Fundal pressure during the second stage of labour

Fundal pressure in second stage of labor (Kristeller maneuver) is associated with increased risk of levator ani muscle avulsion

“…Although the Kristeller maneuver is commonly used in some countries, many obstetricians believe it has no justifiable use in today's obstetric practice. One of the main reasons for the heterogeneity in the use of this practice is the scarcity of high‐quality data on its benefits and risks. To our knowledge, this is the first study to evaluate the effect of the Kristeller maneuver on the incidence of levator ani avulsion.…”

“…Obstetricians and patients should be aware that, to date, there are no proven benefits from the application of the maneuver, and that it is associated with a higher risk of pelvic floor injury. This should be taken into account when the performance of the maneuver is being evaluated.…”

“…Association of the maneuver with maternal and perinatal complications has been reported in several studies. Among the possible consequences, fetal shoulder dystocia, fetal acidosis, maternal rib fracture, severe perineal tears, uterine rupture, dyspareunia, stress urinary incontinence, acute postpartum urinary retention and other pelvic floor dysfunctions have been reported 2,[5][6][7][8][9][10][11] . Furthermore, many studies have failed to find any proven benefit from the application of the maneuver 2 .…”

Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study.

“…Univariate and multivariate logistic regression analyses were performed to identify maternal, foetal, and environmental factors associated with nonrecommended care; namely, episiotomy and fundal pressure [11]. We selected these practices because they are potentially harmful when routinely applied to pregnant women and are frequently misused [12][13][14][15]. Explanatory variables were selected based on findings in the literature and frequent reasons to perform them reported in the qualitative strand in this study.…”

“…These qualitative findings explained our quantitative findings; specifically, that providers applied fundal pressure to accelerate the delivery and to avoid operative delivery. Contrary to their perceptions, fundal pressure is strongly not recommended in Philippines national guidelines [20], since it does not change desirable maternal outcomes such as duration of the 2 nd stage, instrumental delivery, or caesarean section, as well as neonatal outcomes such as low arterial cord pH and Apgar scores [14]. Fundal pressure may also increase the occurrence of severe laceration and cervical tears, and the possibility of uterine rupture [15,28,29].…”