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(Bursa city in Turkey) We found that fundal pressure is commonly applied but that this is done without a specific indication, that it is more associated with the performance of an episiotomy, and at the same time, the use of the technique does not have an adverse impact on maternal satisfaction or the health of the mother and infant.

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Pinar S., Karaçam Z. (2018)

Applying fundal pressure in the second stage of labour and its impact on mother and infant health. Health Care Women Int. 2018 ➡ Display this record
➡ episiotomy ; fundal pressure

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Results confirm said phenomenon to be more wide ranging than it appears through official channels.

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Malvasi A., Zaami S., Tinelli A., Trojano G., Montanari Vergallo G., Marinelli E. (2018)

Kristeller maneuvers or fundal pressure and maternal/neonatal morbidity: obstetric and judicial literature review. J Matern Fetal Neonatal Med. 2018 ➡ Display this record
➡ ethics ; iatrogeny ; deontology ; risk of litigation ; informed consent ; fundal pressure

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Our judicial review, which includes many American and British court cases, shows that even in an unscarred uterus the use of fundal pressure exposes practitioners to a significant risk of conviction.

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Zaami S., Malvasi A., Marinelli E. (2018)

Fundal pressure: risk factors in uterine rupture. The issue of liability: complication or malpractice? J Perinat Med. 2018 ➡ Display this record
➡ iatrogeny ; fundal pressure ; risk of litigation

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link established between ani leviator lesion and abdominal expression

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Youssef A, Salsi G, Cataneo I, Pacella G, Azzarone C, Paganotto MC, Krsmanovic J, Montaguti E, Cariello L, Bellussi F, Rizzo N, Pilu G (2018)

Fundal pressure in second stage of labor (Kristeller maneuver) is associated with higher risk of levator ani muscle avulsion. Ultrasound Obstet Gynecol. 2018 ➡ Display this record
➡ iatrogeny ; fundal pressure ; incontinence/prolapsus

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Extraction time >15 min, >6 pulls and >1 cup detachment is associated with increased risk of neonatal complications. These results support compliance with guidelines and recommendations for ventouse deliveries.

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Ekéus C, Wrangsell K, Penttinen S, Åberg K (2018)

Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction). J Matern Fetal Neonatal Med. 2018 ➡ Display this record
➡ fundal pressure ; vacuum extraction (ventouse)

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There is currently insufficient evidence for the routine use of fundal pressure by any method on women in the second stage of labour.

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Hofmeyr GJ, Vogel JP, Cuthbert A, Singata M (2017)

Fundal pressure during the second stage of labour. Cochrane Database Syst Rev. 2017 ➡ Display this record
➡ fundal pressure

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Données disparates concernant un recours systématique à l’expression abdominale. Données peu nombreuses ➡ more…

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It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.

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Gama SG, Viellas EF, Torres JA, Bastos MH, Brüggemann OM, Theme Filha MM, Schilithz AO, Leal MD (2016)

Labor and birth care by nurse with midwifery skills in Brazil. Reprod Health. 2016 ➡ Display this record
➡ c-section/caesarean ; episiotomy ; fundal pressure

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Uterine fundal pressure is associated with increased occurrence of shoulder dystocia and fetal acidosis. In spontaneous deliveries, the risk for lower Apgar scores after 5 and 10 min is increased, as well as the risk for anal sphincter tears.

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Furrer R, Schäffer L, Kimmich N, Zimmermann R, Haslinger C. (2016)

Maternal and fetal outcomes after uterine fundal pressure in spontaneous and assisted vaginal deliveries. J Perinat Med. 2016 ➡ Display this record
➡ fundal pressure

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The various side effects of applying uterine fundal pressure include: uterine rupture, postpartum urinary retention, severe perineal trauma and pain, rib fracture, postpartum dyspareunia, and potential neonatal distress or trauma.

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Hsieh CH (2016)

[To Push or Not to Push? Reflections on the Uterine Fundal Pressure Application in the Second Stage of Labor]. Hu Li Za Zhi. 2016 ➡ Display this record
➡ iatrogeny ; fundal pressure

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The vast majority of the vacuum extractions were conducted in accordance with safety recommendations. However, in a few extractions, safety rules were disregarded and more than six pulls or an extraction time of more than 20 minutes were used to complete the delivery.

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Ahlberg M, Saltvedt S, Ekéus C (2016)

Obstetric management in vacuum-extraction deliveries. Sex Reprod Healthc. 2016 Jun. ➡ Display this record
➡ fundal pressure ; vacuum extraction (ventouse)

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Involving professional midwives more in the care for normal childbirth may help to improve quality of care during normal labour and childbirth in terms of evidence-based practice.

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Farzaneh Pazandeh, PhD, Reinhard Huss, MBBS, MPH, MD (Senior Teaching Fellow), Janet Hirst, PhD, MSc, