Obstetrical Gel Use to Shorten Labor and Prevent Lower Genital Tract Trauma
Condition: Labor Stage, Second
Study type: Interventional
Phase: Phase 4

Summary: 
      Recent literature shows that birth injury is associated with postpartum pelvic floor
      dysfunction (pelvic organ prolapse and fecal and urinary incontinence). Prolonged labor,
      namely during the 2nd stage, is one of the main obstetric risk factors responsible for anal
      sphincter rupture and fecal incontinence. In addition, it is associated with increased
      maternal and neonatal morbidities including increased risk of lower genital tract
      lacerations. In an effort to shorten labor and decrease lower genital tract trauma many
      techniques have been investigated.

      The objective of our study is to investigate whether the use of obstetric gel shortens the
      first and second stage of labor and exerts a protective effect on the lower genital tract.
      Neonatal and maternal morbidities will be also assessed.

      The study design will be a randomized controlled trial of 2 groups, where the patients
      presenting for vaginal delivery will be randomly assigned to either:

        -  Group 1 who will receive the standard care during labor and delivery

        -  Group 2 who will receive the standard care during labor and delivery with the vaginal
           application of the obstetrical gel The goal of this randomized controlled study is to
           compare the length of the first and 2nd stage of labor and the lower genital tract
           integrity in the 2 groups of patients.
    


Intervention name(s): Natalis
Intervention type(s): Drug
Intervention description(s): A specially-designed sterile obstetric gel (Natalis) will be used for this trial. The obstetric gel is a birth gel with no pharmacologic effects that has a purely physical activity. It contains propylene glycol, glycerol, sodium chloride, xanthan gum, hydroxyethylcellulose and water.
Starting with the first vaginal examination the obstetric gel will be used. After each vaginal examination, 3-5 mL of obstetric gel will be introduced into the vaginal birth canal in the area in front of the child using the sterile obstetric gel applicator without any manipulation or massaging. Additional obstetric gel will be added 15-30 minutes after rupture of the membranesOnce the head of the child is visible, the mouth and nose region will be wiped clean. A dry towel will be used to liberate the child in order to prevent the child from slipping
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: In this randomized controlled study, the patients will be randomly assigned to either Group 1 in which they will receive the standard care during labor and delivery without the use of the obstetrical gel or Group 2 in which they will have the standard care during labor and delivery with the vaginal application of the obstetrical gel according to the study protocol. Those 2 groups will be further divided into 4 subgroups where the parity will be accounted for (nulliparous [never delivered beyond 20 weeks of gestation in a previous pregnancy] or primiparous or more). Based on our departmental statistics, ~90% of laboring patients receive epidural. Hence receiving an epidural will not have a major impact on the duration of the second stage of labor; yet, whether the patient received epidural or not will be adjusted for.
Masking: None (Open Label)
Primary purpose: Prevention