Department of General Surgery, University Medical Centre Ljubljana, Medical University, University of Ljubljana, 1000 Ljubljana, Slovenia.
Division of Gynaecology and Obstetrics, Department of Gynaecology, University Medical Centre Ljubljana, Medical University, University of Ljubljana, 1000 Ljubljana, Slovenia.
Eur J Obstet Gynecol Reprod Biol. 2022 Jun;273:65-68. doi: 10.1016/j.ejogrb.2022.04.013. Epub 2022 Apr 15.
The fundal pressure manoeuvre (FPM) is a procedure where the fundus of the uterus is pushed through the abdominal wall by the midwifes and doctors to shorten the terminal phase of the second stage vaginal delivery. Nowadays its use is controversial and associated with many adverse effects. The aim of the study was to evaluate benefits and adverse maternal outcomes after FPM. The correlation of the FPM with episiotomy was evaluated. The role of the FPM on pelvic floor dysfunction such as anal incontinence due to anal sphincter injury was assessed.
The retrospective study was conducted between 2017 and 2021. The women who came to the postpartum examination to Gynaecology department for various reasons and gave vaginal birth to a singleton were included in the study. The women who had instrumental delivery were excluded. Minimal sample size was calculated with calculator.net and set on 45. Two groups were formed one with fundal pressure and one without, 96 and 90 patients respectively. The maternal, fetal, and obstetric factors that could be associated with the application of FPM were examined. The endoanal ultrasound examination was performed on all women included in the study.
The study did not show that FPM would lead to a more frequent occurrence of anal sphincter injury (p = 0.73), effect its location (p = 0.77) and depth (p = 0.97), however the test group tended to have longer ruptures compared to control group (p = 0.1). No statistically significant differences in episiotomies between control and test group (p = 0.075) were shown. Endoanal ultrasound showed discrepancy between clinically stated and ultrasonographical diagnoses of anal sphincter injuries. In 61,3% of patients with anal sphincter injury after FPM, reported one of the anal incontinence problems of varying degrees six months after delivery.
Given that the study proved that FPM is not correlated to the anal sphincter injury it can be used safely. The FPM should be performed carefully and only if necessary to safely finish the labour or in combination with instrumental delivery.
宫底按压手法（FPM）是一种通过助产士和医生将子宫底部通过腹壁推挤来缩短第二产程阴道分娩末期的程序。如今，其使用存在争议，并与许多不良反应相关。本研究旨在评估 FPM 后母婴的获益和不良结局。评估了 FPM 与会阴切开术的相关性。评估了 FPM 对盆底功能障碍（如因肛门括约肌损伤导致的肛门失禁）的影响。
这是一项回顾性研究，于 2017 年至 2021 年进行。纳入因各种原因来妇科进行产后检查并自然分娩单胎的产妇。排除行器械分娩的产妇。使用 calculator.net 计算器计算最小样本量，并设定为 45。将两组产妇，一组有宫底按压，一组无宫底按压，每组 96 例和 90 例。检查了可能与 FPM 应用相关的母婴和产科因素。对所有纳入研究的产妇进行经肛门超声检查。
本研究并未显示 FPM 会更频繁地导致肛门括约肌损伤（p=0.73），也不会影响其位置（p=0.77）和深度（p=0.97），但实验组的裂伤比对照组长（p=0.1）。两组产妇的会阴切开术之间无统计学差异（p=0.075）。经肛门超声检查显示，FPM 后肛门括约肌损伤的临床诊断与超声诊断存在差异。在 FPM 后报告存在肛门失禁的 61.3%的患者中，6 个月后有不同程度的肛门失禁问题。
鉴于本研究证明 FPM 与肛门括约肌损伤无关，因此可以安全使用。FPM 应谨慎操作，仅在必要时安全结束分娩或与器械分娩联合使用。
