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id="_NBK596203_"><span itemprop="name">Evidence reviews for pushing techniques</span></h1><div class="subtitle">Intrapartum care</div><p><b>Evidence review H</b></p><p><i>NICE Guideline, No. 235</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2023 Sep</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5393-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div></div><div class="bkr_clear"></div></div><div id="niceng235er8.s1"><h2 id="_niceng235er8_s1_">Pushing techniques</h2><div id="niceng235er8.s1.1"><h3>Review question</h3><p>What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</p><div id="niceng235er8.s1.1.1"><h4>Introduction</h4><p>A range of different pushing techniques may be used in the second stage of labour to assist with the birth of the baby.</p><p>Spontaneous pushing is when women have an instinctive and irresistible urge to push, and may push several times during one contraction. Directed pushing is when women are encouraged to take a deep breath in at the beginning of the contraction and push to the end of that breath, taking further breaths as necessary and repeating to the end of the contraction. Women can push with an open glottis (on exhalation) or closed glottis (Valsalva manouevre).</p><p>Pushing may either commence as soon as the cervix is fully dilated (immediate pushing), or be delayed from the time of complete cervical dilation to allow a period of passive descent where the uterine contractions alone may propel the baby through the birth canal. In women with regional analgesia (an epidural) in place the urge and ability to push may be reduced, and so a delay may ensure that the baby has descended further into the birth canal before directed pushing is commenced, which may help to shorten the active second stage.</p><p>There is uncertainty as to whether one pushing technique is more beneficial than another, and whether pushing should be delayed or begin immediately at the time of diagnosis of full dilatation of the cervix.</p><p>The aim of this review is to identify the benefits and risks of different pushing techniques and identify the optimal pushing technique for birth outcomes and birth experience for women with and without an epidural.</p></div><div id="niceng235er8.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK596203/table/niceng235er8.tab1/?report=objectonly" target="object" rid-figpopup="figniceng235er8tab1" rid-ob="figobniceng235er8tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng235er8tab1"><a href="/books/NBK596203/table/niceng235er8.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng235er8tab1" rid-ob="figobniceng235er8tab1"><img class="small-thumb" src="/books/NBK596203/table/niceng235er8.tab1/?report=thumb" src-large="/books/NBK596203/table/niceng235er8.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="niceng235er8.tab1"><a href="/books/NBK596203/table/niceng235er8.tab1/?report=objectonly" target="object" rid-ob="figobniceng235er8tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details see the review protocol in <a href="#niceng235er8.appa">appendix A</a>.</p></div><div id="niceng235er8.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng235er8.appa">appendix A</a> and the methods document (<a href="/books/NBK596203/bin/NG235_Supplement_1_Methods.pdf">Supplement 1</a>).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng235er8.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng235er8.s1.1.4.1"><h5>Included studies</h5><p>Nine studies were included for this review. Eight were randomised controlled trials (RCTs) (<a class="bibr" href="#niceng235er8.ref1" rid="niceng235er8.ref1">Ahmadi 2017</a>, <a class="bibr" href="#niceng235er8.ref2" rid="niceng235er8.ref2">Araujo 2021</a>, <a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a>, <a class="bibr" href="#niceng235er8.ref4" rid="niceng235er8.ref4">Barnett 1982</a>, <a class="bibr" href="#niceng235er8.ref13" rid="niceng235er8.ref13">Koyucu 2017</a>, <a class="bibr" href="#niceng235er8.ref17" rid="niceng235er8.ref17">Parnell 1983</a>, <a class="bibr" href="#niceng235er8.ref23" rid="niceng235er8.ref23">Walker 2012</a>, <a class="bibr" href="#niceng235er8.ref25" rid="niceng235er8.ref25">Yuksel 2017</a>) and 1 was a systematic review (<a class="bibr" href="#niceng235er8.ref14" rid="niceng235er8.ref14">Lemos 2017</a>). The systematic review had 16 RCTs included (<a class="bibr" href="#niceng235er8.ref5" rid="niceng235er8.ref5">Buxton 1988</a>, <a class="bibr" href="#niceng235er8.ref7" rid="niceng235er8.ref7">Fitzpatrick 2002</a>, <a class="bibr" href="#niceng235er8.ref8" rid="niceng235er8.ref8">Fraser 2000</a>, <a class="bibr" href="#niceng235er8.ref9" rid="niceng235er8.ref9">Goodfellow 1979</a>, <a class="bibr" href="#niceng235er8.ref10" rid="niceng235er8.ref10">Hansen 2002</a>, <a class="bibr" href="#niceng235er8.ref11" rid="niceng235er8.ref11">Jahdi 2011</a>, <a class="bibr" href="#niceng235er8.ref12" rid="niceng235er8.ref12">Kelly 2010</a>, <a class="bibr" href="#niceng235er8.ref6" rid="niceng235er8.ref6">Lam 2010</a>, <a class="bibr" href="#niceng235er8.ref15" rid="niceng235er8.ref15">Low 2013</a>, <a class="bibr" href="#niceng235er8.ref16" rid="niceng235er8.ref16">Mayberry 1999</a>, <a class="bibr" href="#niceng235er8.ref18" rid="niceng235er8.ref18">Plunkett 2003</a>, <a class="bibr" href="#niceng235er8.ref19" rid="niceng235er8.ref19">Schaffer 2005</a>, <a class="bibr" href="#niceng235er8.ref20" rid="niceng235er8.ref20">Thomson 1993</a>, <a class="bibr" href="#niceng235er8.ref21" rid="niceng235er8.ref21">Vause 1998</a>, <a class="bibr" href="#niceng235er8.ref22" rid="niceng235er8.ref22">Vaziri 2016</a>, <a class="bibr" href="#niceng235er8.ref24" rid="niceng235er8.ref24">Yildirim 2008</a>).</p><p>Three studies (<a class="bibr" href="#niceng235er8.ref1" rid="niceng235er8.ref1">Ahmadi 2017</a>, <a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a>, <a class="bibr" href="#niceng235er8.ref4" rid="niceng235er8.ref4">Barnett 1982</a>) compared directed pushing with open glottis breathing technique to directed pushing with closed glottis or Valsalva manoeuvre breathing technique. Eleven studies (<a class="bibr" href="#niceng235er8.ref2" rid="niceng235er8.ref2">Araujo 2021</a>, <a class="bibr" href="#niceng235er8.ref11" rid="niceng235er8.ref11">Jahdi 2011</a>, <a class="bibr" href="#niceng235er8.ref13" rid="niceng235er8.ref13">Koyucu 2017</a>, <a class="bibr" href="#niceng235er8.ref6" rid="niceng235er8.ref6">Lam 2010</a>, <a class="bibr" href="#niceng235er8.ref15" rid="niceng235er8.ref15">Low 2013</a>, <a class="bibr" href="#niceng235er8.ref17" rid="niceng235er8.ref17">Parnell 1993</a>, <a class="bibr" href="#niceng235er8.ref19" rid="niceng235er8.ref19">Schaffer 2005</a>, <a class="bibr" href="#niceng235er8.ref20" rid="niceng235er8.ref20">Thomson 1993</a>, <a class="bibr" href="#niceng235er8.ref22" rid="niceng235er8.ref22">Vzairi 2016</a>, <a class="bibr" href="#niceng235er8.ref24" rid="niceng235er8.ref24">Yildirim 2008</a>, <a class="bibr" href="#niceng235er8.ref25" rid="niceng235er8.ref25">Yuksel 2017</a>) compared spontaneous pushing to directed pushing using closed glottis. Ten studies (<a class="bibr" href="#niceng235er8.ref5" rid="niceng235er8.ref5">Buxton 1988</a>, <a class="bibr" href="#niceng235er8.ref7" rid="niceng235er8.ref7">Fitzpatrick 2002</a>; <a class="bibr" href="#niceng235er8.ref8" rid="niceng235er8.ref8">Fraser 2000</a>; <a class="bibr" href="#niceng235er8.ref9" rid="niceng235er8.ref9">Goodfellow 1979</a>; <a class="bibr" href="#niceng235er8.ref10" rid="niceng235er8.ref10">Hansen 2002</a>; <a class="bibr" href="#niceng235er8.ref12" rid="niceng235er8.ref12">Kelly 2010</a>; <a class="bibr" href="#niceng235er8.ref16" rid="niceng235er8.ref16">Mayberry 1999</a>; <a class="bibr" href="#niceng235er8.ref18" rid="niceng235er8.ref18">Plunkett 2003</a>; <a class="bibr" href="#niceng235er8.ref21" rid="niceng235er8.ref21">Vause 1998</a>, <a class="bibr" href="#niceng235er8.ref23" rid="niceng235er8.ref23">Walker 2012</a>) compared immediate to delayed pushing.</p><p>The studies were from Brazil, Canada, Denmark, France, Hong Kong, Iran, Ireland, Spain, Turkey, United Kingdom and the United States.</p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK596203/table/niceng235er8.tab2/?report=objectonly" target="object" rid-figpopup="figniceng235er8tab2" rid-ob="figobniceng235er8tab2">Table 2</a>.</p><p>See the literature search strategy in <a href="#niceng235er8.appb">appendix B</a> and study selection flow chart in <a href="#niceng235er8.appc">appendix C</a>.</p></div><div id="niceng235er8.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng235er8.appj">appendix J</a>.</p></div></div><div id="niceng235er8.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK596203/table/niceng235er8.tab2/?report=objectonly" target="object" rid-figpopup="figniceng235er8tab2" rid-ob="figobniceng235er8tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng235er8tab2"><a href="/books/NBK596203/table/niceng235er8.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng235er8tab2" rid-ob="figobniceng235er8tab2"><img class="small-thumb" src="/books/NBK596203/table/niceng235er8.tab2/?report=thumb" src-large="/books/NBK596203/table/niceng235er8.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng235er8.tab2"><a href="/books/NBK596203/table/niceng235er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng235er8tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng235er8.appd">appendix D</a> and the forest plots in <a href="#niceng235er8.appe">appendix E</a>.</p></div><div id="niceng235er8.s1.1.6"><h4>Summary of the evidence</h4><p>Across all comparisons there were generally no important differences between groups, or no evidence of a difference between groups in terms of mode of birth, third/fourth degree tears, Apgar scores <7 at 5 minutes, women’s experience of labour and birth and neonatal admission, with a few exceptions. There were differences between groups in terms of the duration of the active second stage of labour across all comparisons, and some differences for duration of the second stage of labour.