Fundal Pressure Practice in the Late Second Stage of Labor Amongst the Healthcare Practitioners a Survey Based Study
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Date
2024-01
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FORUM: Fraternity of national Research & pUblication Society of Medical sciences
Abstract
BACKGROUND- Caesarean rates have increased considerably in present times. Obstetricians are performing lesser instrumental deliveries in second stage of labour due to less training and skills and fear of litigations. Uterine fundal pressure is pressure applied to a woman’s uterine fundus in the direction of the vagina during the second stage of labour with intention to promote or accelerate the time of vaginal birth. METHODS- The study was a questionnaire – based study that was carried out via google survey forms. The survey was conducted amongst 700 Obstetricians from all over India via Google forms and we received 663 replies. The survey comprised of 8 questions which include practice of fundal pressure, who gives it, success rate, station at which it was given, its use along with instrumental delivery, use of episiotomy, complications if any and lastly the number of contractions for which the fundal pressure was employed by different obstetricians. RESULTS- Fundal pressure was practiced by majority (94.9 %) either regularly or sometimes. Only few 5.1% doctors never used it. Most of the times, it was given by a healthcare worker (55.8%). Nearly one fourth of them (40%) achieved more than 70 % of success rate for vaginal deliveries. Large number of doctors, (56%) were giving fundal pressure at crowning. During instrumental deliveries 55.4 % practiced fundal pressure. Episiotomy was commonly employed (68.2%) before giving fundal pressure. There were no major complications during the procedure, except small perineal or vaginal tears. Half of the respondents practiced fundal pressure up to 3 to 4 contractions. CONCLUSION – In cases of prolonged second stage, fetal distress, failure to progress and maternal exhaustion, fundal pressure is often used to assist vaginal birth. This shortens the second stage & reduces the need for instrumental deliveries or LSCS & improves perinatal outcome. In majority cases fundal pressure gives good results in achieving vaginal deliveries. Very few cases have adverse maternal outcomes in the form of perineal tears.
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Keywords
Fundal pressure, second stage of labour, vaginal births, instrumental deliveries, caesarean sections, outcomes
Citation
Shukla Mauli K., Doshi Haresh U., Singh Kanupriya M.. Fundal Pressure Practice in the Late Second Stage of Labor Amongst the Healthcare Practitioners a Survey Based Study. Indian Journal of Applied Basic Medical Sciences. 2024 Jan; 26A(1): 1-7