Fundal pressure to shorten the second stage of labor: Systematic review and meta-analysis

Abstract

Objectives: Systematically review the evidence on fundal pressure to expedite vaginal delivery.

Study design: Literature search in electronic databases. Randomized controlled trials of fundal pressure to expedite delivery were included in this systematic review and meta-analysis. The primary outcome was the length of the second stage.

Results: We identified 10 randomized controlled trials. Fundal pressure was associated with a shorter length of the second stage of labor (mean difference (MD) -20.33 min, 95% confidence intervals (CI) -28.55, -12.11). Sub-group analysis with only manual pressure or a belt confirmed the association. There was no significant difference in the rate of vaginal delivery (relative risk (RR) 1.00, 95%, CI 0.98, 1.02), one and five minute Apgar scores (MD 0.10, 95%, confidence intervals -0.05, 0.24; and MD 0.02, 95%, CI -0.12, 0.15), neonatal trauma (RR 0.33, 95%, CI 0.01, 7.90), vaginal/perineal laceration (RR 0.83, 95%, CI 0.57, 1.22), cervical laceration (RR 1.30, 95%, CI 0.21, 8.02), episiotomy (RR 1.08, 95%, CI 0.96, 1.21), cesarean section rate (RR 0.72; 95%, CI 0.34, 1.51), operative vaginal deliveries (RR 0.79; 95%, CI 0.55, 1.13) and neonatal intensive care admissions (RR 0.33, 95%, CI 0.01, 7.90). However, patients receiving fundal pressure had a lower umbilical cord arterial pH (MD -0.03, 95%, CI -0.04, -0.01), and a 3.5 non-significantly higher incidence of Apgar scores < 7 at 5 min (4.9% vs 0.7%, RR 3.48, 95%, CI 0.57, 21.32).

Conclusions: Fundal pressure in the second stage is associated with a 20-minute decrease in the length of labor and a small decrease in neonatal umbilical artery pH.

Keywords: Fundal pressure; Kristeller maneuver; Second stage of labor.