Comparison of different positions that a mother is placed in during caesarean section to improve outcomes for both the mother and her newborn

Cluver C, Novikova N, Hofmeyr GJ, Hall DR

Published Online:

June 16, 2010

Caesarean section is an operation that is performed on many pregnant woman to deliver the baby. During caesarean section the mother can be placed in a number of positions on the theatre table. Cushions and wedges can also be used to alter her position on the table and devices can also be used to displace the uterus laterally. This review aimed to assess the best position for the mother to be in during the surgery.

The review authors identified nine randomised controlled trials with a total of 683 woman included and found that there is little difference from them to support or disprove the use of different positions, cushions, wedges or displacers. No studies assessed the impact of position on the risk of surgical complications.

More studies are needed on this topic.

Abstract (click to read)

Background:

During caesarean section mothers can be in different positions. Theatre tables could be tilted laterally, upwards, downwards or flexed and wedges or cushions could be used. There is no consensus on the best positioning at present.

Objectives:

We assessed all available data on positioning of the mother to determine if there is an ideal position during caesarean section that would improve outcomes.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009), PubMed (1966 to 14 September 2009) and manually searched the references of retrieved articles.

Selection criteria:

Randomised trials of woman undergoing caesarean section comparing different positions.

Data collection and analysis:

Two authors assessed eligibility, trial quality and extracted data.

Main results:

We identified 17 studies with a total of 683 woman included. We included nine studies and excluded eight studies. Included trials were of variably quality with small sample sizes. Most comparisons had data from single trials. This is a shortcoming and applicability of results is limited.

The incidence of air embolism was not affected by head up versus horizontal position (risk ratio (RR) 0.91; 95% confidence interval (CI) 0.65 to 1.26). We found no change in hypotensive episodes when comparing left lateral tilt (RR 0.11; 95% CI 0.01 to 1.94), right lateral tilt (RR 1.25; 95% CI 0.39 to 3.99) and head down tilt (mean difference (MD) -3.00; 95% CI -8.38 to 2.38) with horizontal positions or full lateral tilt with 15-degree tilt (RR 1.20; 95% CI 0.80 to 1.79). Hypotensive episodes were decreased with manual displacers (RR 0.11; 95% CI 0.03 to 0.45), a right lumbar wedge compared to a right pelvic wedge (RR 1.64; 95% CI 1.07 to 2.53) and increased in right lateral tilt (RR 3.30; 95% CI 1.20 to 9.08) versus left lateral tilt.

Position did not affect systolic blood pressure when comparing left lateral tilt (MD 2.70; 95% CI -1.47 to 6.87) or head down tilt (RR 1.07; 95% CI 0.81 to 1.42) to horizontal positions, or full lateral tilt with 15-degree tilt (MD -5.00; 95% CI -11.45 to 1.45). Manual displacers showed decreased fall in mean systolic blood pressure compared to left lateral tilt (MD -8.80; 95% CI -13.08 to -4.52).

Position did not affect diastolic blood pressures when comparing left lateral tilt versus horizontal positions. (MD-1.90; 95% CI -5.28 to 1.48). The mean diastolic pressure was lower in head down tilt (MD -7.00; 95% CI -12.05 to -1.95) when compared to horizontal positions.

There were no statistically significant changes in maternal pulse rate, five-minute Apgars, maternal blood pH or cord blood pH when comparing different positions.

Authors' conclusions:

There is limited evidence to support or clearly disprove the value of the use of tilting or flexing the table, the use of wedges and cushions or the use of mechanical displacers. Larger studies are needed.

This record should be cited as:

Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007623. DOI: 10.1002/14651858.CD007623.pub2

Assessed as up to date:

March 14, 2010

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Caesarian section > Other interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Comparison of different positions that a mother is placed in during caesarean section to improve outcomes for both the mother and her newborn

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