Maternal and fetal outcome after fundal uterine pressure (Kristeller maneuver) in spontaneous and assisted vaginal deliveries

Abstract

Results: 9743 vaginal deliveries were analyzed. FUP was applied in 8.9% of spontaneous deliveries (n = 7995) and 12.1% of assisted vaginal deliveries (n = 1748). FUP was associated with a higher incidence of shoulder dystocia in both spontaneous – (1.6% vs. 0.9%, p = 0.14, n. s.; adj. OR 2.44 (CI 95% 1.23 – 4.84)) and assisted vaginal deliveries (9.0% vs. 1.4%, p < 0.01; adj. OR 6.88 (CI 95% 3.50 – 13.53)). In spontaneous vaginal deliveries, FUP was associated with fetal acidosis (arterial pH < 7.2) (31.5% vs. 15.1%, p < 0.01; adj. OR 3.18 (CI 95% 2.64 – 3.82)) and 10’-Apgar < 7 (0.8% vs. 0.3%, p = 0.02; adj. OR 3.04 (CI 95% 1.17 – 7.88)). In assisted vaginal deliveries, FUP was associated with fetal acidosis as well (36.0% vs. 26.8%, p < 0.01; adj. OR 1.59 (CI 95% 1.17 – 2.16)). FUP was notsignificantly associated with adverse maternal outcome such as anal sphincter tears, uterine rupture or increased blood loss. Conclusions: FUP is associated with increased occurrence of shoulder dystocia and fetal acidosis. Fetal acidosis may be increased due to selection bias in a retrospective study. Possible advantages of FUP (prevention of caesarean section) cannot be evaluated.