| Popis: |
Objective: Fundal pressure (FP) and Valsalva (V) are used alone and together to enhance uterine forces during the second stage of labor despite reported complications. We hypothesize that FP aids or complicates delivery by increasing intrauterine pressure (IP). Methods: We investigated the relationship between FP and IP during the second stage in 41 women with epidural analgesia. Intrauterine pressure was measured electronically. Fundal pressure was applied under standardized conditions across a pressure cuff connected to a manometer after the vertex reached +2. Interventions included V or FP during contraction (CTXV, CTXFP); FP during V during contraction (CTXVFP); and FP and V alone between contractions. Integral, amplitude, duration, and basal tone were calculated. Multiple regression was used to identify interactions between maternal, fetal, and labor characteristics, and the effect of FP on IP. Results: IP transiently increased by 92% after V and FP together. Fifty-six percent of the maximal force resulted from contraction, 27% from V, and 17% from FP. Applied over V, FP significantly enhanced IP (P Download : Download full-size image Conclusion: FP increases IP but to a lesser extent than V. Large increases in IP after standardized application of FP could help to predict relative cephalopelvic disproportion and thus prevent further delay of a needed operative delivery. |
