Fundal pressure in second stage of labor (Kristeller maneuver) is associated with increased risk of levator ani muscle avulsion
| Autor: | Federica Bellussi, Nicola Rizzo, L. Cariello, Ginevra Salsi, J. Krsmanovic, G. Pacella, Gianluigi Pilu, Aly Youssef, Elisa Montaguti, C. Azzarone, M. Paganotto, I. Cataneo |
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| Přispěvatelé: | Youssef, A., Salsi, G., Cataneo, I., Pacella, G., Azzarone, C., Paganotto, M.C., Krsmanovic, J., Montaguti, E., Cariello, L., Bellussi, F., Rizzo, N., Pilu, G. |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Radiology
Nuclear Medicine and Imaging medicine.medical_treatment Anal Canal Avulsion 0302 clinical medicine Risk Factors Pregnancy pelvic floor Valsalva maneuver Medicine Childbirth 030212 general & internal medicine Prospective Studies Obstetric Labor Complication 030219 obstetrics & reproductive medicine Pelvic floor Radiological and Ultrasound Technology Obstetrics Vaginal delivery 4D transperineal ultrasound Pregnancy Outcome Obstetrics and Gynecology General Medicine Pelvic Floor Disorder medicine.anatomical_structure Italy Female Case-Control Studie Human Adult medicine.medical_specialty Birth weight fundal pressure Kristeller maneuver Pelvic Floor Disorders 03 medical and health sciences Labor Stage Second Pressure Humans business.industry Risk Factor Odds ratio Delivery Obstetric Obstetric Labor Complications Prospective Studie Reproductive Medicine Case-Control Studies levator ani muscle business Body mass index |
| Popis: | Objective: To investigate the association between application of fundal pressure during the second stage of labor (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury. Methods: This was a prospective case–control study of women recruited immediately after their first vaginal delivery in our university hospital between March 2014 and September 2016. Women who underwent the Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched for body mass index, use of epidural analgesia, duration of second stage of labor and birth weight. All women were invited to undergo four-dimensional (4D) transperineal ultrasound (TPU) 3–6 months postpartum. The main outcome measure was the presence of LAM avulsion on 4D-TPU. TPU results were compared between cases and controls. Multivariate logistic regression analysis was performed to identify independent risk factors for LAM avulsion. Results: During the study period, 134 women in the Kristeller maneuver group and 128 women in the control group underwent TPU assessment. Women who underwent the Kristeller maneuver had a higher prevalence of LAM avulsion than did controls (38/134 (28.4%) vs 18/128 (14.1%); P = 0.005). In addition, women in the Kristeller-maneuver group had a larger hiatal area on maximum Valsalva maneuver and a greater increase in hiatal area from rest to maximum Valsalva. On multivariate logistic regression analysis, use of the Kristeller maneuver was the only independent factor associated with LAM avulsion (odds ratio, 2.5 (95% CI, 1.29–4.51)). Conclusion: The Kristeller maneuver is associated with an increased risk of LAM avulsion when applied in women during their first vaginal delivery. This should be taken into account when deciding to use fundal pressure to accelerate the second stage of labor and when counseling women following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. |
| Databáze: | OpenAIRE |
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