Lateral asymmetric decubitus position does not facilitate rotation of fetal head in occiput posterior position during labor

Various maternal postures can be performed from the beginning of labor in case of fetal occiput posterior position. A randomized controlled trial (EVADELA) showed that lateral asymmetric decubitus posture did not facilitate rotation of fetal head.


Background: Fetal occiput posterior (OP) positions are associated with poorer maternal outcomes than occiput anterior positions. Although methods including instrumental and manual rotation can be used at the end of labor to promote the rotation of the fetal head, various maternal postures may also be performed from the beginning of labor in OP position. Such postures might facilitate flexion of the fetal head and favor its rotation into an occiput anterior (OA) position.

Objective: To study whether a lateral asymmetric decubitus (LAD) posture facilitates the rotation of fetal OP into OA positions.

Study design: EVADELA was a multicenter randomized controlled trial including 322 women from May 2013 through December 2014. Study participants were women laboring with ruptured membranes and a term fetus confirmed by ultrasound to be in cephalic posterior position. Women assigned to the intervention group were asked to lie in a LAD posture on the side opposite that of the fetal spine during the first hour and encouraged to maintain this position for as long as possible during the first stage of labor. In the control group, women adopted a dorsal recumbent posture during the first hour after randomization. The primary outcome was OA position at one hour after randomization. Secondary outcomes were OA position at complete dilatation, mode of delivery, speed of dilatation during the active first stage, maternal pain, and women’s satisfaction.

Results: 160 women were assigned to the intervention group and 162 to the control group. One hour after randomization, the rates of OA position did not differ between the intervention and control groups (21.9% versus 21.6%, P=0.887). Nor did OA rates differ between groups at complete dilatation (43.7% versus 43.2%, P=0.565) or at birth (83.1% versus 86.4%, P=0.436). Finally, the groups did not differ significantly for cesarean delivery rates (18.1% among women in LAD and 14.2% among controls (P=0.608), or for speed of cervical dilatation during the active 1st stage (P=0.684), pain assessment (P=0.705), or women’s satisfaction (P=0.326). No maternal or neonatal adverse effect associated with either posture was observed.

Conclusion: LAD position on the side opposite that of the fetal spine did not facilitate rotation of fetal head. Nevertheless, other maternal positions may be effective in promoting fetal head rotation. Further research is needed; posturing during labor should nonetheless remain a woman’s active choice.

To learn more

Le Ray C, Lepleux F, De La Calle A, Guerin J, Sellam N, Dreyfus M, Chantry AA. Lateral asymmetric decubitus position for the rotation of occipito-posterior positions: multicenter randomized controlled trial EVADELA. Am J Obstet Gynecol 2016 (in press).