</p><div id="niceng235er8.s1.1.6.1"><h5>Direct with open glottis versus directed with closed glottis</h5><p>Directed pushing using an open glottis breathing technique was compared to directed pushing using closed glottis or Valsalva manoeuvre technique. There were no important differences, or no evidence of an important difference between groups in terms of mode of birth, for women of mixed parity who had an epidural. There was no evidence of an important difference between groups for nulliparous or mixed parity women, with or without an epidural, in terms of third/fourth degree tears.</p><p>In terms of the duration of active and passive second stage, there was no important difference between groups for mixed parity women with an epidural. However, for multiparous women without an epidural, directed pushing with open glottis led to a reduction in the duration of the active second stage compared to directed pushing with a closed glottis.</p><p>For multiparous women without an epidural there was no important difference between groups on the duration of the passive second stage.</p><p>The evidence ranged from very low to moderate quality, with the main concerns around imprecision. There were some concerns around risk of bias, and indirectness due to not enough information given as to whether women had been induced.</p></div><div id="niceng235er8.s1.1.6.2"><h5>Spontaneous versus directed</h5><p>Spontaneous pushing was compared to directed pushing. Valsalva manoeuvre or closed glottis was used in both groups. For nulliparous and mixed parity women without an epidural, the evidence showed no important differences or no evidence of an important difference between groups in terms of mode of birth. The exception was a possible increase in the number of caesarean births for spontaneous pushing over directed pushing for nulliparous women with epidural.</p><p>There were no important differences, or no evidence of an important difference for third/fourth degree tears, or Apgar score <7 at 5 minutes for nulliparous women or women of mixed parity without epidural.</p><p>In terms of duration of the active second stage, the evidence for nulliparous women without an epidural showed no differences between groups, however for mixed parity without an epidural, spontaneous pushing led to a decrease in the duration compared to directed pushing. For nulliparous and mixed parity women, with or without an epidural, there was no important difference on the duration of the second stage of labour.</p><p>There were no differences between the groups on maternal satisfaction in nulliparous women without an epidural, or neonatal admission in mixed parity and nulliparous women without an epidural.</p><p>All the evidence for spontaneous versus directed was rated as very low quality with concerns around risk of bias, heterogeneity, indirectness and imprecision. The exception was spontaneous vaginal births in nulliparous women which was rated moderate quality with concerns around risk of bias only.</p></div><div id="niceng235er8.s1.1.6.3"><h5>Immediate versus delayed</h5><p>Immediate pushing was compared to delayed pushing. All the evidence was in women with an epidural. The evidence showed no important differences in terms of spontaneous vaginal birth for nulliparous and multiparous women. There was no important difference for instrumental vaginal births for nulliparous women, or mixed parity, but some evidence on multiparous women showed a possible important increase in the number of instrumental vaginal births for immediate pushing. There was no important difference or no evidence of an important difference on caesarean births for nulliparous or mixed parity women.</p><p>There was no important difference on third/fourth degree tears in nulliparous women, or Apgar score <7 at 5 minutes for nulliparous or mixed parity women.</p><p>There was an important increase in the duration of the active second stage of labour, with immediate pushing for both nulliparous and multiparous women, but evidence for mixed parity showed no important difference between groups.</p><p>Evidence on the passive stage of second stage, and the total second stage showed an important decrease in the duration for immediate pushing, in nulliparous, multiparous and mixed parity. This is expected as the women in the immediate group would have moved to the active/pushing stage of labour sooner than the delayed group.</p><p>There were no important differences between groups for neonatal admissions for nulliparous women.</p><p>The evidence was rated as mainly very low quality, with concerns around risk of bias, heterogeneity, indirectness and imprecision. Some of the evidence was of low and moderate quality.</p></div></div><div id="niceng235er8.s1.1.7"><h4>Economic evidence</h4><div id="niceng235er8.s1.1.7.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.</p></div><div id="niceng235er8.s1.1.7.2"><h5>Excluded studies</h5><p>Economic studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng235er8.appj">appendix J</a>.</p></div><div id="niceng235er8.s1.1.7.3"><h5>Economic model</h5><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div></div><div id="niceng235er8.s1.1.8"><h4>The committee's discussion and interpretation of the evidence</h4><div id="niceng235er8.s1.1.8.1"><h5>The outcomes that matter most</h5><p>The committee agreed that mode of birth was a critical outcome for this review as it would provide women and healthcare professionals with information on whether different pushing techniques were more or less likely to lead to a spontaneous vaginal birth, or whether they would have an impact on the rate of birth with forceps or ventouse, or a caesarean birth, and this in turn would have an impact on women’s experience of labour and birth. The committee also agreed that third/fourth degree tears was a critical outcome for this review, as the quality of life for women following this outcome can be greatly reduced. They also prioritised Apgar score <7 at 5 minutes as a critical outcome for the baby, as this outcome is an indicator for the survival and health outcomes for the neonate.</p><p>The committee also chose important outcomes for this review. They agreed that the duration of the active and the passive second stage of labour were important outcomes as different pushing techniques may lead to longer durations of labour, and information regarding this would be beneficial to women when deciding which approach is best. In addition they agreed that a prolonged active second stage of labour may lead to pelvic floor damage. The committee also wanted to explore women’s experience during labour and whether any pushing techniques had an impact on this, and so included this as an important outcome. The committee recognised the great importance of women’s experience, in particular with this topic, but they were aware that data on this outcome was likely to be sparse and unlikely to inform decision-making in a meaningful way, so they prioritised this outcome as important, rather than critical. The committee also recognised that neonatal admission was an important outcome for this review and would provide an indication of the health of the neonate.</p></div><div id="niceng235er8.s1.1.8.2"><h5>The quality of the evidence</h5><p>The quality of the evidence for outcomes was assessed with GRADE and was rated as moderate to very low.</p><p>Some of the evidence was downgraded due to risk of bias. For subjective outcomes this was due to not being able to blind for interventions. Other concerns around bias were some concerns around the randomisation of participants, incomplete data for some of the evidence and some concerns around selective reporting due to pre-specified protocols not being available.</p><p>There was heterogeneity in some of the evidence that could not be explained by subgroup analysis. Some of the evidence was downgraded for indirectness, this was mainly due to women who had their labour induced, or there were high risk groups included in the population and not enough information regarding the proportion of these women in the total sample.</p><p>Most of the evidence was also downgraded for imprecision around the estimate of effect.</p></div><div id="niceng235er8.s1.1.8.3"><h5>Benefits and harms</h5><p>The committee discussed the evidence and agreed to make recommendations specific to the parity of women (where possible) and whether they had an epidural in situ.</p><p>The committee discussed the evidence for directed and spontaneous pushing (directed with open glottis versus directed with Valsava/closed glottis and spontaneous versus directed, both with Valsava/closed glottis) and noted that most of the evidence showed no difference or no evidence of an important difference between the different types of pushing techniques. The evidence for directed and spontaneous pushing included groups of women both with and without an epidural so the committee agreed to make recommendations for these groups separately.</p><p>In women without an epidural there was a reduction in the duration of active second stage with directed pushing with an open glottis (in multiparous women) and with spontaneous pushing with a closed glottis (in mixed parity women), so the committee agreed to recommend these 2 options.</p><p>In women with an epidural in situ, there was evidence for an increased risk of caesarean birth (in nulliparous women) with spontaneous pushing compared to directed pushing, so the committee recommended directed pushing in these women. This agreed with the committee’s view that as women with an epidural do not get the same urge to push, directed pushing may be more helpful in these women.</p><p>As overall there was no evidence suggesting a clear benefit of one pushing technique over another, the committee agreed that they would not recommend a specific pushing technique and that women’s preferences should be the main factor to consider. They therefore agreed to make a recommendation advising women without an epidural in situ of the potential benefits of spontaneous pushing and pushing while exhaling on the duration of the second stage of labour, and that there may be an increase in the rate of caesarean birth for nulliparous women with an epidural, and so made recommendations advising women of this.