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Randomized Controlled Trial
. 2025 Jul;104(7):1357-1365.
doi: 10.1111/aogs.15130. Epub 2025 Apr 16.

Gentle fundal pressure to facilitate vaginal delivery: A randomized clinical trial

Qing Guo  1 , Hui Du  1 , Ying Feng  1 , Ruifen Jiao  1 , Xu Xie  1 , Mingwei Li  1 , Dean V Coonrod  2   3   4 , Thomas Q Zheng  1   2   3
Affiliations
Randomized Controlled Trial

Gentle fundal pressure to facilitate vaginal delivery: A randomized clinical trial

Qing Guo et al. Acta Obstet Gynecol Scand. 2025 Jul.

Abstract

Introduction: Fundal pressure during the second stage of labor is widely practiced but understudied. Violent fundal pressure can cause maternal and fetal injuries. Many providers believe the maneuver is effective. Administrative efforts to ban fundal pressure are unsuccessful and only drive the procedure to an underground practice.

Material and methods: In this single-center, open-label, randomized trial, nulliparous women with term singleton cephalic pregnancy under epidural analgesia were assigned to receive gentle manual fundal pressure (GMFP) or routine labor care. The GMFP was designed not to exceed a maximum of 120 mmHg. Women were randomized after 30 min of pushing in the second stage of labor. The primary outcome was the time from randomization to delivery. Secondary outcomes were mode of delivery, episiotomy, perineal laceration, cord blood pH, and other maternal and fetal outcomes.

Results: Between July 2023 and January 2024, 164 women were randomized to GMFP (n = 82) or to routine care (n = 82). The time from randomization to vaginal delivery did not show statistical significance between the fundal pressure group and the control group (mean [SD], 46.3 [33.3] vs. 55.9 [45.8] min; p = 0.13). Significantly fewer women in the fundal pressure group had operative vaginal deliveries (4 of 82 [4.9%]) than women in the control group (13 of 82 [15.9%]; relative risk [RR] 0.308, 95% confidence interval [CI] 0.105-0.904; p = 0.021). Similarly, mediolateral episiotomy was performed in fewer women in the fundal pressure group (6 of 82 [7.32%]) than in the control group (16 of 82 [19.51%], RR 0.375, 95% CI 0.154-0.910; p = 0.022). Other maternal and fetal outcomes were similar in the two groups.

Conclusions: GMFP resulted in a nonsignificant reduction in the second stage of labor and a significant reduction in operative vaginal delivery and episiotomy without an increase in adverse outcomes. Fundal pressure during the second stage of labor deserves further investigation.

Keywords: episiotomy; fundal pressure; operative vaginal delivery; second stage of labor; umbilical cord blood pH.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Gentle manual fundal pressure study flow diagram.
FIGURE 2
FIGURE 2
Time to birth.
See this image and copyright information in PMC

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