positions could increase the incidence of SVB further in this group of women. The results also raise questions about the role of maternal position in second-stage labour in women without an epidural.
Trial registration:
Current Controlled Trials ISRCTN35706297.
Funding:
This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in Health Technology Assessment, Vol 21, No. 65. See the NIHR Journals Library website for further project information.
Item Type: | Journal Article | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Subjects: | R Medicine > RG Gynecology and obstetrics | |||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
|||||||||
Library of Congress Subject Headings (LCSH): | Peridural anesthesia, Labor (Obstetrics), Childbirth -- Complications, Delivery (Obstetrics), Perineum -- Rupture | |||||||||
Journal or Publication Title: | Health Technology Assessment | |||||||||
Publisher: | NIHR Health Technology Assessment programme | |||||||||
ISSN: | 1366-5278 | |||||||||
Official Date: | November 2017 | |||||||||
Dates: |
|
|||||||||
Volume: | 21 | |||||||||
Number: | 65 | |||||||||
Page Range: | pp. 1-176 | |||||||||
DOI: | 10.3310/hta21650 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Reuse Statement (publisher, data, author rights): | © Queen’s Printer and Controller of HMSO 2017. This work was produced by Bick et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 21 August 2019 | |||||||||
Date of first compliant Open Access: | 27 August 2019 | |||||||||
RIOXX Funder/Project Grant: |
|
|||||||||
Contributors: |
|
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |
Downloads
Downloads per month over past year