Safety of uterine fundal pressure maneuver during second stage of labor in a tertiary perinatal medical center: A retrospective observational study

Hayata, Eijiro; Nakata, Masahiko; Takano, Mayumi; Umemura, Nahomi; Nagasaki, Sumito; Oji, Ayako; Maemura, T.; Katagiri, Yuki; Morita, Mineto

doi:10.1016/j.tjog.2018.10.033

Cited by 9 publications

(19 citation statements)

References 10 publications

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“…In our study, the use of MFP in combination with vacuum-assisted deliveries was more commonly utilized than previously reported (49.8% vs 23.0%) [20]. This is because MFP has been adopted as a standard practice among vacuum-assisted deliveries in Japan [21]. Although unclear whether there exist any biological and clinical differences between vacuum-assisted deliveries with or without MFP, previous studies have indicated that the prevalence of neonatal complications in vacuum-assisted deliveries combined with MFP was signi cantly higher than vacuum-assisted deliveries without MFP [20,22,23].…”

Section: Discussionmentioning

confidence: 54%

Association Between Placental Location and Neonatal Outcomes in Manual Fundal Pressure-Assisted Vaginal Deliveries: A Retrospective Cohort Study

Kamijo¹,

Shigemi²,

Kaszynski³

et al. 2021

Preprint

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Purpose: Manual fundal pressure (MFP) is globally used to assist vaginal deliveries during the second stage of labor; however, there is insufficient evidence on the risk factors in MFP-assisted vaginal deliveries for adverse neonatal outcomes. The aim of the present study was to investigate the association between placental location and neonatal outcomes in MFP-assisted vaginal deliveries.Methods: The present was a single-center observational study using a cohort of all MFP-assisted vaginal singleton deliveries from 2016 to 2020. Placental location was divided into two categories: posterior-lateral and anterior-fundal. The primary outcome was a neonatal adverse composite including umbilical artery blood pH <7.2, Apgar score <7 at 5 min, neonatal intensive care unit admission and neonatal resuscitation. We used logistic regression models to investigate the association between placental location and neonatal outcomes. Results: We extracted 522 MFP-assisted deliveries among 5053 vaginal deliveries. The proportion of posterior-lateral and anterior-fundal placentation was 239 (45.8%) and 283 (54.2%), respectively. The crude prevalence of neonatal composite outcome for posterior-lateral and anterior-fundal placentation was 69 (28.9%) and 112 (39.6%), respectively. The prevalence of neonatal composite outcome in the anterior-fundal group was significantly higher than that in the posterior-lateral group. Multivariable logistic regression analysis found that the prevalence of neonatal adverse outcome in the anterior-fundal group was significantly higher compared with the posterior-lateral group (adjusted odds ratio, 1.55; 95% confidence interval, 1.05–2.28).Conclusion: Anterior-fundal placentation was significantly associated with an increased risk of neonatal adverse outcomes compared to posterior-lateral placentation in MFP-assisted vaginal deliveries.

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Section: Discussionmentioning

confidence: 54%

Association Between Placental Location and Neonatal Outcomes in Manual Fundal Pressure-Assisted Vaginal Deliveries: A Retrospective Cohort Study

Kamijo¹,

Shigemi²,

Kaszynski³

et al. 2021

Preprint

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“…In another study, it was stated that there was an increase in the elongation of the episiotomy incision and cervical laceration in the fundal pressure group 16 . Likewise, many studies in the literature have revealed that fundal pressure applied in the second stage of labor increases the risk of perineal laceration 15,18,27 . Upon reviewing other studies in the literature, parallelism was observed between the studies in terms of deepening in the episiotomy incision and cervical laceration in the fundal pressure group 14,17,18 …”

Section: Discussionmentioning

confidence: 89%

Effect of uterine fundal pressure applied in the second stage of labor on birth outcomes and neonatal oxygen saturation

