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Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration

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Abstract

Objective

Owing to the lack of evidence supporting the use of uterine fundal pressure maneuver in vaginal delivery, the role of the maneuver is undetermined and remains controversial. The aim of this study was to identify the prone factor of the use of uterine fundal pressure maneuver and to evaluate its obstetrical outcomes.

Methods

All vaginal delivery records between 1 January 2005 and 30 April 2006 were evaluated. Maternal and neonatal variables and obstetrical complications were analyzed for subjects underwent uterine fundal pressure maneuver.

Results

Six hundred sixty-one vaginal deliveries were evaluated. Fundal pressure maneuver was performed in 39 cases (5.9%, 95% CI 4.4–7.1). Primiparity (76.9 vs. 53.3%; odds ratio 2.92, 95% CI 1.36–6.25, P = 0.004), larger maternal body weight gain during pregnancy (11.16 ± 0.4 kg vs. 10.05 ± 0.16 kg, P = 0.013), and longer duration of labor (922.3 ± 111.7 vs. 566.6 ± 18.3 min, P = 0.003) were prone risk factors for the use of uterine fundal pressure maneuver at vaginal delivery. One case of shoulder dystocia following uterine fundal pressure maneuver was reported (2.5 vs. 0%). Episiotomy (76.9 vs. 44.9%, P < 0.001) and vacuum extraction (41.0 vs. 3.8%, P < 0.001) were frequently performed with uterine fundal pressure maneuver. Uterine fundal pressure maneuver increased the risk of severe perineal laceration (28.1 vs. 4.8%; odds ratio 2.71, 95% CI 1.03–7.15, P = 0.045). The risk of severe perineal laceration was synergistically increased with the concurrent use of uterine fundal pressure maneuver with vacuum extraction and episiotomy.

Conclusion

Uterine fundal pressure maneuver during the second stage of labor increased the risk of severe perineal laceration. The use of the maneuver must be cautioned and careful attention must be paid to its application.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 22 South Greene Street, P.O. Box 290, Baltimore, MD, 21201, USA

    Koji Matsuo

  2. Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan

    Yasuhiko Shiki & Masato Yamasaki

  3. Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan

    Koichiro Shimoya

Authors
  1. Koji Matsuo
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  2. Yasuhiko Shiki
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  3. Masato Yamasaki
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  4. Koichiro Shimoya
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Correspondence to Koji Matsuo.

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Matsuo, K., Shiki, Y., Yamasaki, M. et al. Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration. Arch Gynecol Obstet 280, 781–786 (2009). https://doi.org/10.1007/s00404-009-1015-2

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  • DOI: https://doi.org/10.1007/s00404-009-1015-2

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