Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of OB/GYN, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2022 Dec;306(6):1953-1957. doi: 10.1007/s00404-022-06497-1. Epub 2022 Mar 12.
Due to a concern of severe adverse neonatal and maternal complications, fundal pressure (FP) maneuver has been discouraged by several national obstetric guidelines as well as the World Health Organization. In this manuscript, we argue that previously published evidence pointing to unfavorable effects of FP might not be relevant to the common practice. Our main concern is that the inherent limitations of published studies undermining the association of FP with various obstetric complications, in conjunction with fear of medical-legal implications, might lead to an absolute avoidance of this procedure, with a potential subsequent increase in vacuum-assisted and cesarean deliveries. We suggest establishing standardized guidelines for FP application, intend to prevent application of uncontrollable and aggressive pressure, assist the obstetricians in case of legal claims, and yet to preserve the use of gentle and respectful FP application to benefit the delivery.
由于担心严重的母婴不良并发症，一些国家的产科指南以及世界卫生组织都不鼓励使用宫底按压（fundal pressure，FP）手法。在本文中，我们认为，之前发表的指出 FP 可能产生不良影响的证据可能与常见的做法无关。我们主要担心的是，发表的研究存在固有局限性，这些局限性削弱了 FP 与各种产科并发症之间的关联，再加上对医疗法律后果的恐惧，可能导致人们完全避免这种操作，从而可能增加使用真空吸引和剖宫产。我们建议制定 FP 应用的标准化指南，旨在防止不可控和激进的压力应用，在出现法律索赔的情况下为产科医生提供帮助，同时保留轻柔且尊重的 FP 应用，以利于分娩。
