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

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https://afar.info/id=3019

Created on : 23 Aug 2018
Modified on : 04 Nov 2018

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Bibliographical entry (without author) :

Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration. Arch Gynecol Obstet. 2009

Author(s) :

Matsuo K, Shiki Y, Yamasaki M, Shimoya K.

Year of publication :

2009

URL(s) :

https://www.ncbi.nlm.nih.gov/pubmed/19263062
https://doi.org/10.1007/s00404-009-1015-2.

Résumé (français)  :

OBJECTIF :
En raison du manque de preuves à l’appui de la manœuvre utérine sous pression vaginale lors de l’accouchement par voie vaginale, le rôle de la manœuvre est indéterminé et demeure controversé. Le but de cette étude était d’identifier le facteur prédictif de l’utilisation de la manœuvre utérine sous pression et d’évaluer ses résultats obstétricaux.

METHODES :
Tous les dossiers d’accouchement vaginal entre le 1er janvier 2005 et le 30 avril 2006 ont été évalués. Les variables maternelles et néonatales et les complications obstétricales ont été analysées pour les sujets soumis à une manœuvre utérine sous pression.

RÉSULTATS :
Six cent soixante et un accouchements par voie basse ont été évalués. Une expression abdominale a été effectuée dans 39 cas (5,9%, IC à 95%: 4,4-7,1). Primiparité (76,9 vs 53,3%; odds ratio 2,92, IC à 95% 1,36-6,25, P = 0,004), gain de poids maternel plus important pendant la grossesse (11,16 ± 0,4 kg vs 10,05 ± 0,16 kg, P = 0,013 ), et une durée de travail plus longue (922,3 ± 111,7 vs 566,6 ± 18,3 min, p = 0,003) étaient des facteurs de risque prédictifs de l’utilisation de l’expression abdominale à la naissance lors de l’accouchement par voie basse. Un cas de dystocie de l’épaule à la suite d’une expression abdominale a été signalé (2,5% contre 0%).
L’épisiotomie (76,9 vs 44,9%, p 0,001) et l’extraction par ventouse (41,0 vs 3,8%, p 0,001) ont souvent été réalisées avec l’expression abdominale. L’expression abdominale a augmenté le risque de lacération périnéale sévère (28,1 contre 4,8%; rapport de cotes 2,71, IC à 95% 1,03-7,15, P = 0,045). Le risque de lacération périnéale sévère était augmenté de manière synergique avec l’utilisation concomitante de l’expression abdominale avec la ventouse et l’épisiotomie.

CONCLUSION :
L’expression abdominale pendant la seconde phase du travail augmentait le risque de lacération périnéale sévère. La prudence est requise dans le recours à l’expression abdominale.

Abstract (English)  :

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.

CONCLUSION:
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.

Sumário (português)  :

OBJETIVO:
Devido à falta de evidências que apóiem ​​o uso da manobra de pressão uterina no parto vaginal, o papel da manobra é indeterminado e permanece controverso. O objetivo deste estudo foi identificar o fator propenso do uso da manobra de pressão uterina e avaliar seus resultados obstétricos.

MÉTODOS:
Todos os registros de parto vaginal entre 1 de janeiro de 2005 e 30 de abril de 2006 foram avaliados. Variáveis ​​maternas e neonatais e complicações obstétricas foram analisadas para indivíduos submetidos à manobra de pressão uterina.

RESULTADOS:
Seiscentos e sessenta e um partos vaginais foram avaliados. A manobra de pressão basal foi realizada em 39 casos (5,9%, IC95% 4,4-7,1). Primiparidade (76,9 vs 53,3%; odds ratio 2,92, IC 95% 1,36-6,25, P = 0,004), maior ganho de peso materno durante a gravidez (11,16 +/- 0,4 kg vs. 10,05 +/- 0,16 kg, P = 0,013 e maior duração do trabalho de parto (922,3 +/- 111,7 vs. 566,6 +/- 18,3 min, P = 0,003) eram fatores de risco propensos ao uso da manobra de pressão uterina no parto vaginal. Um caso de distocia de ombro após manobra de pressão uterina foi relatado (2,5 vs. 0%). Episiotomia (76,9 vs. 44,9%, P 0,001) e extração a vácuo (41,0 vs. 3,8%, P 0,001) foram freqüentemente realizadas com manobra de pressão uterina. A manobra de pressão uterina do fundo aumentou o risco de laceração perineal grave (28,1 vs. 4,8%; odds ratio 2,71, 95% IC 1,03-7,15, P = 0,045). O risco de laceração perineal grave foi aumentado sinergicamente com o uso concomitante de manobra de pressão uterina com extração a vácuo e episiotomia.

CONCLUSÃO:
A manobra de pressão uterina durante a segunda fase do trabalho de parto aumentou o risco de laceração perineal grave. O uso da manobra deve ser advertido e atenção cuidadosa deve ser dada à sua aplicação.

Comments :

Argument (français) :

L’expression abdominale pendant la seconde phase du travail augmentait le risque de lacération périnéale sévère.

Argument (English):

Uterine fundal pressure maneuver during the second stage of labor increased the risk of severe perineal laceration.

Argumento (português):

A manobra de pressão uterina durante a segunda fase do trabalho de parto aumentou o risco de laceração perineal grave

Keywords :

➡ perineal/vaginal tears ; fundal pressure

Author of this record :

Alison Passieux — 23 Aug 2018
➡ latest update : Bernard Bel — 04 Nov 2018

Related records
Pinned by #3018   Api O, Api M. (2010). Is it time to relinquish fundal pressure maneuver? Arch Gynecol Obstet. 2010 Apr;281(4):779-80. ➡ https://afar.info/id=3018
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