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

Abstract

Objective: Fundal pressure (FP), a controversial obstetric maneuver due to its potential benefits and risks, lacks robust evidence concerning its effects. This study aimed to evaluate the maternal and neonatal outcomes associated with the application of FP during the second stage of labor.

Methods: Following our departmental protocol, FP is applied by obstetricians trained under the supervision of the head of the labor ward. Its implementation requires patient consent and documentation. This case-control study encompassed vaginal deliveries (VDs) involving FP (FP group) during the second stage of labor. The control group included subsequent deliveries matched 1:1 for gestational age, parity, and mode of delivery (vacuum extraction [VE] or VD). Maternal and neonatal outcomes were compared between the groups. Composite adverse outcomes included the presence of at least one of the following: grade 3-4 perineal tear, shoulder dystocia, postpartum hemorrhage, postpartum hospitalization exceeding 4 days, or postpartum use of analgesics exceeding five doses.

Results: Among 12 048 deliveries during the 3-year study period, 325 (2.7%) involved FP. There were no significant differences in maternal age, body mass index, or gestational age between the FP (n = 325) and control groups (n = 325). However, the FP group exhibited higher rates of labor induction (41.5% vs. 19.3%, P < 0.0001), oxytocin augmentation (52% vs. 23.6%, P < 0.0001), and prolonged duration of the second stage of labor (1.88 ± 1.2 vs. 1.57 ± 1.3 h, P = 0.003). There were no significant differences in the rate of postpartum hemorrhage, composite adverse maternal outcomes, or early neonatal outcomes between the groups.

Conclusion: Fundal pressure, when administered by trained obstetricians, was not associated with adverse obstetric, maternal, or neonatal outcomes.