title: Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration.
abstract: OBJECTIVE
  Owing to the lack of evidence supporting the use of uterine fundal pressure maneuver in vaginal delivery, the role of the maneuver is undetermined and remains controversial. The aim of this study was to identify the prone factor of the use of uterine fundal pressure maneuver and to evaluate its obstetrical outcomes.
  
  
  METHODS
  All vaginal delivery records between 1 January 2005 and 30 April 2006 were evaluated. Maternal and neonatal variables and obstetrical complications were analyzed for subjects underwent uterine fundal pressure maneuver.
  
  
  RESULTS
  Six hundred sixty-one vaginal deliveries were evaluated. Fundal pressure maneuver was performed in 39 cases (5.9%, 95% CI 4.4-7.1). Primiparity (76.9 vs. 53.3%; odds ratio 2.92, 95% CI 1.36-6.25, P = 0.004), larger maternal body weight gain during pregnancy (11.16 +/- 0.4 kg vs. 10.05 +/- 0.16 kg, P = 0.013), and longer duration of labor (922.3 +/- 111.7 vs. 566.6 +/- 18.3 min, P = 0.003) were prone risk factors for the use of uterine fundal pressure maneuver at vaginal delivery. One case of shoulder dystocia following uterine fundal pressure maneuver was reported (2.5 vs. 0%). Episiotomy (76.9 vs. 44.9%, P < 0.001) and vacuum extraction (41.0 vs. 3.8%, P < 0.001) were frequently performed with uterine fundal pressure maneuver. Uterine fundal pressure maneuver increased the risk of severe perineal laceration (28.1 vs. 4.8%; odds ratio 2.71, 95% CI 1.03-7.15, P = 0.045). The risk of severe perineal laceration was synergistically increased with the concurrent use of uterine fundal pressure maneuver with vacuum extraction and episiotomy.
  
  
  CONCLUSIONS
  Uterine fundal pressure maneuver during the second stage of labor increased the risk of severe perineal laceration. The use of the maneuver must be cautioned and careful attention must be paid to its application.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 22 South Greene Street, PO Box 290, Baltimore, MD 21201, USA. koji.matsuo@gmail.com
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Shiki
authors.forename: Masato
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Koichiro
authors.initials: K
authors.lastname: Shimoya
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D022125:Lacerations / Q000209:etiology; D016015:Logistic Models; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011312:Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D014590:Uterine Contraction / Q000502:physiology; D014599:Uterus / Q000502:physiology