The Influence of Maternal Position During the Expulsive Stage and its Impact on Perineal Outcomes: A Scoping Review
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https://orcid.org/0009-0005-3200-8183
Maria João Freitas
https://orcid.org/0000-0003-3248-2326
Helena Presado
https://orcid.org/0000-0002-6852-7875
Abstract
Most women about 85%, suffer some kind of perineal injury during labor, which can be spontaneous or through episiotomy. The position that the parturient woman adopts during the expulsive period leads to different results in terms of the type of perineal injury, so it is necessary to understand the factors involved in the delivery process. To map the scientific evidence regarding the position of the parturient during the expulsive period and the outcome at perineal level. Scoping Review (SR) in four databases: MEDLINE, CINAHL, BOn and PubMed. The research question was "What is the perineal outcome of the position adopted by the parturient during the expulsive period?" formulated using the mnemonic PCC- Population (parturients), Concept (position of the parturient in the expulsive period and the results produced at the perineal level) and Context (expulsive period). 107 articles were identified, duplicates were excluded, after reading the title and abstract 13 articles were selected for full reading and 13 articles were included in the SR. With the use of upright positions in the expulsive period, there is a higher rate of perineal integrity, however there are more grade I and II perineal lacerations compared to horizontal positions. In the lithotomy and semi-sitting positions, there is a higher rate of episiotomy and a lower rate of grade I and II perineal lacerations. There are other factors that can influence the occurrence of lacerations, such as the use of perineal protection techniques, the condition of the perineum and parity. The perineal result is influenced by the position adopted by the parturient, health professionals must be equipped with techniques and knowledge to facilitate different positions, according to needs, decisions and comfort of the parturient.
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