</p><p>The committee discussed the evidence for the timing of pushing (immediate compared to delayed) and noted that all the evidence was in women with an epidural in situ, but that it had been possible to break it down into nulliparous and multiparous women. They discussed that the evidence showed an important increase in the duration of the active second stage for immediate pushing in both nulliparous and multiparous women, meaning that the active second stage was shorter with delayed pushing. The committee noted that, as expected, the duration of the passive second stage was reduced with immediate pushing, but that despite the increase in the duration of the active stage with immediate pushing, the total duration of the second stage was reduced with immediate pushing. The committee agreed that although there may be some damage to the pelvic floor in the passive second stage, due to the presenting part pushing on the pelvic floor, it was a prolonged active second stage which led to more pelvic floor damage, and so they agreed they would make recommendations advising women with epidurals of the benefits of delayed pushing. For multiparous women with an epidural in situ there was evidence immediate pushing increased the rate of birth with forceps or ventouse, and so this evidence reinforced the recommendation that these women should be advised to delay pushing.</p><p>The committee discussed that the exact timing of the delay would be useful to include in the recommendations and looked at the evidence for further detail on the timings. The committee discussed the evidence for multiparous women, which favoured a 1 hour delay over immediate pushing in terms of duration of the active second stage, as well as a possible reduction in instrumental births. They agreed that this was also in line with current practice and therefore included this in their recommendation.</p><p>The committee discussed the evidence for nulliparous women, and discussed the variation in practice with regard to the length of delay of pushing for this group of women. They noted that the studies used a range of timings for delay from up to 1 hour and up to 3 hours. The committee considered the effect estimates for the different timings separately based on the data provided in the forest plots. The evidence showed that the benefit was specific to the evidence that used a delay of up to 2 and up to 3 hours. The committee considered the benefits alongside the harms of recommendation for up to 3 hours delay. Although the evidence for a 3 hour delay did not show a difference between interventions in the mode of birth outcomes, or neonatal admission, the committee were aware of the risks of post-partum haemorrhage, pelvic floor damage and incontinence related issues with very long second stages. They therefore agreed that a 3 hour delay may offer the same benefits as a 2 hour delay but may also increase the likelihood of these adverse consequences and so agreed to recommend a 2 hour delay as for the appropriate time for delayed pushing in nulliparous women.</p></div><div id="niceng235er8.s1.1.8.4"><h5>Cost effectiveness and resource use</h5><p>The committee noted that there were no costs associated with the different pushing techniques themselves but any difference in outcomes could result in a difference in resource use between alternative approaches. However, as the review did not find consistent evidence of a difference in outcomes such as mode of birth, neonatal admission, and duration of the active second stage of labour, the committee concluded that evidence on cost-effectiveness was inconclusive and that it was reasonable for the recommendations on pushing technique to be based on the clinical evidence and the woman’s choice.</p><p>Again, the committee reasoned that any differences in outcomes were likely to be the principal driver of costs associated with the length of delay in pushing and that any delay thought to produce a clinical benefit was likely to be cost-effective. The recommendations made by the committee reflected current practice and are not expected to have a significant resource impact on the NHS.</p></div><div id="niceng235er8.s1.1.8.5"><h5>Other factors the committee took into account</h5><p>The committee were aware that defining delay in the second stage of labour needed to take into account the periods of delayed pushing, and so cross-checked these recommendations with the section of the guideline on defining delay, to ensure consistency.</p></div></div><div id="niceng235er8.s1.1.9"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.9.7, 1.9.9 and 1.9.10.</p></div></div><div id="niceng235er8.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng235er8.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref1"><p id="p-182">
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<strong>Ahmadi 2017</strong>
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</p>Ahmadi, Zohre, Torkzahrani, Shahnaz, Roosta, Firouze
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et al (2017) Effect of Breathing Technique of Blowing on the Extent of Damage to the Perineum at the Moment of Delivery: A Randomized Clinical Trial. Iranian journal of nursing and midwifery research
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22(1): 62–66 [<a href="/pmc/articles/PMC5364755/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5364755</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28382061" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28382061</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref2"><p id="p-183">
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<strong>Araujo 2021</strong>
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</p>Araujo,, Delgado, Alexandre, Maia, Juliana Netto
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et al (2021) Efficacy of spontaneous pushing with pursed lips breathing compared with directed pushing in maternal and neonatal outcomes. Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology: 1–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/34581237" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34581237</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref3"><p id="p-184">
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<strong>Barasinski 2020</strong>
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</p>Barasinski, C.; Debost-Legrand, A.; Vendittelli, F. (2020) Is directed open-glottis pushing more effective than directed closed-glottis pushing during the second stage of labor? A pragmatic randomized trial - the EOLE study. Midwifery
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91: 102843 [<a href="https://pubmed.ncbi.nlm.nih.gov/32992159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32992159</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref4"><p id="p-185">
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<strong>Barnett 1982</strong>
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</p>Barnett, M. M. and Humenick, S. S. (1982) Infant outcome in relation to second stage labor pushing method. Birth (Berkeley, Calif.)
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9: 221–228</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref5"><p id="p-186">
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<strong>Buxton 1988</strong>
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</p>Buxton, E. J.; Redman, C. W. E.; Obhrai, M. (1988) Delayed pushing with lumbar epidural in labour - Does it increase the incidence of spontaneous delivery?.
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Journal of Obstetrics and Gynaecology
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8(3): 258–261</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref6"><p id="p-187">
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<strong>Lam 2010</strong>
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</p>Co Lam, C. and McDonald, S. J. (2010) Comparison of pushing techniques used in the second stage of labour for their effect on maternal perception of fatigue in the early postpartum period among Chinese women. Hong kong journal of gynaecology, obstetrics and midwifery
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10(1): 13–21</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref7"><p id="p-188">
|
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<strong>Fitzpatrick 2002</strong>
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</p>Fitzpatrick, Myra, Harkin, Rosemary, McQuillan, Katherine
|
|
et al (2002) A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence. BJOG: an international journal of obstetrics and gynaecology
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109(12): 1359–65 [<a href="https://pubmed.ncbi.nlm.nih.gov/12504971" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12504971</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref8"><p id="p-189">
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<strong>Fraser 2000</strong>
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</p>Fraser, W. D., Marcoux, S., Krauss, I.
|
|
et al (2000) Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group. American journal of obstetrics and gynecology
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182(5): 1165–72 [<a href="https://pubmed.ncbi.nlm.nih.gov/10819854" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10819854</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref9"><p id="p-190">
|
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<strong>Goodfellow</strong>
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|
</p>Goodfellow, CF and Studd, C (1979) The reduction of forceps in primigravidae with epidural analgesia--a controlled trial. The British journal of clinical practice
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33(10): 287–288 [<a href="https://pubmed.ncbi.nlm.nih.gov/393289" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 393289</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref10"><p id="p-191">
|
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<strong>Hansen 2002</strong>
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</p>Hansen, Susan L.; Clark, Steven L.; Foster, Joyce C. (2002) Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstetrics and gynecology
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99(1): 29–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/11777506" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11777506</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref11"><p id="p-192">
|
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<strong>Jahdi 2011</strong>
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</p>Jahdi, F., Shahnazari, M., Kashanian, M.
