Abstract
Purpose
To evaluate the role of uterine fundal pressure during the second stage of labor (Kristeller maneuver) on pelvic floor dysfunction (urinary and anal incontinence, genital prolapse, pelvic floor strength).
Methods
522 primiparous women, enrolled 3 months after vaginal delivery, were divided in two groups: group A (297 women) identifies the women who received Kristeller maneuvers with different indications (e.g. fetal distress, failure to progress, mother exhaustion), group B (225 women) the women without maneuver. Participants were questioned about urogynecological symptoms and examined by Q-tip test, digital test, vaginal perineometry and uroflowmetric stop test score.
Results
Mediolateral episiotomies, dyspareunia and perineal pain were significantly higher in Kristeller group, whereas urinary and anal incontinence, genital prolapse and pelvic floor strength were not significantly different between the groups.
Conclusions
Kristeller maneuver does not modify puerperal pelvic floor function but increases the rate of episiotomies.
References
Verheijen EC, Raven JH, Hofmeyr GJ (2009) Fundal pressure during the second stage of labor. Cochrane Database Syst Rev (4). Art. No.: CD006067. doi:10.1002/14651858.CD006067.pub2
Cox J, Cotzias CS, Siakpere O, Osuagwu FI, Holmes EP, Paterson-Brown S (1999) Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia? Br J Obstet Gynaecol 106(12):1280–1286
Merhi ZO, Awonuga AO (2005) The role of uterine fundal pressure in the management of the second stage of labor: a reappraisal. Obstet Gynecol Surv 60(9):599–603
Api O, Balcin ME, Ugurel V, Api M, Turan C, Unal O (2009) The effect of uterine fundal pressure on the duration of the second stage of labor: a randomized controlled trail. Acta Obstet Gynecol Scand 88:320–324
Cosner KR (1996) Use of fundal pressure during second stage of labor. A pilot study. J Nurse Midwifery 41(4):334–337
De Leeuw JW, Vierhout ME, Struijk PC, Auwerda HJ, Bac DJ, Wallemburg HC (2001) Anal sphincter damage after vaginal delivery: relationship of anal endosonography and manometry to anorectal complaints. BJOG 108:383–387
Zetterstrom J, Lopez A, Anzen B, Norman M, Holmstrom B, Mellgren A (1999) Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol 94(1):21–28
Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
Signorello LB, Harlow BL, Chekos AK, Repke JT (2001) Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol 184:881–890
Pregazzi R, Sartore A, Bortoli P, Grimaldi E, Ricci G, Guaschino S (2002) Immediate postpartum perineal examination as a predictor of puerperal pelvic floor dysfunction. Obstet Gynecol 99:581–584
Isherwood PJ, Rane A (2000) Comparative assessment of pelvic floor strength using a perineometer and digital examination. Br J Obstet Gynaecol 107(8):1007–1011
Sampselle CM (1993) Using a stopwatch to assess pelvic muscle strength in the urine stream interruption test. Nurs Pract 18(1):14–16, 18–20
Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17
Matsuo K, Shiki Y, Yamasaki M, Shimoya K (2009) Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration. Arch Gynecol Obstet 280(5):781–786
Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S (2004) The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 103(4):669–673
Conflict of interest
The authors state that they have no conflicts of interest and that the study has been approved by the institutional review board.
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Sartore, A., De Seta, F., Maso, G. et al. The effects of uterine fundal pressure (Kristeller maneuver) on pelvic floor function after vaginal delivery. Arch Gynecol Obstet 286, 1135–1139 (2012). https://doi.org/10.1007/s00404-012-2444-x
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DOI: https://doi.org/10.1007/s00404-012-2444-x