Sir, We read with interest the paper written by Hasegawa and colleagues analyzing the obstetric factors associated with uterine rupture [1]. The authors found that fundal pressure in the second stage (Kristeller’s maneuver) was applied in approximately one every four women with uterine rupture, and in one every three women with rup- ture on unscarred uterus. Kristeller’s maneuver remains one of the most contro- versial and underreported obstetric practices [2,3]. Very little evidence exist on the benefits and safety of the Kristeller’s maneuver. Recently, the World Health Organization issued a document stating fundal pressure in the second stage is not recommended [4]. The authors developing the document declared to have “serious con- cerns about the potential for harm to mother and baby with this procedure” [4]. In addition to these concerns, one of the main problems in research performed on the maneuver is that it is frequently unreported. In a recent study published by our group on Kristeller’s maneuver, we found that in 90% of cases it is not reported in the women’s file [5]. We believe that under- or the total absence of reporting of the maneuver is as challenging and risky as the maneuver itself. Over the past 5 years, in our University Hospital we aimed at reducing the rate of Kristeller’s maneuver and to increase its reporting using a systematic approach. This approach included conducting research to investigate the risks of the maneuver on the pelvic floor, increasing caregivers’ awareness on the con- cerns and evidence regarding the maneuver, and audit- ing the incidence of the application of the maneuver and the rate of its reporting over time.

Youssef A., Brunelli E., Bianchini L., Dodaro M.G., Bellussi F., Salsi G. (2021). Fundal pressure in the second stage of labor: time to face the invisible enemy. THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, 34(18), 3094-3095 [10.1080/14767058.2019.1677600].

Fundal pressure in the second stage of labor: time to face the invisible enemy

Youssef A.
Conceptualization
;
Dodaro M. G.
Membro del Collaboration Group
;
Bellussi F.
Membro del Collaboration Group
;
Salsi G.
Membro del Collaboration Group
2021

Abstract

Sir, We read with interest the paper written by Hasegawa and colleagues analyzing the obstetric factors associated with uterine rupture [1]. The authors found that fundal pressure in the second stage (Kristeller’s maneuver) was applied in approximately one every four women with uterine rupture, and in one every three women with rup- ture on unscarred uterus. Kristeller’s maneuver remains one of the most contro- versial and underreported obstetric practices [2,3]. Very little evidence exist on the benefits and safety of the Kristeller’s maneuver. Recently, the World Health Organization issued a document stating fundal pressure in the second stage is not recommended [4]. The authors developing the document declared to have “serious con- cerns about the potential for harm to mother and baby with this procedure” [4]. In addition to these concerns, one of the main problems in research performed on the maneuver is that it is frequently unreported. In a recent study published by our group on Kristeller’s maneuver, we found that in 90% of cases it is not reported in the women’s file [5]. We believe that under- or the total absence of reporting of the maneuver is as challenging and risky as the maneuver itself. Over the past 5 years, in our University Hospital we aimed at reducing the rate of Kristeller’s maneuver and to increase its reporting using a systematic approach. This approach included conducting research to investigate the risks of the maneuver on the pelvic floor, increasing caregivers’ awareness on the con- cerns and evidence regarding the maneuver, and audit- ing the incidence of the application of the maneuver and the rate of its reporting over time.
2021
Youssef A., Brunelli E., Bianchini L., Dodaro M.G., Bellussi F., Salsi G. (2021). Fundal pressure in the second stage of labor: time to face the invisible enemy. THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, 34(18), 3094-3095 [10.1080/14767058.2019.1677600].
Youssef A.; Brunelli E.; Bianchini L.; Dodaro M.G.; Bellussi F.; Salsi G.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/725152
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