Kristeller misunderstood?

Abstract

Samuel Kristeller (1820–1900) was active in Berlin/Germany; he died there 125 years ago. The authors, led by Guo (2025), examine an “obstetric old-fashioned” technique that has been intensively discussed since at least the 1990s: Kristeller maneuvers or “fundal pressure.” Studies on this topic are rare, which is why the authors are to be thanked for this RCT!

In the introduction, Guo et al. write in the July issue of AOGS that Samuel Kristeller used this technique to accelerate vaginal delivery in emergency situations.¹

In the almost 160 years that have passed since Samuel Kristeller's publication,² Kristeller maneuvers have certainly been performed countless times worldwide during the expulsion period in both out-of-hospital and hospital births, without most users being familiar with the original publication. It is also not cited in the abovementioned article and is not included in the references. Therefore, a brief explanation:

Samuel Kristeller first published his method for supporting labor in 1867 in a “preliminary communication” in the Berliner Klinische Wochenschrift (Berlin Clinical Weekly).² Reading the original report, it becomes clear that Kristeller used the hand grip regardless of the completeness of the cervix, the position of the fetus, or the height of the uterus, essentially as a substitute for a lack of or no labor activity or the absence of labor-inducing medication. Three quotes from Kristeller's work are provided to illustrate his approach at the time: “The pressure lasts 5–8 s….Then I take a break of 0.5–3 mins….I repeat the compressions 10–40 times. In difficult cases, after a series of 10–15 compressions, I take a longer break of 10–15 mins…” Kristeller further notes, “…that the expressio procedure competes excellently with extraction…” and “…that the procedure should be performed with the necessary moderation….”² It becomes clear that the Kristeller maneuver was intended to prevent complications from the so-called internal maneuvers or the use of forceps in an era of poor hygiene and high risk of infection. Moreover, Kristeller was probably well aware of the dangers of “expressio fetus”²—discussed today in other contexts.

Two other ideas by Kristeller, which also pursued the goal of a more gentle (operative) birth, have been virtually forgotten: A (bloody) incision of the cervix was intended to shorten the expulsion period in emergency cases.³ Finally, in 1862, Kristeller first described a dynamometric device in forceps, which was intended to measure and regulate the pressure on the fetal skull.⁴