title: Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia?
abstract: OBJECTIVE
  To assess whether an inflatable obstetric belt, synchronised to apply uniform fundal pressure during a uterine contraction, reduces operative delivery rates when used in the second stage of labour.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Five hundred nulliparae with a singleton cephalic pregnancy at term and with an epidural in labour were recruited during the first stage and randomised at full dilatation. Standard care involved one hour passive second stage and one hour active pushing after which instrumental delivery was performed if delivery was not imminent. Those randomised to the belt group, in addition to standard care, had the inflatable obstetric belt for the whole second stage of labour.
  
  
  METHODS
  Mode of delivery.
  
  
  RESULTS
  One hundred and eleven of the 260 women in the belt group (42.7%) compared with 94 of the 240 in the control group (39.2%) had a spontaneous vertex delivery (P = 0.423). The lift-out instrumental delivery rate was similar between the two groups: 108 belts (41.5%), compared with 101 controls (42.1%) (P = 0.902), whereas rotational instrumental deliveries in the belt group were 26 belts (10%) compared with 36 controls (15%) (P = 0.09). Fifteen women (5.8%) in the belt group and nine women (3.8%) in the control group had a caesarean section in the second stage (P = 0.292). An intact perineum was more likely in the belt group (16.5% compared with 9.6%, P = 0.022) as was a third degree tear (6.5% compared with 0.4%, P = 0.001).
  
  
  CONCLUSIONS
  The inflatable obstetric belt did not significantly reduce operative delivery rates when used in this clinical setting in the second stage of labour.
authors.affiliation: Queen Charlotte's and Chelsea Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Cox
authors.forename: C S
authors.initials: CS
authors.lastname: Cotzias
authors.forename: O
authors.initials: O
authors.lastname: Siakpere
authors.forename: F I
authors.initials: FI
authors.lastname: Osuagwu
authors.forename: E P
authors.initials: EP
authors.lastname: Holmes
authors.forename: S
authors.initials: S
authors.lastname: Paterson-Brown
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D001458:Bandages; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D009774:Obstetrics / Q000295:instrumentation*; D010298:Parity; D011247:Pregnancy