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Fundal pressure during the second stage of labour

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Verheijen, EC, Raven, Joanna and Hofmeyr, GJ (2009) 'Fundal pressure during the second stage of labour'. Cochrane Database of Systematic Reviews, Issue 4, CD006067.

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Abstract

Background

Fundal pressure during the second stage of labour involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal in an attempt to assist spontaneous vaginal delivery and avoid prolonged second stage or the need for operative delivery. Fundal pressure has also been applied using an inflatable girdle. A survey in the United States found that 84% of the respondents used fundal pressure in their obstetric centres.There is little evidence to demonstrate that the use of fundal pressure is effective to improve maternal and/or neonatal outcomes. Several anecdotal reports suggest that fundal pressure is associated with maternal and neonatal complications: for example, uterine rupture, neonatal fractures and brain damage. There is a need for objective evaluation of the effectiveness and safety of fundal pressure in the second stage of labour.

Objectives

To determine the benefits and adverse effects of fundal pressure in the second stage of labour.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008).

Selection criteria

Randomised and quasi-randomised controlled trials of fundal pressure versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation.

Data collection and analysis

Three review authors independently assessed for inclusion all the potential studies. We extracted the data using a pre-designed form. We entered data into Review Manager software and checked for accuracy.

Main results

We excluded two of three identified trials from the analyses for methodological reasons. This left no studies on manual fundal pressure. We included one study (500 women) of fundal pressure by means of an inflatable belt versus no fundal pressure to reduce operative delivery rates. The methodological quality of the included study was good.

Use of the inflatable belt did not change the rate of operative deliveries (RR 0.94, 95% CI 0.80 to 1.11). Fetal outcomes in terms of five-minute Apgar scores below seven (RR 4.62, 95% CI 0.22 to 95.68), low arterial cord pH (RR 0.47, 95% CI 0.09 to 2.55) and admission to the neonatal unit (RR 1.48, 95% CI 0.49 to 4.45) were also not different between the groups. There was no severe neonatal or maternal mortality or morbidity. There was an increase in intact perineum (RR 1.73, 95% CI 1.07 to 2.77), as well as anal sphincter tears (RR 15.69, 95% CI 2.10 to 117.02) in the belt group. There were no data on long-term outcomes.

Item Type: Article
Subjects: WQ Obstetrics > Labor > WQ 300 General works
WQ Obstetrics > Labor > WQ 330 Complications of labor
WQ Obstetrics > Obstetric Surgical Procedures > WQ 415 Delivery (including preparatory manipulation)
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI): https://doi.org/10.1002/14651858.CD006067.pub2
Related URLs:
Depositing User: Faye Moody
Date Deposited: 04 Jan 2012 16:39
Last Modified: 06 Feb 2018 13:04
URI: https://archive.lstmed.ac.uk/id/eprint/2463

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