Recruiting

Observational Study

Sponsor:

Washington University School of Medicine

Code:

NCT06636149

Conditions

Labor Stage, First

Prolonged Labor

Eligibility Criteria

Sex: Female

Age: 12+

Healthy Volunteers: Not accepted

Interventions

Circuit of maternal position changes during labor

Study Details

Brief summary:

This pilot, randomized control trial will test whether or not a specific circuit of position changes improves maternal outcomes in cases of prolonged labor.

Patient who have prolonged labor will be approached for consent and randomization to one of two study groups: circuit intervention against routine standard of care position changes. 82 patients will be enrolled in the study. Exclusion criteria will include: any uterine infection prior to randomization, magnesium sulfate treatment, major fetal anomalies, BMI ≥50, non-reassuring fetal status prior to randomization, or any maternal diagnosis that precludes safety or feasibility of the circuit of maternal position changes.

The 3 aims of the study will include: the outcome that the circuit of position changes has on the duration of the first stage of labor, maternal and neonatal morbidity, and maternal satisfaction.

Conditions

Labor Stage, First

Prolonged Labor

Study ID

NCT06636149

Start date

Dec 10, 2024

Status verified date

Mar, 2026

Completion date

May 31, 2028

Anticipated

Primary completion date

Apr 1, 2028

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: Female

Age: 12+

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • English-speaking patients
  • Singleton, vertex pregnancies
  • 34 weeks' gestation or later
  • Admitted to Labor and Delivery in spontaneous labor or for an induction of labor
  • Prolonged labor course as defined by: cervical dilation less than 6 cm after 8 hours or more of ruptured membranes (spontaneous or artificial) and oxytocin infusion, or cervical dilation 6 cm or more and less than 1-cm cervical dilation change over 2 hours or more with ruptured membranes and oxytocin infusion

Exclusion Criteria:

  • Intraamniotic infection prior to randomization
  • Magnesium sulfate treatment
  • Major fetal anomalies
  • BMI ≥50
  • Non-reassuring fetal status prior to randomization
  • Any maternal diagnosis that precludes safety or feasibility of intrapartum circuit of maternal position changes

Study Design

Enrollment

82 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Circuit Intervention Arm

The intervention cohort will undergo the circuit of position changes every 2 hours. The circuit will be repeated up to 3 times or until the second stage of labor is achieved, delivery occurs, or labor arrest diagnosis is made. Participants will be considered as adherent to intervention arm if they undergo one complete circuit of maneuvers. Nurses will keep patients on continuous fetal monitoring during the circuit of position changes. Any persistent non-reassuring fetal status in one position of the circuit will prompt progression to the next position in the circuit. The planned circuit of maneuvers will be: 10-minutes of side-lying release on one side 10-minutes of side-lying release on other side 10-minutes of open-knee chest 10-minutes of shaking apples 20-minutes of flying cowgirl on one side 20-minutes of flying cowgirl on opposite side as position 5 20-minutes of running man on same side as position 5 20-minutes of running man on opposite side as position 5

no intervention: Control Arm

Patients randomized to the control arm will have their labor courses managed per current best practice recommendations. This will include nurse or patient facilitated position changes per the discretion of the patient's clinical care team. Routine position changes allowed in this control group will include walking, sitting, squatting, thrones, supine, hands and knees, and lateral decubitus with or without peanut ball. No positions in the circuit intervention group will be permitted to be used in the control group. Any circuit positions used in the control group will be tracked and documented.

Interventions

Circuit of maternal position changes during labor

The intervention cohort will undergo the circuit of position changes every 2 hours. The circuit will be repeated up to 3 times or until the second stage of labor is achieved, delivery occurs, or labor arrest diagnosis is made. Participants will be considered as adherent to intervention arm if they undergo one complete circuit of maneuvers. Nurses will keep patients on continuous fetal monitoring during the circuit of position changes. Any persistent non-reassuring fetal status in one position of the circuit will prompt progression to the next position in the circuit. The planned circuit of maneuvers will be:

10-minutes of side-lying release on one side 10-minutes of side-lying release on other side 10-minutes of open-knee chest 10-minutes of shaking apples 20-minutes of flying cowgirl on one side 20-minutes of flying cowgirl on opposite side as position 5 20-minutes of running man on same side as position 5 20-minutes of running man on opposite side as position 5

Primary outcome measure

  • First stage of labor duration [ Time Frame: From enrollment until delivery ]

Central Contacts and Locations

Central contacts

Drew Hensel Maternal Fetal Medicine Fellow, MD

314-718-0839dhensel@wustl.edu

Locations

Washington University Medicine

Recruiting

Saint Loius, Missouri, United States, 63110

Contacts

Drew Hensel, MD

314-718-0839dhensel@wustl.edu

More Information

Sponsor

Washington University School of Medicine

Last update posted

Mar 13, 2026

Last verified

Mar, 2026

Keywords

  • Circuit
  • Position changes
  • Labor
  • Prolonged labor
  • Labor dystocia

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-09. This information was provided to ClinicalTrials.gov by Washington University School of Medicine on 2026-03-13.