Malvasi Antonio, Zaami Simona, Tinelli Andrea, Trojano Giuseppe, Montanari Vergallo Gianluca, Marinelli Enrico
a Department of Obstetrics and Gynaecology , GVM Care & Research Santa Maria Hospital , Bari , Italy.
b International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics , Moscow Institute of Physics and Technology, State University , Moscow , Russia.
J Matern Fetal Neonatal Med. 2019 Aug;32(15):2598-2607. doi: 10.1080/14767058.2018.1441278. Epub 2018 Feb 21.
A significant amount of data concerning maternal-fetal damage arising from the exertion of Kristeller maneuvers (KMs) or fundal pressure (FP) go unreleased due to medicolegal implications.
For this reason, the paper gathers information as to the real magnitude of litigation related to FP-induced damages and injuries. The authors have undertaken a research in order to include general search engines (PubMed-Medline, Cochrane, Embase, Google, GyneWeb) and legal databases (De Jure, Italian database of jurisprudence daily update; Westlaw, Thomson Reuters, American ruling database and Bailii, UK Court Ruling Database).
Results confirm said phenomenon to be more wide ranging than it appears through official channels. Several courts of law, both in the United States of America (USA) and in European Union (EU) Member States as well, have ruled against the use of the maneuver itself, assuming a stance conducive to a presumption of guilt against those doctors and healthcare providers who resorted to KMs or FP during deliveries. Given how rife FP is in mainstream obstetric practice, it is as if there were a wide gap between obstetric real-life and what official jurisprudence and healthcare institutions-sanctioned official practices are.
The authors think that it would be desirable to draft specifically targeted guidelines or recommendations on maneuvers during vaginal delivery, in which to point out exactly what kinds of maneuvering techniques are to be absolutely banned and what maneuvers are to be allowed, and under what conditions their application can be considered appropriate.
由于法医学方面的影响，大量关于克氏手法（KMs）或宫底加压（FP）导致母胎损伤的数据未被公布。
因此，本文收集了与FP所致损伤相关诉讼实际规模的信息。作者进行了一项研究，以纳入通用搜索引擎（PubMed - Medline、Cochrane、Embase、Google、GyneWeb）和法律数据库（De Jure，意大利每日更新的法理学数据库；Westlaw，汤森路透美国裁决数据库以及Bailii，英国法院裁决数据库）。
结果证实该现象比通过官方渠道所呈现的更为广泛。美国和欧盟成员国的几家法院都裁定反对使用该手法本身，对那些在分娩过程中采用KMs或FP的医生和医疗服务提供者持倾向于有罪推定的立场。鉴于FP在主流产科实践中非常普遍，产科实际情况与官方法理学及医疗机构认可的官方做法之间似乎存在很大差距。
作者认为，制定专门针对阴道分娩操作的指导方针或建议是可取的，其中应明确指出哪些操作技术绝对禁止，哪些操作允许，以及在何种情况下其应用可被视为适当。
