Comparative Study of the Outcome of Delivery by Fundal Pressure in Second –Stage of Labor with Spontaneous Delivery.

Abstract

Abstract: Introduction: Delivery has extensive effect in women's health and it is one of the most important proceedings in woman's life. Labor is physiological event and almost all of woman enable to be delivered without help. Management of the second –stage of labor has been described in terms of onset, duration, maternal positioning, perineal outcome, fetal outcome and the need for intervention. One intervention that has been used to accompany maternal effort is fundal pressure. The use of this procedure is poorly described in the medical literature and controversy exists about its safety. The use of fundal pressure during the second stage of labor is a cause of great concern for many obstetric nurses. There is not a study about effect of the application fundal pressure in duration of second stage of labor. The influence of fundal pressure on the fetus and mother requires further studies. Material and Methods: This was analytic studies that 144 woman with vaginal delivery of a singleton fetus in cephalic presentation were included. All of the mothers were considered low –risk women. Patients with previous surgery in uterus and pelvic floor were excluded. 72 deliveries in which fundal pressure was used to expedite birth were matched with 72 deliveries that occurred spontaneously. Several parameters such as length of second stage, Apgar scores, maternal and fetal outcome were determine in the two groups. Duration, Number of fundal pressure and phase of second stage of the application fundal pressure was recorded. Women were selected through nonprobability sampling. A questionnaire was used for data gathering. Descriptive statistics (frequencies, mean and standard deviation) and inferential statistics (T test and Z test) were used for data analysis. Results: Fundal pressure was used in 70.8% and 29.2% of deliveries with and without indication, respectively. In the group of women who were delivered with use of fundal pressure, second stage labor was longer and a higher incidence of spreading and tear exception of episiotomy was observed compared with those women who delivered spontaneously. Conclusion: Fundal pressure is associated with an increased rate of perineal lacerations. Several reports link birth trauma (intracranial hemorrhage) with the use of vacuum, forceps and even cesarean section. Perhaps use of fundal pressure has more advantages than operative intervention. Although, the influence of fundal pressure on the fetus requires further studies. We found some adverse effects for fundal pressure during the second stage of labor. We do not suggest general and uncritical use of this technique except in the group of women that benefit from fundal pressure.