|
|
et al (2011) A randomized controlled trial comparing the physiological and directed pushing on the duration of the second stage of labor, the mode of delivery and apgar score. International Journal of Collaborative Research on Internal Medicine and Public Health
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3(2): 159–165</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref12"><p id="p-193">
|
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<strong>Kelly 2010</strong>
|
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</p>Kelly, Mary, Johnson, Eileen, Lee, Vickie
|
|
et al (2010) Delayed versus immediate pushing in second stage of labor. MCN. The American journal of maternal child nursing
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35(2): 81–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/20215948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20215948</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref13"><p id="p-194">
|
|
<strong>Koyucu 2017</strong>
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</p>Koyucu, Refika Genc and Demirci, Nurdan (2017) Effects of pushing techniques during the second stage of labor: A randomized controlled trial. Taiwanese journal of obstetrics & gynecology
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|
56(5): 606–612 [<a href="https://pubmed.ncbi.nlm.nih.gov/29037544" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29037544</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref14"><p id="p-195">
|
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<strong>Lemos 2017</strong>
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</p>Lemos, A., Amorim, M. M., Dornelas de Andrade, A.
|
|
et al (2017) Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews
|
|
2017(3): cd009124 [<a href="/pmc/articles/PMC6464699/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6464699</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28349526" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28349526</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref15"><p id="p-196">
|
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<strong>Low 2013</strong>
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</p>Low, Lisa Kane, Miller, Janis M., Guo, Ying
|
|
et al (2013) Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. International urogynecology journal
|
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24(3): 453–60 [<a href="/pmc/articles/PMC3980478/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3980478</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22829349" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22829349</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref16"><p id="p-197">
|
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<strong>Mayberry 1999</strong>
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|
</p>Mayberry, L. J., Hammer, R., Kelly, C.
|
|
et al (1999) Use of delayed pushing with epidural anesthesia: findings from a randomized, controlled trial. Journal of perinatology: official journal of the California Perinatal Association
|
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19(1): 26–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/10685198" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10685198</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref17"><p id="p-198">
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<strong>Parnell 1993</strong>
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</p>Parnell, C., Langhoff-Roos, J., Iversen, R.
|
|
et al (1993) Pushing method in the expulsive phase of labor. A randomized trial. Acta obstetricia et gynecologica Scandinavica
|
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72(1): 31–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/8382428" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8382428</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref18"><p id="p-199">
|
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<strong>Plunkett 2003</strong>
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</p>Plunkett, BA, Lin, A, Wong, CA
|
|
et al (2003) Management of the second stage of labor in nulliparas with continuous epidural analgesia. Obstetrics and gynecology
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102(1): 109–114 [<a href="https://pubmed.ncbi.nlm.nih.gov/12850615" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12850615</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref19"><p id="p-200">
|
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<strong>Schaffer 2005</strong>
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</p>Schaffer, J. I., Bloom, S. L., Casey, B. M.
|
|
et al (2005) A randomized trial of the effects of coached vs uncoached maternal pushing during second stage of labor on postpartum pelvic floor structure and function. American journal of obstetrics and gynecology
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192: 1692–1696 [<a href="https://pubmed.ncbi.nlm.nih.gov/15902179" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15902179</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref20"><p id="p-201">
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<strong>Thomson 1993</strong>
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</p>Thomson, A. M. (1993) Pushing techniques in the second stage of labour. Journal of advanced nursing
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18(2): 171–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/8436706" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8436706</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref21"><p id="p-202">
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<strong>Vause 1998</strong>
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</p>Vause, S.; Congdon, H. M.; Thornton, J. G. (1998) Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial. British journal of obstetrics and gynaecology
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105(2): 186–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/9501784" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9501784</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref22"><p id="p-203">
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<strong>Vaziri 2016</strong>
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</p>Vaziri, Farideh, Arzhe, Amene, Asadi, Nasrin
|
|
et al (2016) Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial. Iranian Red Crescent medical journal
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18(10): e29279 [<a href="/pmc/articles/PMC5286842/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5286842</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28180019" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28180019</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref23"><p id="p-204">
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<strong>Walker 2012</strong>
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</p>Walker, Carolina, Rodriguez, Tania, Herranz, Ana
|
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et al (2012) Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. International urogynecology journal
|
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23(9): 1249–56 [<a href="https://pubmed.ncbi.nlm.nih.gov/22297706" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22297706</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref24"><p id="p-205">
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<strong>Yildirim 2008</strong>
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</p>Yildirim, Gulay and Beji, Nezihe Kizilkaya (2008) Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth (Berkeley, Calif.)
|
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35(1): 25–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/18307484" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18307484</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng235er8.ref25"><p id="p-206">
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<strong>Yuksel 2017</strong>
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</p>Yuksel, Hilal, Cayir, Yasemin, Kosan, Zahide
|
|
et al (2017) Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. Journal of integrative medicine
|
|
15(6): 456–461 [<a href="https://pubmed.ncbi.nlm.nih.gov/29103415" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29103415</span></a>]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng235er8.appa"><h3>Appendix A. Review protocols</h3><p id="niceng235er8.appa.et1"><a href="/books/NBK596203/bin/niceng235er8-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 244K)</span></p></div><div id="niceng235er8.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng235er8.appb.et1"><a href="/books/NBK596203/bin/niceng235er8-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 187K)</span></p></div><div id="niceng235er8.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng235er8.appc.et1"><a href="/books/NBK596203/bin/niceng235er8-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 163K)</span></p></div><div id="niceng235er8.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng235er8.appd.et1"><a href="/books/NBK596203/bin/niceng235er8-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 492K)</span></p></div><div id="niceng235er8.appe"><h3>Appendix E. Forest plots</h3><p id="niceng235er8.appe.et1"><a href="/books/NBK596203/bin/niceng235er8-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Forest plots for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 438K)</span></p></div><div id="niceng235er8.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng235er8.appf.et1"><a href="/books/NBK596203/bin/niceng235er8-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 340K)</span></p></div><div id="niceng235er8.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng235er8.appg.et1"><a href="/books/NBK596203/bin/niceng235er8-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</a><span class="small"> (PDF, 195K)</span></p></div><div id="niceng235er8.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng235er8.apph.s1"><h4>Economic evidence tables for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng235er8.appi"><h3>Appendix I. Economic model</h3><div id="niceng235er8.appi.s1"><h4>Economic model for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng235er8.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng235er8.appj.s1"><h4>Excluded studies for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</h4><div id="niceng235er8.appj.s1.1"><h5>Excluded effectiveness studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng235er8appjtab1"><a href="/books/NBK596203/table/niceng235er8.appj.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng235er8appjtab1" rid-ob="figobniceng235er8appjtab1"><img class="small-thumb" src="/books/NBK596203/table/niceng235er8.appj.tab1/?report=thumb" src-large="/books/NBK596203/table/niceng235er8.appj.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng235er8.appj.tab1"><a href="/books/NBK596203/table/niceng235er8.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng235er8appjtab1">Table</a></h4><p class="float-caption no_bottom_margin">- Intervention Secondary analysis of a RCT. Analysis only looked at suboptimal analgesia and related outcomes, therefore not relevant to the protocol. Primary RCT included under Fraser 2000</p></div></div></div><div id="niceng235er8.appj.s1.2"><h5>Excluded economic studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng235er8appjtab2"><a href="/books/NBK596203/table/niceng235er8.appj.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng235er8appjtab2" rid-ob="figobniceng235er8appjtab2"><img class="small-thumb" src="/books/NBK596203/table/niceng235er8.appj.tab2/?report=thumb" src-large="/books/NBK596203/table/niceng235er8.appj.