Possible feto-maternal clinical risk of the Kristeller’s expression

Abstract

The aim of this clinical case study is evaluation of possible intrapartal complication of the uncritical Kristeller’s expression. In this retrospective clinical study, data on seven parturients with significant maternal or fetal intrapartum complications during the second labor stage and Kristeller expression, associated with the maneuver, were analyzed. Data was obtained from patient files: history of delivery delivery room protocol and neonatal reports from two tertiary maternal wards. There were five uterine ruptures that were treated by laparotomy and uterine sutures. Atypical rupture location on the uterine fundus occurred in one case, isthmus rupture in three cases, and rupture of the scar left after a previous cesarean section as a potential risk factor for uterine rupture in one case. Complex uterine cervicoisthmic rupture with incomplete colporrhexis occurred during the delivery of a macrosomic child at an outpatient ward. In one case, unilateral fracture of the tenth and eleventh ribs resolved spontaneously without complications. One case of peripartum trauma, possibly associated with extensive expression was observed in one neonates: cutaneous and subcutaneous hematoma on the back with traumatic unilateral adrenal hemorrhage. Both newborns were monitored, successfully treated, and discharged from the hospital free from complications. In conclusion, in the obstetrics as a high risk profession, a very critical approach should be exercised on choosing this maneuver, which should be reserved for the rare and strictly indicated cases, thereby strictly following the professional rules to avoid generally unnecessary and unpleasant litigation and forensic expertise.