title: The Valsalva maneuver duration during labor expulsive stage: repercussions on the maternal and neonatal birth condition.
abstract: OBJECTIVE
  This cross-sectional study was designed to examine the effects of the Valsalva Maneuver (VM) and its duration on the acid- base equilibrium of the neonate and its maternal repercussions during the expulsive stage of labor, after standard breathing and pushing instructions were given.
  
  
  METHODS
  A convenience sample of women with low risk pregnancy (n=33; mean age 22.5±3.7 y and gestational age 38.1±1.12 wks) and their newborns were studied during the expulsive stage of vaginal labor. Coaching consisted of standard recommendations for breathing including prolonged VMs coordinated with pushing. Maternal outcomes included the need for uterus fundal pressure maneuver and episiotomy, perineal trauma and posture. Neonatal outcomes included blood gases sampled from the umbilical cord, and Apgar scores. Data were analyzed with the Fisher's exact test, chi-square test, and Pearson correlation coefficient.
  
  
  RESULTS
  None of the maternal outcomes were associated with VM duration. With respect to neonatal outcomes, increased VM duration was associated with reduced venous umbilical pH (r=-0.40; p=0.020), venous base excess (r=-0.42; p=0.014) and with arterial base excess (r=-0.36; p=0.043). Expulsive stage time was negatively associated with umbilical venous and arterial pH.
  
  
  CONCLUSIONS
  VM duration during fetal expulsion in labor negatively affects fetal acid-base equilibrium and potentially the wellbeing of the neonate. Our results support the need to consider respiratory strategies during labor, to minimize potential risk to the mother and neonate.
authors.affiliation: Physical Therapy Department, Universidade Federal de Pernambuco, Recife, PE, Brazil. lemosandrea@bol.com.br
authors.forename: Andrea
authors.initials: A
authors.lastname: Lemos
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dean
authors.forename: Armèle Dornelas
authors.initials: AD
authors.lastname: de Andrade
mesh_terms: D000136:Acid-Base Equilibrium; D003430:Cross-Sectional Studies; D005260:Female; D005312:Fetal Blood; D006801:Humans; D007231:Infant, Newborn / Q000097:blood; D007749:Labor Stage, Third / Q000502:physiology*; D011247:Pregnancy; D013997:Time Factors; D014636:Valsalva Maneuver / Q000502:physiology*; D055815:Young Adult