Among the maneuvers that are used in the second stage of labor, uterine fundal pressure is one of the most controversial. The prevalence of its use is unknown. We reviewed the existing literature to assess whether there is justification for the use of fundal pressure in the contemporary management of the second stage of labor. Only one randomized, controlled study and a few prospective studies, review articles, and case reports have been published. No confirmed benefit of the procedure has been documented and a few adverse events have been reported in association with its use. Alternative management strategies in the second stage of labor exist and should be considered whenever possible. In conclusion, the role of fundal pressure is understudied and remains controversial in the management of the second stage of labor. We believe that caution should be exercised using this maneuver until it is proven to be safe and effective.
Target Audience: Obstetricians & Gynecologists, Family Physicians
Learning Objectives: After completion of this article, the reader should be able to recall that there is a scarcity of literature related to the efficacy and safety of using fundal pressure during the second stage of labor, state that there is no confirmed benefit of the procedure and there may be some adverse maternal/fetal effects, and explain that there are alternative strategies for management of the second stage of labor.
*PGY3 Resident, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York; and †Attending Physician, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
Chief Editor’s Note: This article is the 24th of 36 that will be published in 2005 for which a total of up to 36 Catgory 1 CME credits can be earned. Instructions for how credits can be earned appear on the last page of the Table of Contents. This CME activity is supported by an unrestricted educational grant from Procter & Gamble.
The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.
Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity.
Reprint requests to: Zaher O. Merhi, MD, Maimonides Medical Center, 967 48th Street, Brooklyn, NY 11219. E-mail: firstname.lastname@example.org.