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

Reproductive Health

Meghan A. Bohren¹  Caroline S. E. Homer²  Alyce N. Wilson²  Liz Comrie-Thomson²  Mairead Connolly³  Elise Farrington³  Laura Phung³  Joshua P. Vogel⁴ 

[1] Gender and Women’s Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, 3010, Parkville, VIC, Australia;Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, 3004, Melbourne, VIC, Australia;Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, 3004, Melbourne, VIC, Australia;Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 3010, Parkville, VIC, Australia;Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, 3004, Melbourne, VIC, Australia;School of Population and Global Health, The University of Melbourne, 2010, Parkville, VIC, Australia;

关键词: Fundal pressure;    Intrapartum care;    Kristeller maneuver;    Labour and childbirth;    Mistreatment during childbirth;    Quality of care;   

DOI  :  10.1186/s12978-021-01148-1

来源: Springer

【 摘 要 】

BackgroundUterine 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.MethodsThe 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.ResultsEighty 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).ConclusionsThe 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.

【 授权许可】

CC BY