Fundal pressure to shorten the second stage of labor: Systematic review and meta-analysis

Systematically review the evidence on fundal pressure to expedite vaginal delivery.

Literature search in electronic databases. Randomized controlled trials of fundal pressure to expedite delivery were included in this systematic review and meta-analysis. The primary outcome was the length of the second stage.

We identified 10 randomized controlled trials. Fundal pressure was associated with a shorter length of the second stage of labor (mean difference (MD) -20.33 min, 95% confidence intervals (CI) -28.55, -12.11). Sub-group analysis with only manual pressure or a belt confirmed the association. There was no significant difference in the rate of vaginal delivery (relative risk (RR) 1.00, 95%, CI 0.98, 1.02), one and five minute Apgar scores (MD 0.10, 95%, confidence intervals -0.05, 0.24; and MD 0.02, 95%, CI -0.12, 0.15), neonatal trauma (RR 0.33, 95%, CI 0.01, 7.90), vaginal/perineal laceration (RR 0.83, 95%, CI 0.57, 1.22), cervical laceration (RR 1.30, 95%, CI 0.21, 8.02), episiotomy (RR 1.08, 95%, CI 0.96, 1.21), cesarean section rate (RR 0.72; 95%, CI 0.34, 1.51), operative vaginal deliveries (RR 0.79; 95%, CI 0.55, 1.13) and neonatal intensive care admissions (RR 0.33, 95%, CI 0.01, 7.90). However, patients receiving fundal pressure had a lower umbilical cord arterial pH (MD -0.03, 95%, CI -0.04, -0.01), and a 3.5 non-significantly higher incidence of Apgar scores < 7 at 5 min (4.9% vs 0.7%, RR 3.48, 95%, CI 0.57, 21.32).

Fundal pressure in the second stage is associated with a 20-minute decrease in the length of labor and a small decrease in neonatal umbilical artery pH.