Early Diagnosis and Intervention for Fetal Malposition in Active Labor and Its Impact on Mode of Delivery

NCT ID: NCT05881629

Last Updated: 2025-09-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-01

Study Completion Date

2026-09-01

Brief Summary

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The goal of this randomized trial is to test if changing a person's position in labor can increase the chances of delivering their baby vaginally.

Specifically, it aims to answer the questions:

* In fetuses who are facing upwards (occiput posterior, OP) or sideways (occiput transverse, OT) during labor, does changing the patient's position during active labor to a side-lying posture with a peanut ball increase the chances of them having a successful, spontaneous vaginal delivery?
* Does changing the patient's position in active labor affect the position of the baby at the time of delivery?
* Do intentional position changes in labor impact patient-perceived autonomy during their labor and delivery experience?

Participants will:

* Receive an ultrasound during labor to determine the position of their baby
* Be asked to adopt a specific position in labor (side-lying with peanut ball) if they are randomized to the study group
* Receive additional ultrasounds during labor to assess their baby's position
* Fill out a questionnaire about their labor experience following the delivery of their baby

Detailed Description

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In this randomized trial, the investigators aim to evaluate the effects of early ultrasound diagnosis and active management of fetal malposition during the first stage of labor. Specifically, the investigators will compare the modified Sims (side-lying) position ipsilateral to fetal spine with the addition of a peanut ball versus free maternal position choice in occiput posterior (OP) or occiput transverse (OT) fetuses diagnosed by ultrasound during active labor, defined as greater than 6cm cervical dilation. The primary outcome will be operative delivery rates, defined as either cesarean delivery or instrumental vaginal delivery with vacuum or forceps. The investigators will also assess rates of spontaneous rotation to occiput anterior (OA) position at complete dilation and at delivery, as well as the impact of the position changes on the patient's labor experience and their perceived autonomy.

Conditions

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Cesarean Delivery Affecting Fetus Labor Dystocia Labor Complication

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Intervention group (side-lying position with peanut ball) versus control group (free position choice, no peanut ball)
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Side-lying peanut ball group

Participants randomized to this group will be asked to adopt a side-lying, lateral position on the ipsilateral side of the fetal spine. A peanut ball will be positioned between the participant's legs while in this position. They will be asked to maintain this position for 60 minutes.

Group Type EXPERIMENTAL

Maternal position change to side-lying lateral with peanut ball

Intervention Type BEHAVIORAL

Participants will be assisted into a position lying on their side, specifically the same side as the fetal spine diagnosed by ultrasound. An inflated peanut ball will be positioned between the legs to open the pelvis. They will be asked to maintain the position for 60 minutes.

Control group

Participants randomized to this group will be able to adopt any position of their choosing during the 60-minute study period. They will not be able to use a peanut ball during this time.

Group Type PLACEBO_COMPARATOR

Free maternal position

Intervention Type BEHAVIORAL

Participants will be asked to adopt any position of their choosing and to maintain it for 60 minutes. They will be asked to not use a peanut ball during the 60 minute study period.

Interventions

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Maternal position change to side-lying lateral with peanut ball

Participants will be assisted into a position lying on their side, specifically the same side as the fetal spine diagnosed by ultrasound. An inflated peanut ball will be positioned between the legs to open the pelvis. They will be asked to maintain the position for 60 minutes.

Intervention Type BEHAVIORAL

Free maternal position

Participants will be asked to adopt any position of their choosing and to maintain it for 60 minutes. They will be asked to not use a peanut ball during the 60 minute study period.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Maternal age \>18
* Term gestation (\>37 weeks)
* Singleton pregnancy
* Spontaneous or induced active labor (cervical dilation 6-9cm)
* Epidural anesthesia
* Cephalic fetal presentation, OP/OT position diagnosed by bedside ultrasound
* Continuous external fetal monitoring
* Ability to consent

Exclusion Criteria

* Multiple gestations
* Unanesthetized labor
* Known fetal anomalies
* Known intrauterine fetal demise
* Inability to consent
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Women and Infants Hospital of Rhode Island

OTHER

Sponsor Role lead

Responsible Party

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Kathryn Anderson

Resident physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexis Gimovsky, MD

Role: PRINCIPAL_INVESTIGATOR

Women and Infant's Hospital of Rhode Island

Locations

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Women and Infant's Hospital of Rhode Island

Providence, Rhode Island, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Kathryn M Anderson, MD

Role: CONTACT

401-274-1100

Alexis Gimovsky, MD

Role: CONTACT

Other Identifiers

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2015598-1

Identifier Type: -

Identifier Source: org_study_id

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