Fundal pressure in second stage of labor (Kristeller maneuver) is associated with increased risk of levator ani muscle avulsion

• DOI: 10.1002/uog.19085
• Publication Date: 2018-05-11T02:54:11Z
• Authors: A. Youssef; G. Salsi; I. Cataneo; G. Pacella; C. Azzarone; M. C. Paganotto; J. Krsmanovic; E. Montaguti; L. Cariello; F. Bellussi; N. Rizzo; G. Pilu
• Keywords: Episiotomy

To investigate the association between application of fundal pressure during second stage labor (Kristeller maneuver) and risk levator ani muscle (LAM) injury.This was a prospective case-control study women recruited immediately after their first vaginal delivery in our university hospital March 2014 September 2016. Women who underwent Kristeller maneuver were as cases. For each case, control (no Kristeller) matched for body mass index, use epidural analgesia, duration birth weight. All invited to undergo four-dimensional (4D) transperineal ultrasound (TPU) 3-6 months postpartum. The main outcome measure presence LAM avulsion on 4D-TPU. TPU results compared cases controls. Multivariate logistic regression analysis performed identify independent factors avulsion.During period, 134 group 128 assessment. had higher prevalence than did controls (38/134 (28.4%) vs 18/128 (14.1%); P = 0.005). In addition, Kristeller-maneuver larger hiatal area maximum Valsalva greater increase from rest Valsalva. On multivariate analysis, only factor associated with (odds ratio, 2.5 (95% CI, 1.29-4.51)).The is an increased when applied delivery. This should be taken into account deciding accelerate counseling following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.