Secondary outcomes
| GAP in upright position n=388 | Upright position n=386 | Routine practice n=384 | P values | Adjusted risk ratio* (95% CI) | |||||||||
| N | n | % | N | n | % | N | n | % | GAP versus routine practice | Upright versus routine practice | GAP versus upright | ||
| Maternal outcomes | |||||||||||||
| No spontaneous birth within 15 min | 388 | 154 | 39.7 | 386 | 169 | 43.8 | 384 | 165 | 43.0 | 0.47 | 0.91 (0.77 to 1.08) | 1.01 (0.86 to 1.19) | 0.90 (0.76 to 1.06) |
| Operative birth (vacuum to forceps or caesarean section)¶ | 388 | 14 | 3.6 | 386 | 15 | 3.9 | 384 | 17 | 4.4 | 0.84 | 0.91 (0.77 to 1.08) | 1.01 (0.86 to 1.19) | 0.90 (0.76 to 1.06) |
| Second-degree or higher perineal tear | 385 | 27 | 7.0 | 384 | 25 | 6.5 | 383 | 21 | 5.5 | 0.67 | 1.28 (0.74 to 2.20) | 1.19 (0.68 to 2.07) | 1.08 (0.64 to 1.81) |
| Episiotomy | 386 | 79 | 20.5 | 384 | 81 | 21.1 | 383 | 86 | 22.5 | 0.79 | 0.91 (0.69 to 1.19) | 0.93 (0.71 to 1.22) | 0.97 (0.74 to 1.28) |
| Episiotomy or second-degree or higher perineal tear | 386 | 105 | 27.2 | 384 | 104 | 27.1 | 383 | 107 | 27.9 | 0.96 | 0.97 (0.77 to 1.22) | 0.97 (0.77 to 1.22) | 1.002 (0.79 to 1.26) |
| Mother was uncomfortable or very uncomfortable during second stage of labour | 378 | 54 | 14.3 | 378 | 64 | 16.9 | 383 | 24 | 6.3 | <0.0001 | 2.36 (1.51 to 3.67) | 2.93 (1.91 to 4.51) | 0.80 (0.59 to 1.09) |
| Labour augmented in the second stage to after randomisation | 387 | 13 | 3.4 | 386 | 10 | 2.6 | 384 | 6 | 1.6 | 0.28 | 2.11 (0.82 to 5.44) | 1.32 (0.59 to 2.93) | 1,60 (0.59 to 4.33) |
| Additional management required for postpartum haemorrhage | 388 | 9 | 2.3 | 386 | 8 | 2.1 | 384 | 7 | 1.8 | 0.89 | 1.25 (0.47 to 3.32) | 1.12 (0.41 to 3.06) | 1.12 (0.44 to 2.85) |
| Neonatal outcomes | |||||||||||||
| Cord blood pH <7.2 | 49 | 20 | 40.8 | 49 | 20 | 40.8 | 52 | 18 | 40.8 | 0.76 | 1.24 (0.75 to 2.05) | 1.15 (0.70 to 1.90) | 1.07 (0.67 to 1.74) |
| Cord blood pH <7.2 or high lactate (≥8 mmol/L) | 55 | 29 | 52.7 | 60 | 32 | 53.3 | 59 | 26 | 44.1 | 0.57 | 1.06 (0.80 to 1.41) | 1.06 (0.80 to 1.40) | 1.00 (0.75 to 1.34) |
| 5 min Apgar score <7 | 380 | 8 | 2.1 | 377 | 4 | 1.1 | 379 | 5 | 1.3 | 0.47 | 1.62 (0.53 to 4.88) | 0.81 (0.22 to 3.00) | 1.98 (0.60 to 6.51) |
| Neonatal trauma | 388 | 0 | 0.0 | 386 | 0 | 0.0 | 384 | 2 | 0.5 | 0.11† | NA‡ | NA‡ | NA‡ |
| Neonatal encephalopathy | 388 | 3 | 0.8 | 386 | 1 | 0.3 | 384 | 5 | 1.3 | 0.21‡ | 0.59 (0.14 to 2.43) | 0.20 (0.02 to 1.69) | 2.96 (0.31 to 28.23) |
| Admission to NICU for >24 hours | 388 | 3 | 0.8 | 386 | 5 | 1.3 | 384 | 8 | 2.1 | 0.25‡ | 0.38 (0.10 to 1.40) | 0.62 (0.21 to 1.88) | 0.60 (0.15 to 2.49) |
| Composite adverse neonatal outcome§ | 388 | 29 | 7.5 | 386 | 27 | 7.0 | 384 | 33 | 8.6 | 0.69 | 0.86 (0.54 to 1.38) | 0.82 (0.51 to 1.32) | 1.05 (0.64 to 1.72) |
| Neonatal death | 388 | 1 | 0.3 | 386 | 1 | 0.3 | 384 | 2 | 0.5 | 0.70‡ | NA‡ | NA‡ | NA‡ |
*Adjusted for centre.
†Fisher’s exact test.
‡Too few observations.
§This composite neonatal outcome includes: trauma, encephalopathy, cord blood pH <7.2, 5 min Apgar <7 or NICU admission >24 hours.
¶Operative birth includes caesarean section, vacuum or forceps.
GAP, gentle assisted pushing; NA, not applicable; NICU, neonatal intensive care unit.