Einfluss der unterschiedlichen Geburtspositionen auf mütterliche Geburtsverletzungen und kindliche Parameter während spontaner vaginaler Geburt

Magnetic resonance imaging of the active second stage of labour: proof of principle

OBJECTIVE

To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible.

MATERIALS AND METHODS

Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour.

RESULTS

Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts.

CONCLUSION

CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications.

Women’s position during labour: influence on maternal and neonatal outcome

AIM

To assess the maternal, perineal and neonatal outcomes of an upright position compared with a supine position during vaginal delivery, in terms of defined outcome variables.

METHODS

This case-control study was carried out at the Department of Obstetrics and Gynaecology of the University Hospital Vienna between 1997 and 2002. A total of 307 women who delivered in an upright position were enrolled in the study. Upright position was defined as free squatting and was also described as an alternative birth position. 307 controls, delivering in a supine position, were selected from the delivery database as the next parity-matched normal spontaneous vaginal delivery. Our analysis was restricted to a sample of women with a gestational age > 37 weeks, a normal sized fetus and a pregnancy with cephalic presentation. Women with medical or obstetric risk factors were excluded.

RESULTS

A statistically significant decrease for the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.001) was observed in women using the upright birth position. The length of the first and second stages of labour did not significantly differ between the two groups (p > 0.05). A significantly lower rate of episiotomy was detected in women who delivered in an upright position compared with women delivering supine (p = 0.0001). The frequency of perineal tears, and vaginal and labial trauma did not differ between the two groups (p > 0.05). When analysing maternal blood loss, no significant differences between the two groups were found (p > 0.05). No differences in APGAR score < 7 at 1 and 5 minutes or cord pH < 7.1 were observed (p > 0.05).

CONCLUSIONS

The data indicate that labouring and delivering in an upright position is associated with beneficial effects such as a lower rate of episiotomy, and a reduced use of medical analgesia and oxytocin. In our opinion, the best recommendation is to give low-risk maternity patients the option of bearing in the mode that is most comfortable for them.