The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic
- PDF / 4,240,168 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 104 Downloads / 141 Views
ORIGINAL ARTICLE
The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage Taha Takmaz 1 & Serdar Aydın 1,2
&
İrana Gorchiyeva 1 & Ayse Filiz Gökmen Karasu 1
Received: 9 June 2020 / Accepted: 26 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Uterine fundal pressure is applied to accelerate birth by increasing the expulsive force of the uterus in the second stage of delivery. The aim of the study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on the rate of pelvic floor damage among primiparous women using three-dimensional transperineal ultrasonography. Methods The women were divided into two groups: the fundal pressure group included women where the fundal pressure maneuver was applied (n = 39); the control group included women who delivered spontaneously without fundal pressure (n = 47). 3D-TPU was performed within 48 h of delivery, and LAM biometry, LAM defect and loss of tenting were determined. Results Anteroposterior hiatal dimensions on resting, maximal Valsalva and maximal PFMC were found to be higher in the fundal pressure group (p < 0.0001, p = 0.008, p = 0.007, respectively). The mean hiatal area at rest was larger in the fundal pressure group than in the control group (p = 0.04). The rate of LAM defect was significantly higher in the fundal pressure group (p = 0.001). The rate of loss of tenting was significantly higher in the fundal pressure group (p < 0.0001). According to multivariate regression models, the fundal pressure was the only independent factor associated with LAM defect (OR = 5.63; 95% CI = 12.01–15.74) and loss of tenting (OR = 8.74; 95% CI = 2.89–26.43). Conclusions Fundal pressure during the second stage of delivery is associated with a higher risk of LAM defect and loss of anterior vaginal wall support. Clinical Trial Registration NCT03752879 Keywords Levator ani muscle . Fundal pressure pelvic floor . Transperineal ultrasound . Vaginal delivery
Introduction Approximately 140 million deliveries occur annually in the world, most of which are vaginal deliveries [1]. Pregnancy, especially vaginal birth, is considered the most important risk factor for pelvic floor dysfunction [2]. The levator ani muscle (LAM), including its U-shaped medial section, the pubovisceral ligament, supports the pelvic floor like a hammock and plays a critical role in maintaining its functional and
* Serdar Aydın [email protected] 1
Department of Obstetric and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, İstanbul, Turkey
2
Department of Obstetric and Gynecology, Koc University School of Medicine, Sarıyer, İstanbul, Turkey
structural integrity. The LAM undergoes considerable stretching during vaginal birth so that the fetus can pass through the birth canal, and LAM avulsion occurs in 13– 36% of women, primarily during the first vaginal birth [3, 4]. Furthermore, high birthweight, prolonged second st
Data Loading...
