Hip Extension at Crowning Did Not Reduce Perineal Lacerations

A randomized, pragmatic trial in nulliparous patients with term singleton pregnancies compared directed hip extension at crowning with usual, undirected positioning during vaginal delivery. In the intention-to-treat analysis, rates of significant perineal lacerations were similar between groups (66.6% vs 66.2%), though an as-treated analysis (with 25% nonadherence in the intervention group) showed lower unadjusted rates of significant lacerations and obstetric anal sphincter injuries with extension, differences that were not significant after adjustment. The trial concluded that hip extension did not reduce significant perineal lacerations at term vaginal delivery.

Most relevant for: Nulliparous patients undergoing their first vaginal delivery of a term singleton fetus.

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