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng235er8.appj.tab2"><a href="/books/NBK596203/table/niceng235er8.appj.tab2/?report=objectonly" target="object" rid-ob="figobniceng235er8appjtab2">Table</a></h4></div></div></div></div></div><div id="niceng235er8.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng235er8.appk.s1"><h4>Research recommendations for review question: What are the benefits and risks of the different pushing techniques (immediate, spontaneous, delayed, directed) in the second stage of labour in women with and without regional analgesia?</h4><p>No research recommendations were made for this review question.</p></div></div></div></div><div class="fm-sec"><div><p>Final version</p></div><div><p>Evidence reviews underpinning recommendations 1.9.7, 1.9.9, 1.9.10 in the NICE guideline September 2023</p><p>These evidence reviews were developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="https://www.gov.wales/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div><div class="small"><span class="label">Bookshelf ID: NBK596203</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/37856643" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">37856643</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng235er8tab1"><div id="niceng235er8.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK596203/table/niceng235er8.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng235er8.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng235er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><td headers="hd_b_niceng235er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Women in the second stage of labour with or without regional analgesia who are pregnant with a single baby who has not been identified before labour to be at high risk of adverse outcomes; who go into labour at term (37 to 42 weeks of pregnancy) and who do not have any pre-existing medical conditions or antenatal conditions that predispose to a higher risk birth</div></li><li class="half_rhythm"><div>Singleton babies born at term (37 to 42 weeks of pregnancy) with no previously identified problems (for example congenital malformations, genetic anomalies, intrauterine growth restriction, placental problems)</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng235er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng235er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Any kind of breathing or pushing technique in the second stage of labour.</p>
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<p>Interventions will be categorised as follows:<ul><li class="half_rhythm"><div>Timing of pushing techniques:<ul class="circle"><li class="half_rhythm"><div>Immediate/active pushing: this refers to pushing techniques which begin as soon as the woman is fully dilated</div></li><li class="half_rhythm"><div>Passive descent or delayed pushing: this refers to pushing techniques which allow for spontaneous descent</div></li></ul></div></li><li class="half_rhythm"><div>Type of pushing techniques:<ul class="circle"><li class="half_rhythm"><div>Directed pushing or Valsalva manoeuvre: this refers to pushing techniques which encourage women to take a deep breath at the beginning of a contraction, then hold it and bear down throughout the contraction</div></li><li class="half_rhythm"><div>Spontaneous, physiological or mother-led pushing: this refers to pushing techniques which follow the woman’s natural urge to push</div></li></ul></div></li></ul></p>
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</td></tr><tr><th id="hd_b_niceng235er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng235er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Different timing of pushing techniques compared against each other (for example, immediate versus delayed pushing)</div></li><li class="half_rhythm"><div>Different type of pushing techniques compared against each other (for example, directed versus spontaneous pushing)</div></li><li class="half_rhythm"><div>Different timing of pushing techniques compared against different type of pushing techniques (for example, immediate versus directed)</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng235er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng235er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<b>Critical:</b>
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<ul><li class="half_rhythm"><div>Mode of birth (spontaneous vaginal, instrumental vaginal, caesarean birth)</div></li><li class="half_rhythm"><div>Third/fourth degree tears</div></li><li class="half_rhythm"><div>Apgar score <7 at 5 minutes</div></li></ul>
|
|
</p>
|
|
<p>
|
|
<b>Important:</b>
|
|
<ul><li class="half_rhythm"><div>Duration of active second stage (minutes)/duration of pushing (minutes)</div></li><li class="half_rhythm"><div>Duration of passive second stage (minutes)</div></li><li class="half_rhythm"><div>Women’s experience of labour and birth</div></li><li class="half_rhythm"><div>Neonatal admission</div></li></ul>
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|
</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng235er8tab2"><div id="niceng235er8.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies.</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK596203/table/niceng235er8.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng235er8.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref1" rid="niceng235er8.ref1">Ahmadi 2017</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>Iran</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>N=172 women</p>
|
|
<p>Primiparous</p>
|
|
<p>No epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed breathing with open glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed breathing holding the breath</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Third/fourth degree tears</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref2" rid="niceng235er8.ref2">Araujo 2021</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>Brazil</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=210 women</p>
|
|
<p>Mixed parity</p>
|
|
<p>No epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spontaneous pushing</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed pushing using closed glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mode of birth:<ul class="circle"><li class="half_rhythm"><div>Spontaneous vaginal birth</div></li><li class="half_rhythm"><div>Instrumental birth</div></li><li class="half_rhythm"><div>Caesarean birth</div></li></ul></div></li><li class="half_rhythm"><div>Apgar score <7 at 5 minutes</div></li><li class="half_rhythm"><div>Duration of active second stage</div></li><li class="half_rhythm"><div>Duration of second stage</div></li><li class="half_rhythm"><div>Women’s experience of labour and birth</div></li><li class="half_rhythm"><div>Neonatal admission</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>France</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=250 women</p>
|
|
<p>Mixed parity</p>
|
|
<p>With epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed breathing with open glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed breathing with closed glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mode of birth:<ul class="circle"><li class="half_rhythm"><div>Spontaneous vaginal birth</div></li><li class="half_rhythm"><div>Instrumental vaginal birth</div></li><li class="half_rhythm"><div>Caesarean birth</div></li></ul></div></li><li class="half_rhythm"><div>Third/fourth degree tears</div></li><li class="half_rhythm"><div>Duration of active second stage</div></li><li class="half_rhythm"><div>Duration of passive second stage</div></li><li class="half_rhythm"><div>Neonatal admission</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref4" rid="niceng235er8.ref4">Barnett 1982</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>United States</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=10 women</p>
|
|
<p>Multiparous</p>
|
|
<p>No epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed breathing with open glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed breathing with Valsalva manoeuvre (closed glottis)</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Duration of active second stage</div></li><li class="half_rhythm"><div>Duration of second stage</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref13" rid="niceng235er8.ref13">Koyucu 2017</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>Turkey</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=80 women</p>
|
|
<p>Nulliparous</p>
|
|
<p>No epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spontaneous</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed closed glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mode of birth<ul class="circle"><li class="half_rhythm"><div>Spontaneous vaginal birth</div></li></ul></div></li><li class="half_rhythm"><div>Third/fourth degree tears</div></li><li class="half_rhythm"><div>Duration of second stage</div></li><li class="half_rhythm"><div>Neonatal admission</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref14" rid="niceng235er8.ref14">Lemos 2017</a>
|
|
</p>
|
|
<p>Cochrane systematic review</p>
|
|
<p>Canada, Hong Kong, Iran, Ireland, Turkey, United Kingdom, United States</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>K=16 (<a class="bibr" href="#niceng235er8.ref5" rid="niceng235er8.ref5">Buxton 1988</a>, <a class="bibr" href="#niceng235er8.ref7" rid="niceng235er8.ref7">Fitzpatrick 2002</a>, <a class="bibr" href="#niceng235er8.ref8" rid="niceng235er8.ref8">Fraser 2000</a>, <a class="bibr" href="#niceng235er8.ref9" rid="niceng235er8.ref9">Goodfellow 1979</a>, <a class="bibr" href="#niceng235er8.ref10" rid="niceng235er8.ref10">Hansen 2002</a>, <a class="bibr" href="#niceng235er8.ref11" rid="niceng235er8.ref11">Jahdi 2011</a>, <a class="bibr" href="#niceng235er8.ref12" rid="niceng235er8.ref12">Kelly 2010</a>, <a class="bibr" href="#niceng235er8.ref6" rid="niceng235er8.ref6">Lam 2010</a>, <a class="bibr" href="#niceng235er8.ref15" rid="niceng235er8.ref15">Low 2013</a>, <a class="bibr" href="#niceng235er8.ref16" rid="niceng235er8.ref16">Mayberry 1999</a>, <a class="bibr" href="#niceng235er8.ref18" rid="niceng235er8.ref18">Plunkett 2003</a>, <a class="bibr" href="#niceng235er8.ref19" rid="niceng235er8.ref19">Schaffer 2005</a>, <a class="bibr" href="#niceng235er8.ref20" rid="niceng235er8.ref20">Thomson 1993</a>, <a class="bibr" href="#niceng235er8.ref21" rid="niceng235er8.ref21">Vause 1998</a>, <a class="bibr" href="#niceng235er8.ref22" rid="niceng235er8.ref22">Vaziri 2016</a>, <a class="bibr" href="#niceng235er8.ref24" rid="niceng235er8.ref24">Yildirim 2008</a>)</p>
|
|
<p>N=3911 women</p>
|
|
