Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis

Abstract

Objective: To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. Method: A systematic review with meta-analysis. Te searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. Te Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles. Results: Tere were 26 studies listed and 8 were selected for the meta-analysis. Te level of scientifc evidence was classifed by the GRADE System and considered high. Tere was no statistically signifcant diference between upright positions in relation to horizontal positions. Despite this fnding, the upright positions showed reduced rates of severe perineal lacerations. Conclusion: Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately afrm their efectiveness to the detriment of horizontal positions for an intact perineum outcome.