title: Lying Down after Premature Rupture of the Membranes in Term Singleton Pregnancies: An Evidence-Based Recommendation?
abstract: Objectives:In many countries pregnant women in term singleton pregnancies are advised by obstetricians and midwives to lie down immediately after rupture of membranes until engagement of the foetal head is confirmed. The horizontal positioning aims to prevent the prolapse of the umbilical cord. The objective of this systematic review is to assess the effects of the maternal lying down measure in term singleton pregnancies.Search methods:We searched the databases of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL (Issue 10, 2015) from their inception until September 30th, 2015. Additionally, we searched selected trial registers, the reference lists of potentially relevant studies and national and international obstetrical clinical guidelines. All types of studies without language restriction were selected.Main results:One retrospective study was found. Only one woman with a term singleton pregnancy had the event of an umbilical cord prolapse following premature rupture of membranes (0.008%). The study did not report on the presence of an engaged foetal head in this woman.Conclusions and implications:Recommendations cannot be made in favour or against the lying down positioning based solely on the single identified study. For that reason, the widespread recommendation given by obstetricians and midwives should be critically reassessed. Also, induction of maternal anxiety and increased costs to the healthcare system following transportation to the delivery unit have to be considered in the light of the given minimal risk of umbilical cord prolapse in conjuncture with lacking evidence for the utility of the common recommendation.
authors.affiliation: Department for Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Portz
authors.affiliation: Pediatric Nephrology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Pediatric Nephrology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Weitz
mesh_terms: D000293:Adolescent; D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology* / Q000451:nursing*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009774:Obstetrics / Q000592:standards*; D056888:Patient Positioning / Q000592:standards* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011391:Prolapse; D018570:Risk Assessment; D016896:Treatment Outcome; D014470:Umbilical Cord / Q000473:pathology*; D055815:Young Adult