Obstetric Gel Use to Shorten Labor and Prevent Lower Genital Tract Trauma: A Randomized Controlled Trial.

Abstract

Objectives: Vaginal delivery is associated with numerous forms of lower genital tract trauma. Several practices were developed to decrease the duration of the second stage of labor and the likelihood of lower genital tract trauma. Applying obstetric gel is one practice that has been studied in literature, with insufficient and somewhat conflicting evidence. The aim of this study was to compare the duration of the first and second stages of labor, and the integrity of lower genital tract, with or without the application of obstetric gel.

Design: A randomized controlled trial was conducted, where delivering women were randomly assigned, based on individual stratifications, to receive either standard care during labor and delivery (n = 82), or with the additional application of the obstetric gel (n = 78).

Participants/materials, setting, methods: A specifically designed sterile obstetric gel (Natalis®) was applied in the intervention group starting with the first vaginal examination after admission, with a total of 20-30 mL administered per childbirth. Descriptive and inferential statistics were implemented to describe the sample and compare outcomes across the intervention and the control groups, which were further divided depending on their parity (nulliparous and multiparous). The primary outcome was the duration of the second stage of labor.

Results: A total of 160 women were recruited. The obstetric gel did not significantly shorten the duration of the first and second stages of labor, among other labor outcomes. However, an underpowered subgroup analysis showed that nulliparas who had obstetric gel application have had a significantly shorter duration of the second stage of labor compared with the control group (69.5 ± 45.3 vs. 97.5 ± 54.3 min; p value = 0.041).

Limitation: A major limitation in our clinical trial is the small sample size that didn't account for subgrouping of parity when estimating the study's power.

Conclusions: The obstetric gel did not incur statistically significant effect on labor outcomes including the duration of the second stage of labor. While being underpowered, nulliparas in the intervention group had a shorter duration of the second stage of labor than the control group. The lack of certainty in our results calls for more research to tackle this problem with adequate power to conclude valid results and to further confirm our subgroup findings in order to consider utilizing this practice that aims at improving the delivery experience.