Akpınar

Çapık

2022

J of Obstet and Gynaecol

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Aim To examine the effect of fundal pressure applied in the second stage of labor on birth outcomes and neonatal O2 saturation. Methods The study is of a descriptive and comparative type. Research data were collected in the obstetrics clinic of a Maternity Hospital between August 15, 2019 and February 15, 2020. The study sample consisted of 160 pregnant women who met the research criteria (80 pregnant women who received fundal pressure, 80 pregnant women who did not receive fundal pressure). Results The duration of the second and third stages of labor was found to be shorter in the nonfundal pressure group (t = −3.422, p = 0.001; t = 2.195, p = 0.030). When the groups were compared, the formation of perineal trauma and second‐degree laceration, episiotomy requirement, elongation of the episiotomy incision and cervical laceration rate were found to be significantly higher in the fundal pressure group χ2 = 10.794 p = 0.001; χ2 = 8.403 p = 0.004; χ2 = 10.014, p = 0.002; χ2 = 16.579 p = 0.000; χ2 = 16.276 p = 0.000). The 1st and 5th min Apgar scores of the newborns were lower in the fundal pressure group (t = −6.377, p = 0.000; t = −3.581, p = 0.001). The 1st, 5th, 10th, and 15th min oxygen saturation of the newborns were determined to be significantly lower in the fundal pressure group (t = −4.753, p = 0.000; t = −2.427, p = 0.016; t = −2.604, p = 0.010; t = −2.492, p = 0.014). Conclusion According to the study results, it was determined that the uterine fundal pressure has a negative effect on birth outcomes and neonatal oxygen saturation. Adverse effects of fundal pressure application should be revealed in different aspects.

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“…Both reviews cite the potential for the manoeuvre to cause harm, indicating that evidence regarding safety for the baby is insufficient [7,26]. Some observational studies have reported increased rates of adverse events following fundal pressure application, such as perineal damage, shoulder dystocia, neonatal fractures and brachial plexus injuries, neonatal hypoxia, lower Apgar scores and higher rates of Neonatal intensive Care Unit admission [13][14][15][16][17][18]. However, assessing adverse outcomes of fundal pressure using observational methods has limitations, as the indication for fundal pressure may be a pathological scenario that in itself predisposes adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have reported concerns on potential harmful outcomes for the woman and baby with the misuse of fundal pressure, such as when excessive force is used [13][14][15][16][17][18]. Increased risk of adverse events such as perineal damage, shoulder dystocia and neonatal birth injuries in women who receive fundal pressure has been reported in observational studies [13][14][15][16][17][18]. Additionally, use of fundal pressure may result in reduced women's satisfaction with the labour and birth experience, and could decrease the likelihood of the woman engaging with skilled health personnel in future births [11,19].…”

Section: Introductionmentioning

confidence: 99%

“…Some authors have reported concerns on potential harmful outcomes for the woman and baby with the misuse of fundal pressure, such as when excessive force is used [ 13 – 18 ]. Increased risk of adverse events such as perineal damage, shoulder dystocia and neonatal birth injuries in women who receive fundal pressure has been reported in observational studies [ 13 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis

et al. 2021

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Background Uterine fundal pressure involves a birth attendant pushing on the woman’s uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities. Methods The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity. Results Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4–27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women’s self-report). Conclusions The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.

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Safety of uterine fundal pressure maneuver during second stage of labor in a tertiary perinatal medical center: A retrospective observational study

Cited by 9 publications

References 10 publications

Association Between Placental Location and Neonatal Outcomes in Manual Fundal Pressure-Assisted Vaginal Deliveries: A Retrospective Cohort Study

Association Between Placental Location and Neonatal Outcomes in Manual Fundal Pressure-Assisted Vaginal Deliveries: A Retrospective Cohort Study

Effect of uterine fundal pressure applied in the second stage of labor on birth outcomes and neonatal oxygen saturation

The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis

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