<p>With and without epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Immediate (<a class="bibr" href="#niceng235er8.ref5" rid="niceng235er8.ref5">Buxton 1988</a>, <a class="bibr" href="#niceng235er8.ref7" rid="niceng235er8.ref7">Fitzpatrick 2002</a>, <a class="bibr" href="#niceng235er8.ref8" rid="niceng235er8.ref8">Fraser 2000</a>, <a class="bibr" href="#niceng235er8.ref9" rid="niceng235er8.ref9">Goodfellow 1979</a>, <a class="bibr" href="#niceng235er8.ref10" rid="niceng235er8.ref10">Hansen 2002</a>, <a class="bibr" href="#niceng235er8.ref12" rid="niceng235er8.ref12">Kelly 2010</a>, <a class="bibr" href="#niceng235er8.ref16" rid="niceng235er8.ref16">Mayberry 1999</a>, <a class="bibr" href="#niceng235er8.ref18" rid="niceng235er8.ref18">Plunkett 2003</a>, <a class="bibr" href="#niceng235er8.ref21" rid="niceng235er8.ref21">Vause 1998</a>)</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Delayed</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mode of birth<ul class="circle"><li class="half_rhythm"><div>Spontaneous vaginal birth</div></li><li class="half_rhythm"><div>Instrumental birth</div></li><li class="half_rhythm"><div>Caesarean birth</div></li></ul></div></li><li class="half_rhythm"><div>Third/fourth degree tears</div></li><li class="half_rhythm"><div>Apgar score <7 at 5 minutes</div></li><li class="half_rhythm"><div>Duration of active second stage</div></li><li class="half_rhythm"><div>Duration of passive second stage</div></li><li class="half_rhythm"><div>Duration of second stage</div></li><li class="half_rhythm"><div>Women’s experience of labour and birth</div></li><li class="half_rhythm"><div>Neonatal admission</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spontaneous (<a class="bibr" href="#niceng235er8.ref11" rid="niceng235er8.ref11">Jahdi 2011</a>, <a class="bibr" href="#niceng235er8.ref6" rid="niceng235er8.ref6">Lam 2010</a>, <a class="bibr" href="#niceng235er8.ref15" rid="niceng235er8.ref15">Low 2013</a>, <a class="bibr" href="#niceng235er8.ref19" rid="niceng235er8.ref19">Schaffer 2005</a>, <a class="bibr" href="#niceng235er8.ref20" rid="niceng235er8.ref20">Thomson 1993</a>, <a class="bibr" href="#niceng235er8.ref22" rid="niceng235er8.ref22">Vaziri 2016</a>, <a class="bibr" href="#niceng235er8.ref24" rid="niceng235er8.ref24">Yildirim 2008</a>)</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed closed glottis/Valsalva manoeuvre</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref17" rid="niceng235er8.ref17">Parnell 1983</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>Denmark</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=306 women</p>
|
|
<p>Primiparous, or multiparous after a caesarean birth</p>
|
|
<p>No epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spontaneous</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed using Valsalva manoeuvre</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Duration of active second stage</div></li><li class="half_rhythm"><div>Duration of second stage</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref23" rid="niceng235er8.ref23">Walker 2012</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>Spain</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=199 women</p>
|
|
<p>Mixed parity</p>
|
|
<p>With epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Immediate</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Delayed</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Mode of birth<ul class="circle"><li class="half_rhythm"><div>Spontaneous vaginal birth</div></li><li class="half_rhythm"><div>Instrumental birth</div></li></ul></div></li><li class="half_rhythm"><div>Duration of active second stage</div></li><li class="half_rhythm"><div>Apgar score <7 at 5 minutes</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng235er8.ref25" rid="niceng235er8.ref25">Yuksel 2017</a>
|
|
</p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>Turkey</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=250 women</p>
|
|
<p>Nulliparous</p>
|
|
<p>No epidural</p>
|
|
</td><td headers="hd_h_niceng235er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spontaneous</td><td headers="hd_h_niceng235er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directed closed glottis</td><td headers="hd_h_niceng235er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Duration of second stage</div></li></ul>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng235er8appjtab1"><div id="niceng235er8.appj.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK596203/table/niceng235er8.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng235er8.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason</th></tr></thead><tbody><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Abenhaim, Haim A. and Fraser, William D. (2008) Impact of pain level on second-stage delivery outcomes among women with epidural analgesia: results from the PEOPLE study. American journal of obstetrics and gynecology
|
|
199(5): 500.e1–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/18565489" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18565489</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention</p>
|
|
<p>Secondary analysis of a RCT. Analysis only looked at suboptimal analgesia and related outcomes, therefore not relevant to the protocol. Primary RCT included under <a class="bibr" href="#niceng235er8.ref8" rid="niceng235er8.ref8">Fraser 2000</a></p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Amin, S. (2022) To push or not to push with neuraxial analgesia at full dilatation. BJOG: An International Journal of Obstetrics and Gynaecology
|
|
129(supplement1): 108
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract only</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Barasinski, C., Legrand, A., Lemery, D.
|
|
et al (2018) Directed open-glottis pushing versus directed closed-glottis pushing during labor-eole study. International Journal of Gynecology and Obstetrics
|
|
143(supplement3): 235
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</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Barasinski, C.; Lemery, D.; Vendittelli, F. (2016) Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?. Gynecologie, obstetrique & fertilite
|
|
44(10): 578–583 [<a href="https://pubmed.ncbi.nlm.nih.gov/27568414" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27568414</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- More recent systematic review available</p>
|
|
<p>More recent review with relevant studies available</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Barasinski, Chloe, Debost-Legrand, Anne, Savary, Denis
|
|
et al (2022) Does the type of pushing at delivery influence pelvic floor function at 2 months postpartum?
|
|
A pragmatic randomized trial-The EOLE study. Acta obstetricia et gynecologica Scandinavica [<a href="/pmc/articles/PMC9780713/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9780713</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36352788" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36352788</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Secondary analysis</p>
|
|
<p>Secondary analysis of <a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a>. Main outcomes relevant to the review have been included under <a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a>. This publication adds additional outcomes that do not match the outcomes for the review</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Barasinski, Chloe and Vendittelli, Francoise (2016) Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial-the EOLE study protocol. BMJ open
|
|
6(12): e012290 [<a href="/pmc/articles/PMC5223691/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5223691</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27998899" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27998899</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Study protocol only. Full results assessed under <a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a></p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bloom, Steven L., Casey, Brian M., Schaffer, Joseph I.
|
|
et al (2006) A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. American journal of obstetrics and gynecology
|
|
194(1): 10–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/16389004" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16389004</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Results included under another publication</p>
|
|
<p>Results included under Schaffer 2005, which is included under <a class="bibr" href="#niceng235er8.ref14" rid="niceng235er8.ref14">Lemos 2017</a></p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Brancato, Robyn M.; Church, Sara; Stone, Patricia W. (2008) A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
|
|
37(1): 4–12 [<a href="https://pubmed.ncbi.nlm.nih.gov/18226152" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18226152</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- More recent systematic review available</p>
|
|
<p>All relevant studies included in more recent systematic reviews</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a id="niceng235er8.appj.ref9"></a>Cahill, A. G., Srinivas, S. K., Tita, A. T. N.
|
|
et al (2018) Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: a Randomized Clinical Trial. JAMA
|
|
320(14): 1444–1454 [<a href="/pmc/articles/PMC6583005/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6583005</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30304425" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30304425</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population</p>
|
|
<p>Over 33% of women had their labour induced</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cahill, A. G., Srinivas, S. K., Tita, A. T. N.
|
|
et al (2019) Effect of immediate vs delayed pushing on rates of spontaneous vaginal delivery among nulliparous women receiving neuraxial analgesia: A randomized clinical trial. Obstetrical and Gynecological Survey
|
|
74(3): 131–133 [<a href="/pmc/articles/PMC6583005/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6583005</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30304425" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30304425</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Editorial commentary</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cahill, Alison G. (2017) Identifying the Best Way to Manage Labor. Missouri medicine
|
|
114(3): 160–162 [<a href="/pmc/articles/PMC6140234/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6140234</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30228572" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30228572</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Not an experiment study design</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chang, S. C., Chou, M. M., Lin, K. C.
|
|
et al (2011) Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery
|
|
27(6): 825–831 [<a href="https://pubmed.ncbi.nlm.nih.gov/20952110" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20952110</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Not a randomised controlled trial</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
d, R. B. R. (2018) Efficacy of Pushing Down Free Compared to Pushing Down With Command in Maternal and Neonatal Outcomes: A Randomized Clinical Trial. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-556d22" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID=RBR-556d22</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial entry only, unable to locate protocol or published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
de Tayrac, Renaud and Letouzey, Vincent (2016) Methods of pushing during vaginal delivery and pelvic floor and perineal outcomes: a review. Current opinion in obstetrics & gynecology
|
|
28(6): 470–476 [<a href="https://pubmed.ncbi.nlm.nih.gov/27749356" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27749356</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Not a randomised controlled trial, or systematic review. Relevant references checked and all have been identified by the search and assessed at full text stage</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Di Mascio, Daniele, Saccone, Gabriele, Bellussi, Federica
|
|
et al (2020) Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: a systematic review and meta-analysis of randomized controlled trials. American journal of obstetrics and gynecology
|
|
223(2): 189–203 [<a href="https://pubmed.ncbi.nlm.nih.gov/32067972" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32067972</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- More recent systematic review available</p>
|
|
<p>More recent review available with all relevant references included</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fitzpatrick, M., O’Brien, C., McQuillan, K. et al (2000) Comparison of immediate and delayed pushing in second stage of labor on anal sphincter integrity and mode of delivery. American journal of obstetrics and gynecology
|
|
182: 37
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Abstract only</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Flynn, P., Franiek, J., Janssen, P.
