Effectiveness and Safety of Fundal Pressure in Second Stage of Labour

Abstract

Objective: To evaluate the effectiveness and safety of fundal pressure (Kristeller manoeuvre) in second stage of labour at a tertiary care Hospital (KGH).

Methodology: This descriptive case series study was conducted at the Gynaecology and Obstetrics department of Kharadar General Hospital, Karachi, from July 2022 to December 2022. The study included women with singleton pregnancies at 37 weeks or more gestational age, who had reached the second stage of labor, regardless of age or parity. Fundal pressure was applied through manual or instrumental means to the maternal abdomen in the direction of the birth canal. Effectiveness and safety were measured by successful normal vaginal deliveries (NVD) and reduced complications. Data were collected using a self-designed study proforma.

Results: The participants in the study had an average age of 23.51 ± 4.11 years, and the mean gestational age was 38.29 ± 1.88 weeks. Of the cases, 40.6% underwent induced labor (IOL), while 59.4% experienced spontaneous labor. All 64 study subjects, successfully delivered by NVD and no instances of instrumental deliveries or cesarean sections were observed. Out of all, only two cases had degree-I perineal tears, and one case had a degree-II perineal tear. Only two women experienced postpartum hemorrhage (PPH), and one case was found with fetal distress. No significant associations were observed between PPH and perineal tears with age, parity, and booking status in the given sample (p > 0.05).

Conclusion: Fundal pressure observed with minimal complications and successful normal deliveries. However, the findings cannot be unequivocally recommended for the use of fundal pressure due to several limitations. To establish more robust and conclusive evidence, further large-scale studies are recommended.