The modified Mueller-Hillis maneuver in predicting abnormalities in second stage labor

Abstract

Objective: To assess prospectively the utility of a modification of the Mueller-Hillis maneuver in predicting abnormalities of the second stage of labor. Methods: The Mueller-Hillis maneuver was modified by limiting its use to the second stage of labor during a contraction. The maneuver was performed by one examiner; descent of 1 cm or more was deemed a positive maneuver. Descent less than 1 cm was deemed a negative maneuver. Labor outcomes were analyzed according to the results of this maneuver. Resuls: Seventy patients were enrolled in this study. Fifty-one (72.9%) had ≥1 cm descent maneuver and 19 (27.1%) had ≤1 cm descent. A descent ≥1 cm was significantly predictive of vaginal delivery (100%) and a descent s 1 cm was significantly associated with an increased cesarean section rate ( P = 0.001), prolonged second stage of labor ( P = 0.001), abnormal position ( P = 0.01) and higher station ( P = 0.001). Conclusions: A positive modified Mueller-Hillis maneuver in second stage labor had a high predictive value for vaginal delivery, whereas a negative maneuver was significantly associated with high operative delivery rate, prolonged second stage labor and abnormal position. These results indicate that this modification of the Mueller-Hillis maneuver needs to be considered for its utility in second stage labor.