|
|
et al (1997) How can second-stage management prevent perineal trauma? Critical review. Canadian family physician Medecin de famille canadien
|
|
43: 73–84 [<a href="/pmc/articles/PMC2255173/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2255173</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9626426" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9626426</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention</p>
|
|
<p>References checked but studies included for review did not meet the intervention criteria set out in the protocol</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gillesby, Erica, Burns, Suzan, Dempsey, Amy
|
|
et al (2010) Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
|
|
39(6): 635–44 [<a href="https://pubmed.ncbi.nlm.nih.gov/21044148" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21044148</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population</p>
|
|
<p>Over 33% of population had labour induced</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gregory, T., Cahill, A. G., Woolfolk, C.
|
|
et al (2022) Impact of Pushing Timing on Occult Injury of Levator Ani: a Multicenter Randomized Controlled Trial. American Journal of Obstetrics and Gynecology
|
|
226(1supplement): S81–S82 [<a href="/pmc/articles/PMC9064971/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9064971</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35202591" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35202591</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gregory, W. T., Cahill, A. G., Woolfolk, C.
|
|
et al (2022) Impact of Pushing Timing on Occult Injury of Levator Ani: Secondary Analysis of a Randomized Trial. American journal of obstetrics and gynecology [<a href="/pmc/articles/PMC9064971/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9064971</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35202591" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35202591</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome</p>
|
|
<p>Secondary analysis of RCT assessed under <a class="bibr" href="#niceng235er8.appj.ref9" rid="niceng235er8.appj.ref9">Cahill 2018</a>. Secondary analysis doesn’t provide relevant outcomes matching protocol criteria</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Grobman, W. (2015) Obstetric outcomes associated with the duration of pushing in nulliparas. American Journal of Obstetrics and Gynecology
|
|
212(1 suppl1): 281
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Irct138805252170N (2011) Comparing effects of Spontaneous pushing versus Valsalva pushing technique in Birth on outcome of delivery in primiparous in Iran hospital in 2009. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT138805252170N2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=IRCT138805252170N2</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Reference to trial protocol. Unable to locate access protocol, or published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Irct138807192248N (2012) The effect of abdominal massage with breathing techniques on the resulting outcomes of labor in primiparous women. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT138807192248N4" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=IRCT138807192248N4</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Reference to trial protocol. Unable to locate access protocol, or published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Irct201102041845N (2011) kind of pushing and postpartum fatigue. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT201102041845N3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=IRCT201102041845N3</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only. Unable to locate full published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Irct2014051210327N (2014) The effect of pushing with the open glottis in lateral position on maternal and fetal outcomes. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT2014051210327N6" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=IRCT2014051210327N6</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Clinical trial entry only. Full results assessed under Vaziri 2015</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Irct201405258801N (2014) Effect of pushing with breathing techniques on perineal statue and delivery outcome in nulliparous in Kamali hospital in Karaj. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT201405258801N7" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=IRCT201405258801N7</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Reference to trial protocol. Unable to locate access protocol, or published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Irct2014092819310N (2014) Effect of pushing with breathing techniques on perineal statue and delivery outcome in nulliparous in Kamali hospital in Karaj. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT2014092819310N1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=IRCT2014092819310N1</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Reference to trial protocol. Unable to locate access protocol, or published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Knauth, D. G. and Haloburdo, E. P. (1986) Effect of pushing techniques in birthing chair on length of second stage of labor. Nursing research
|
|
35(1): 49–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/3632848" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3632848</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome</p>
|
|
<p>Not enough data provided for outcomes of interest</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lai, M. L., Lin, K. C., Li, H. Y.
|
|
et al (2009) Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women. The journal of nursing research JNR
|
|
17(1): 62–72 [<a href="https://pubmed.ncbi.nlm.nih.gov/19352230" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19352230</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Not a randomised controlled trial</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lin, P. and Newton, W. (2000) Does delayed pushing reduce difficult deliveries for nulliparous women with epidural analgesia?. The Journal of family practice
|
|
49(9): 783–784 [<a href="https://pubmed.ncbi.nlm.nih.gov/11032199" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11032199</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Commentary on randomised trial already included (<a class="bibr" href="#niceng235er8.ref8" rid="niceng235er8.ref8">Fraser 2000</a>)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Maresh, M.; Choong, K. H.; Beard, R. W. (1983) Delayed pushing with lumbar epidural analgesia in labour. British journal of obstetrics and gynaecology
|
|
90(7): 623–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/6871129" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6871129</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population</p>
|
|
<p>Over 33% of women had their labour induced</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Menez-Orieux, C., Linet, T., Philippe, H. J.
|
|
et al (2005) Delayed versus immediate pushing in the second stage of labor for nulliparous parturients with epidural analgesia: a meta-analysis of randomized trials. Journal de gynecologie obstetrique ET biologie de la reproduction
|
|
34(5): 440–447 [<a href="https://pubmed.ncbi.nlm.nih.gov/16142134" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16142134</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Language</p>
|
|
<p>Article not in English (French article)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Moore, Thomas R. (2007) Randomized trial of coached versus uncoached maternal pushing in the second stage of labor. American journal of obstetrics and gynecology
|
|
196(1): e34–e34 [<a href="https://pubmed.ncbi.nlm.nih.gov/16824471" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16824471</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Editorial letter</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2015) Study of the Type of Pushing at Delivery. <a href="https://clinicaltrials.gov/show/NCT02474745" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT02474745</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Study protocol only. Full results assessed under <a class="bibr" href="#niceng235er8.ref3" rid="niceng235er8.ref3">Barasinski 2020</a></p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2014) Optimizing Management of the 2nd Stage of Labor: Multicenter Randomized Trial. <a href="https://clinicaltrials.gov/show/NCT02137200" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT02137200</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only. Full results assessed under Cahill 2008</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2014) Randomized Control Trial of Second Stage of Labor. <a href="https://clinicaltrials.gov/show/NCT02101515" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT02101515</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population</p>
|
|
<p>Trial protocol only, however published results show over 33% of women had labour induced</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2017) BREATHING EXERCISES FOR LABOR PAIN AND DURATION. <a href="https://clinicaltrials.gov/show/NCT03066973" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT03066973</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only, full results assessed under <a class="bibr" href="#niceng235er8.ref25" rid="niceng235er8.ref25">Yuksel 2017</a></p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2017) Alternative to Intensive Management of the Active Phase of the Second Stage of Labor. <a href="https://clinicaltrials.gov/show/NCT03018860" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT03018860</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only, unable to locate full published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2017) Early Versus Delayed Pushing in the Second Stage of Labor. <a href="https://clinicaltrials.gov/show/NCT03121274" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT03121274</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only. Full results assessed under <a class="bibr" href="#niceng235er8.appj.ref48" rid="niceng235er8.appj.ref48">Saad 2022</a></p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2019) The Effects Of Pushing Techniques During Second Stage Of Labour On Maternal and Newborn Health. <a href="https://clinicaltrials.gov/show/NCT04207658" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT04207658</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only, unable to locate full published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2020) Effectiveness of Breathing Exercises During the Second Stage of Labor. <a href="https://clinicaltrials.gov/show/NCT04556643" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT04556643</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only. Unable to locate full published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2020) Regulated Expiratory Breathing Method During Childbirth. <a href="https://clinicaltrials.gov/show/NCT04219631" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT04219631</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only. Unable to locate full published results</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nct (2021) Pushing and Manual Perineal Protection Techniques. <a href="https://clinicaltrials.gov/show/NCT04823598" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://clinicaltrials.gov/show/NCT04823598</a>
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Trial protocol only. Study is ongoing (April 2022)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Neta, Joana Nunes, Amorim, Melania Maria, Guendler, Julianna
|
|
et al (2022) Vocalization during the second stage of labor to prevent perineal trauma: A randomized controlled trial. European journal of obstetrics, gynecology, and reproductive biology
|
|
275: 46–53 [<a href="https://pubmed.ncbi.nlm.nih.gov/35728488" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35728488</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention</p>
|
|
<p>Intervention does not meet the criteria specified in the protocol. Women were directed with pushing but not as described in the protocol</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Parnell, J. C., Langhoff-Roos, J., Iversen, R.
|
|
et al (1993) Pushing technique in the expulsive phase of labor. A randomized study. Ugeskrift for laeger
|
|
155(29): 2259–2262 [<a href="https://pubmed.ncbi.nlm.nih.gov/8328095" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8328095</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Language</p>
|
|
<p>Article not in English (German)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Prins, M., Boxem, J., Lucas, C.
