title: [Methods of pushing at vaginal delivery and pelvi-perineal consequences. Review].
abstract: BACKGROUND
  The main objective of that review was to evaluate the pelvi-perineal consequences of the different methods of pushing at vaginal delivery.
  
  
  METHODS
  A review on PubMed, the Cochrane Library and EM-Premium was performed from 1984 to 2014. Among 29 manuscripts analysed, only nine randomised controlled trials (including one meta-analysis of three trials) comparing Valsalva and spontaneous pushing were selected. A 10 th study, secondary analysis of a randomized controlled trial comparing different methods of perineal protection (warm compresses, massage and manual protection), was also selected.
  
  
  RESULTS
  Two trials have shown that spontaneous pushing reduces the risk of perineal tears, but studies were heterogeneous and discordant results do not allowed definitive conclusions. Results on the duration of the second stage of labour are conflicting. The method of pushing does not seem to affect the rate of episiotomy, instrumental delivery and cesarean section. Maternal satisfaction seems to be better after spontaneous pushing. It seems that there is no negative effect of spontaneous pushing on neonate well-being, and one study has shown a significant improvement of prenatal fetal parameters during the expulsive phase.
  
  
  CONCLUSIONS
  According to current knowledge, both techniques of pushing during the expulsive phase at delivery seem comparable in terms of duration, risk of perineal tears and neonatal outcome.
authors: École de maïeutique, faculté de médecine, 186, chemin du Carreau-de-Lanes, 30900 Nîmes, France.
authors: N
authors: N
authors: Ratier
authors: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France.
authors: E
authors: E
authors: Balenbois
authors: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France.
authors: V
authors: V
authors: Letouzey
authors: École de maïeutique, faculté de médecine, 186, chemin du Carreau-de-Lanes, 30900 Nîmes, France; Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France.
authors: P
authors: P
authors: Marès
authors: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France. Electronic address: renaud.detayrac@chu-nimes.fr.
authors: R
authors: R
authors: de Tayrac
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology* / Q000517:prevention & control*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy
keywords: Accouchement par voie vaginale; Conséquences pelvi-périnéales; Pelvi-perineal consequences; Poussée en Valsalva; Poussée en expiration; Poussée spontanée; Spontaneous pushing; Vaginal delivery; Valsalva pushing