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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 20 Aug 2018
Modified on : 28 Aug 2018

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Bibliographical entry (without author) :

Fundal pressure in second stage of labor (Kristeller maneuver) is associated with higher risk of levator ani muscle avulsion. Ultrasound Obstet Gynecol. 2018

Author(s) :

Youssef A, Salsi G, Cataneo I, Pacella G, Azzarone C, Paganotto MC, Krsmanovic J, Montaguti E, Cariello L, Bellussi F, Rizzo N, Pilu G

Year of publication :


URL(s) :

Résumé (français)  :

La manœuvre de Kristeller est associée à un risque plus élevé d’avulsion du léviator ani lorsqu’elle est effectuée chez la femme lors de son premier accouchement. Cela devrait être pris en compte lors de la décision d’exercer une expression abdominale pour accélérer la deuxième étape et conseiller les femmes après l’accouchement.

Abstract (English)  :

to investigate the association between fundal pressure in the second stage (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury.

This was a prospective case-control study conducted in our university hospital. We recruited women immediately following their first vaginal delivery. Women who underwent Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched by BMI, epidural analgesia, second stage duration and birthweight. All women were invited to undergo a postpartum 4D transperineal ultrasound (TPUS). The main outcome measure was the presence of LAM avulsion at 4D TPUS. TPUS results were compared between cases and controls. A multivariate logistic regression was performed to identify independent risk factors of LAM avulsion.

During the study period, 134 women in the Kristeller group and 128 women in the control group underwent TPUS. Women in the Kristeller group had a higher prevalence of LAM avulsion in comparison with controls (38/134; 28.4% vs.18/128; 14.1%, p= 0.005). In addition, the Kristeller group had a larger hiatal area at maximum Valsalva maneuver and a higher increase in hiatal area on Valsalva. On multivariate logistic regression Kristeller maneuver was the only independent factor associated with LAM avulsion (OR 2.5, 95 C.I. 1.29- 4.51).

Kristeller maneuver is associated with a higher risk of levator ani muscle avulsion when applied in women during their first delivery. This should be taken into account when deciding to perform fundal pressure to accelerate the second stage and when counseling women following childbirth

Sumário (português)  :

A manobra de Kristeller está associada a um maior risco de avulsão do músculo elevador do ânus quando aplicada em mulheres durante o primeiro parto. Isso deve ser levado em consideração ao decidir-se por exercer a pressão do fundo para acelerar o segundo estágio e ao aconselhar as mulheres após o parto.

Resumen (español)  :

Comments :

Argument (français) :

lien établi entre lésion du leviator ani et expression abdominale

Argument (English):

link established between ani leviator lesion and abdominal expression

Argumento (português):

ligação estabelecida entre a lesão do ânus e a expressão abdominal

Argumento (español):

Keywords :

➡ iatrogeny ; fundal pressure ; incontinence/prolapsus

Author of this record :

Alison Passieux — 20 Aug 2018
➡ latest update : Alison Passieux — 28 Aug 2018

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