|
|
et al (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG : an international journal of obstetrics and gynaecology
|
|
118(6): 662–70 [<a href="https://pubmed.ncbi.nlm.nih.gov/21392242" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21392242</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- More recent systematic review available</p>
|
|
<p>All relevant studies included in more recent systematic reviews</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Richter, H. E., Gregory, W., Lowder, J.
|
|
et al (2020) Impact of second stage pushing timing on post partum pelvic floor morbidity: Multicenter randomized controlled trial. International Urogynecology Journal
|
|
31(suppl1): S20–S21
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a id="niceng235er8.appj.ref48"></a>Saad, Hany, Maged, Ahmed M., Meshaal, Hadeer
|
|
et al (2022) Delayed versus early pushing during the second stage of labour in primigravidas under epidural anaesthesia with occipitoposterior malposition: a randomised controlled study. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
|
|
42(1): 23–27 [<a href="https://pubmed.ncbi.nlm.nih.gov/33892614" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33892614</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population</p>
|
|
<p>Over 1/3 of population are women who had their labour induced.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Saucedo, A. M., Tuuli, M. G., Gregory, T.
|
|
et al (2022) Intrapartum Risk Factors for Pelvic Organ Prolapse Postpartum. American Journal of Obstetrics and Gynecology
|
|
226(1supplement): S250–S251 [<a href="https://pubmed.ncbi.nlm.nih.gov/35853583" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35853583</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Saucedo, Alexander M, Richter, Holly E, Gregory, W Thomas
|
|
et al (2022) Intrapartum Risk Factors Associated with Pelvic Organ Prolapse at Six Months Postpartum: Intrapartum Factors for Pelvic Organ Prolapse. American journal of obstetrics & gynecology MFM: 100692 [<a href="https://pubmed.ncbi.nlm.nih.gov/35853583" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35853583</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Full text is abstract only</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Schaffer, J. I., Bloom, S. L., Casey, B. M.
|
|
et al (2005) A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. American journal of obstetrics and gynecology
|
|
192(5): 1692–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/15902179" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15902179</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Duplicate</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shinozaki, Katsuko, Suto, Maiko, Ota, Erika
|
|
et al (2022) Postpartum urinary incontinence and birth outcomes as a result of the pushing technique: a systematic review and meta-analysis. International urogynecology journal [<a href="/pmc/articles/PMC9206626/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9206626</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35103823" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35103823</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Cochrane systematic review included</p>
|
|
<p>Overlap in included studies with a Cochrane systematic review (<a class="bibr" href="#niceng235er8.ref14" rid="niceng235er8.ref14">Lemos 2017</a>). Cochrane review prioritised as methods are more aligned with NICE methods</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Simpson, Ben and Waring, Gareth J. (2021) Regarding Delayed vs immediate pushing in the second stage of labor in women with neuraxial analgesia: a systematic review and meta-analysis of randomized controlled trials. American journal of obstetrics and gynecology
|
|
225(4): 468–469 [<a href="https://pubmed.ncbi.nlm.nih.gov/34174202" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34174202</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Comment article</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Simpson, Kathleen Rice and James, Dotti C. (2005) Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial. Nursing research
|
|
54(3): 149–57 [<a href="https://pubmed.ncbi.nlm.nih.gov/15897790" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15897790</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population</p>
|
|
<p>All women having an elective induction of labour</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Szu, Li-Ting, Chou, Pao-Yu, Lin, Pu-Hung
|
|
et al (2021) Comparison of maternal and fetal outcomes between delayed and immediate pushing in the second stage of vaginal delivery: systematic review and meta-analysis of randomized controlled trials. Archives of gynecology and obstetrics
|
|
303(2): 481–499 [<a href="https://pubmed.ncbi.nlm.nih.gov/32990782" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32990782</span></a>]
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</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- More recent systematic review available</p>
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|
<p>A Cochrane systematic review, and more recent systematic include the same relevant studies</p>
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|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tctr (2019) The success rate of spontaneous vaginal birth : directed and spontaneous pushing method in Phramongkutklao hospital. <a href="https://trialsearch.who.int/Trial2.aspx?TrialID=TCTR20190817005" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://trialsearch<wbr style="display:inline-block"></wbr>​.who<wbr style="display:inline-block"></wbr>​.int/Trial2.aspx?TrialID<wbr style="display:inline-block"></wbr>​=TCTR20190817005</a>
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</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design</p>
|
|
<p>Trial protocol only. Study has not begun recruitment (April 2022)</p>
|
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</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Thomson, A. M. (1995) Maternal behaviour during spontaneous and directed pushing in the second stage of labour. Journal of advanced nursing
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22(6): 1027–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/8675854" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8675854</span></a>]
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</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design</p>
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<p>Observational part of a randomised controlled trial. Randomised controlled trial assessed separately under <a class="bibr" href="#niceng235er8.ref20" rid="niceng235er8.ref20">Thomson 1993</a></p>
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</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Tuuli, M. G., Gregory, T., Arya, L. A.
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et al (2020) 7: Impact of second stage pushing timing on maternal pelvic floor morbidity: Multicenter randomized controlled trial. American Journal of Obstetrics and Gynecology
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222(1supplement): 6 [<a href="https://pubmed.ncbi.nlm.nih.gov/36603202" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36603202</span></a>]
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</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Study design</p>
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<p>Conference abstract</p>
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</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Tuuli, Methodius G., Frey, Heather A., Odibo, Anthony O.
|
|
et al (2012) Immediate compared with delayed pushing in the second stage of labor: a systematic review and meta-analysis. Obstetrics and gynecology
|
|
120(3): 660–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/22872146" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22872146</span></a>]
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|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- More recent systematic review available</p>
|
|
<p>All relevant studies included in more recent systematic reviews</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Vause, S.; Congdon, H. M.; Thornton, J. G. (1998) A randomized controlled trial of immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia. Br-j-obstet-gynaecol
|
|
105: 85 [<a href="https://pubmed.ncbi.nlm.nih.gov/9501784" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9501784</span></a>]
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</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design</p>
|
|
<p>Full text is abstract only</p>
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</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Waghmare, S. V. and Upendra, S. (2020) A systematic literature review on pushing down technique during second stage of labour on maternal and neonatal outcome. Indian Journal of Forensic Medicine and Toxicology
|
|
14(4): 3976–3978
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text unavailable</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Walker, C., Rodriguez, T., Herranz, A.
|
|
et al (2011) Second stage of labor with postural change and lateral position in women with epidural analgesia: A randomized controlled trial. International Urogynecology Journal and Pelvic Floor Dysfunction
|
|
22(suppl1): S11–S12
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design</p>
|
|
<p>Conference abstract</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Yao, Jiasi, Roth, Heike, Anderson, Debra
|
|
et al (2022) Benefits and risks of spontaneous pushing versus directed pushing during the second stage of labour among women without epidural analgesia: A systematic review and meta-analysis. International journal of nursing studies
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|
134: 104324 [<a href="https://pubmed.ncbi.nlm.nih.gov/35908423" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35908423</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design</p>
|
|
<p>Systematic review, with relevant studies already included under Cochrane systematic review</p>
|
|
</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Yildirim, G. and Beji, N. K. (2008) Effects of pushing techniques in birth on mother and fetus: A randomized study. Obstetrical and Gynecological Survey
|
|
63(8): 488–489 [<a href="https://pubmed.ncbi.nlm.nih.gov/18307484" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18307484</span></a>]
|
|
</td><td headers="hd_h_niceng235er8.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design</p>
|
|
<p>Editorial comment</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng235er8appjtab2"><div id="niceng235er8.appj.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK596203/table/niceng235er8.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng235er8.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng235er8.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng235er8.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng235er8.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Greiner, K., Tuuli, M. G., Srinivas, S. K.
|
|
et al (2020) 702: Immediate versus delayed pushing in nulliparous women: A cost-effectiveness analysis. American Journal of Obstetrics and Gynecology
|
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222(1supplement): S444–S445
|
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</td><td headers="hd_h_niceng235er8.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng235er8.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Petrou, S.; Coyle, D.; Fraser, W. D. (2000) Cost-effectiveness of a delayed pushing policy for patients with epidural anesthesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group. American journal of obstetrics and gynecology
|
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182(5): 1158–64 [<a href="https://pubmed.ncbi.nlm.nih.gov/10819853" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10819853</span></a>]
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</td><td headers="hd_h_niceng235er8.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Unlikely to reflect current NHS practice and costs given Canadian setting and date of publication</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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