Decline number of uterine fundal pressure maneuver in Japan recent 5 years

Association between placental location and neonatal outcomes in manual fundal pressure-assisted vaginal deliveries: A retrospective single-center study in Japan

AIM

Manual fundal pressure (MFP) is still used to assist vaginal deliveries during the second stage of labor in predominantly lower-middle income countries; however, there is insufficient evidence on the risk factors in MFP-assisted vaginal deliveries for adverse neonatal outcomes. The aim of the present study was to investigate the association between placental location and neonatal outcomes in MFP-assisted vaginal deliveries.

METHODS

The present study was a single-center retrospective cohort study in patients with all MFP-assisted vaginal singleton deliveries from January 2016 to December 2020. Placental location was divided into two categories: posterior-lateral and anterior-fundal. The primary outcome was a neonatal adverse composite including umbilical artery blood pH <7.2, Apgar score <7 at 5 min, neonatal intensive care unit admission and neonatal resuscitation. We used multivariable logistic regression models to investigate the association between placental location and neonatal outcomes.

RESULTS

We extracted 522 MFP-assisted deliveries among 5053 vaginal deliveries. The proportion of posterior-lateral and anterior-fundal placentation was 239 (45.8%) and 283 (54.2%), respectively. The crude prevalence of neonatal composite outcome in the anterior-fundal group was significantly higher than that in the posterior-lateral group (39.6% vs. 28.9%; p = 0.013). Multivariable logistic regression analysis found that the prevalence of neonatal adverse outcome in the anterior-fundal group was significantly higher compared with the posterior-lateral group (adjusted odds ratio, 1.52; 95% confidence interval, 1.04-2.23).

CONCLUSION

Anterior-fundal placentation was significantly associated with an increased risk of neonatal adverse outcomes compared to posterior-lateral placentation in MFP-assisted vaginal deliveries.

The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis

BACKGROUND

Uterine fundal pressure involves a birth attendant pushing on the woman's uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities.

METHODS

The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity.

RESULTS

Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4-27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women's self-report).

CONCLUSIONS

The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.

Declined use of cervical ripening balloon did not reduce the incidence of umbilical cord prolapse in Japan

AIM

To clarify whether the incidence of umbilical cord prolapse (UCP) at delivery is related to the cervical ripening balloon (CRB).

METHODS

A postal questionnaire study was conducted in 2018 in institutions providing maternity services across Japan. Questions on the number of deliveries, labor inductions, used CRB and cases of UCP in 2017 were included. Because a similar questionnaire survey was conducted in 2012, the incidence of UCP and frequency of the use of CRB were compared.

RESULTS

A total of 1354 answers were assessed (57% of all delivery institutions). The total number of deliveries was 490 279. Of these, 78% were transvaginal; 74 cases of UCP were reported (0.015%), while 13 cases were reported from obstetric facilities never using CRB (0.008%). The incidence of UCP (odds ratio [95% confidence interval]) was 0.036% in the intracervical type (4.3 [1.6-11.3]), 0.091% in the disk-type (11.0 [4.2-29.0]) and 0.067% in the ball-type (8.1 [2.8-22.8]). Frequencies of the use of CRB were 7.3% and 6.6% in the 2012 and 2018 surveys, respectively. The use of the intracervical type increased from 2.8% in the 2012 survey to 3.5% in the 2018 survey, while that of the disk-type and ball-type declined. However, the incidence of UCP was not different between the two surveys regardless of the use of cervical ripening balloons (0.014% vs 0.015% with CRB, 0.005% vs 0.008% without CRB).

CONCLUSION

Although the frequency of CRB use significantly declined, the incidence of UCP did not significantly reduce in the last 5 years.