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

Abstract

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.

Knowledge, attitude and practice of healthcare providers on mistreatment during labour and childbirth: a cross-sectional study in Tehran, Iran, 2021

“…The results of our study showed that 60.8% of the providers did not consider the application of fundal pressure during delivery as a form of mistreatment. Based on the available evidence, the use of fundal pressure during vaginal birth is very common in hospitals [43][44][45][46][47][48]. A systematic review showed that the prevalence of fundal pressure ranged from 0.6 to 69.2% globally [45].…”

Quality aspects relating to giving birth in Switzerland: An analysis of quality indicators in inpatient obstetrics from 2013 to 2017

“…The authors therefore recommend guidelines and recommendations on which manoeuvre techniques can be used and under what circumstances. Because fundal pressure is not beneficial to women and is potentially harmful, the WHO and other bodies strongly advise against it ( 26 – 28 ). Ferrington et al ( 26 ) examined 76 studies from 22 countries and found that uterine fundal pressure is still widespread.…”

“…Because fundal pressure is not beneficial to women and is potentially harmful, the WHO and other bodies strongly advise against it ( 26 – 28 ). Ferrington et al ( 26 ) examined 76 studies from 22 countries and found that uterine fundal pressure is still widespread. More efforts are needed to prevent the potentially unnecessary and harmful management, they said.…”

Association between placental location and neonatal outcomes in manual fundal pressure‐assisted vaginal deliveries: A retrospective single‐center study in Japan

“…Although the use of MFP is not recommended in current WHO/FIGO and several guidelines, the procedure is still utilized to assist vaginal delivery and avoid unnecessary cesarean sections due to various fetal or maternal problems 2–4 . According to a latest systematic review and meta‐analysis, a pooled prevalence of MFP was still 23.2% and the highest prevalence of MFP (34.7%) was reported in the lower‐middle countries of income level 5 . In Japan, MFP‐assisted vaginal deliveries account for 9.5% of all vaginal deliveries 6 …”

“…[2][3][4] According to a latest systematic review and meta-analysis, a pooled prevalence of MFP was still 23.2% and the highest prevalence of MFP (34.7%) was reported in the lowermiddle countries of income level. 5 In Japan, MFPassisted vaginal deliveries account for 9.5% of all vaginal deliveries. 6 There is insufficient evidence that MFP is beneficial to neonatal outcomes.…”