"First do no harm": Fundal pressure during labor-How safe is it?

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Obstetrics

Background:

• Fundal pressure (FP) is an obstetric maneuver with debated benefits and risks.
• Limited robust evidence exists regarding the maternal and neonatal outcomes of FP application.
• This study addresses the need for evidence on FP's safety during the second stage of labor.

Purpose of the Study:

• To evaluate the maternal and neonatal outcomes associated with fundal pressure (FP) during the second stage of labor.
• To compare outcomes between deliveries involving FP and a matched control group.
• To determine if FP, when applied by trained obstetricians, is associated with adverse events.

Main Methods:

• A case-control study design comparing vaginal deliveries with FP (FP group) to matched controls (1:1).
• Matching criteria included gestational age, parity, and mode of delivery (vacuum extraction or vaginal delivery).
• Composite adverse maternal outcomes included severe perineal tears, shoulder dystocia, postpartum hemorrhage, prolonged hospitalization, or excessive analgesic use.

Main Results:

• 325 (2.7%) of 12,048 deliveries involved FP.
• The FP group had higher rates of labor induction, oxytocin augmentation, and prolonged second stage of labor.
• No significant differences were observed in postpartum hemorrhage, composite adverse maternal outcomes, or early neonatal outcomes between groups.

Conclusions:

• Fundal pressure, when administered by trained obstetricians according to protocol, was not associated with adverse obstetric, maternal, or neonatal outcomes.
• The findings suggest that FP can be safely employed under specific conditions.
• Further research may explore optimal techniques and indications for FP use.