Gentle fundal pressure to facilitate vaginal delivery: A randomized clinical trial

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2025-04-16 DOI:10.1111/aogs.15130

Qing Guo, Hui Du, Ying Feng, Ruifen Jiao, Xu Xie, Mingwei Li, Dean V. Coonrod, Thomas Q. Zheng

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引用次数: 0

Abstract

Introduction

Fundal pressure during the second stage of labor is widely practiced but understudied. Violent fundal pressure can cause maternal and fetal injuries. Many providers believe the maneuver is effective. Administrative efforts to ban fundal pressure are unsuccessful and only drive the procedure to an underground practice.

Material and Methods

In this single-center, open-label, randomized trial, nulliparous women with term singleton cephalic pregnancy under epidural analgesia were assigned to receive gentle manual fundal pressure (GMFP) or routine labor care. The GMFP was designed not to exceed a maximum of 120 mmHg. Women were randomized after 30 min of pushing in the second stage of labor. The primary outcome was the time from randomization to delivery. Secondary outcomes were mode of delivery, episiotomy, perineal laceration, cord blood pH, and other maternal and fetal outcomes.

Results

Between July 2023 and January 2024, 164 women were randomized to GMFP (n = 82) or to routine care (n = 82). The time from randomization to vaginal delivery did not show statistical significance between the fundal pressure group and the control group (mean [SD], 46.3 [33.3] vs. 55.9 [45.8] min; p = 0.13). Significantly fewer women in the fundal pressure group had operative vaginal deliveries (4 of 82 [4.9%]) than women in the control group (13 of 82 [15.9%]; relative risk [RR] 0.308, 95% confidence interval [CI] 0.105–0.904; p = 0.021). Similarly, mediolateral episiotomy was performed in fewer women in the fundal pressure group (6 of 82 [7.32%]) than in the control group (16 of 82 [19.51%], RR 0.375, 95% CI 0.154–0.910; p = 0.022). Other maternal and fetal outcomes were similar in the two groups.

Conclusions

GMFP resulted in a nonsignificant reduction in the second stage of labor and a significant reduction in operative vaginal delivery and episiotomy without an increase in adverse outcomes. Fundal pressure during the second stage of labor deserves further investigation.

Abstract Image

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温和的阴道压力促进阴道分娩：一项随机临床试验。

导读：产程第二阶段的底部压力被广泛应用，但研究不足。猛烈的颅底压力可造成产妇和胎儿损伤。许多医疗服务提供者认为这种策略是有效的。禁止资金压力的行政努力是不成功的，只会将这一程序推向地下实践。材料和方法：在这项单中心、开放标签、随机试验中，在硬膜外镇痛下未分娩的足月单胎头位妊娠妇女被分配接受轻柔的手底压（GMFP）或常规分娩护理。GMFP的设计上限不超过120毫米汞柱。妇女在第二产程分娩30分钟后随机分组。主要结局是从随机分配到交付的时间。次要结局是分娩方式、会阴切开术、会阴撕裂、脐带血pH值和其他母胎结局。结果：在2023年7月至2024年1月期间，164名妇女随机分为GMFP组（n = 82）和常规护理组（n = 82）。从随机分组到阴道分娩的时间，基底压力组与对照组比较，差异无统计学意义(mean [SD], 46.3[33.3]对55.9 [45.8]min；p = 0.13)。阴道压力组（82例中有4例[4.9%]）明显少于对照组（82例中有13例[15.9%]）；相对危险度[RR] 0.308, 95%可信区间[CI] 0.105 ~ 0.904；p = 0.021)。同样，基底压力组（82例中有6例[7.32%]）比对照组（82例中有16例[19.51%]）行外阴中外侧切开术的妇女较少，RR 0.375, 95% CI 0.154-0.910；p = 0.022)。两组的其他母胎结局相似。结论：GMFP导致第二产程无显著减少，手术阴道分娩和会阴切开术显著减少，但不良后果未增加。产程第二阶段的子宫压力值得进一步调查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.