Department of Obstetric and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, İstanbul, Turkey.
Department of Obstetric and Gynecology, Koc University School of Medicine, Sarıyer, İstanbul, Turkey.
Int Urogynecol J. 2021 Jul;32(7):1917-1924. doi: 10.1007/s00192-020-04523-x. Epub 2020 Sep 9.
Uterine fundal pressure is applied to accelerate birth by increasing the expulsive force of the uterus in the second stage of delivery. The aim of the study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on the rate of pelvic floor damage among primiparous women using three-dimensional transperineal ultrasonography.
The women were divided into two groups: the fundal pressure group included women where the fundal pressure maneuver was applied (n = 39); the control group included women who delivered spontaneously without fundal pressure (n = 47). 3D-TPU was performed within 48 h of delivery, and LAM biometry, LAM defect and loss of tenting were determined.
Anteroposterior hiatal dimensions on resting, maximal Valsalva and maximal PFMC were found to be higher in the fundal pressure group (p < 0.0001, p = 0.008, p = 0.007, respectively). The mean hiatal area at rest was larger in the fundal pressure group than in the control group (p = 0.04). The rate of LAM defect was significantly higher in the fundal pressure group (p = 0.001). The rate of loss of tenting was significantly higher in the fundal pressure group (p < 0.0001). According to multivariate regression models, the fundal pressure was the only independent factor associated with LAM defect (OR = 5.63; 95% CI = 12.01-15.74) and loss of tenting (OR = 8.74; 95% CI = 2.89-26.43).
Fundal pressure during the second stage of delivery is associated with a higher risk of LAM defect and loss of anterior vaginal wall support.
NCT03752879.
子宫底压力通过增加第二产程子宫的排出力来加速分娩。本研究旨在使用三维经会阴超声评估第二产程中使用子宫底压力对初产妇盆底损伤的影响。
将产妇分为两组：子宫底压力组（n=39）中应用子宫底压力操作；对照组（n=47）中自发性分娩不使用子宫底压力。在分娩后 48 小时内进行 3D-TPU，并确定 LAM 生物测量、LAM 缺陷和穹隆丧失。
在休息、最大 Valsalva 和最大 PFMC 时，子宫底压力组的前后径裂孔尺寸更高（p<0.0001、p=0.008、p=0.007）。子宫底压力组休息时裂孔面积大于对照组（p=0.04）。子宫底压力组的 LAM 缺陷发生率显著更高（p=0.001）。子宫底压力组穹隆丧失的发生率显著更高（p<0.0001）。根据多元回归模型，子宫底压力是与 LAM 缺陷（OR=5.63；95%CI=12.01-15.74）和穹隆丧失（OR=8.74；95%CI=2.89-26.43）相关的唯一独立因素。
第二产程中的子宫底压力与 LAM 缺陷和前阴道壁支持丧失的风险增加相关。
NCT03752879。
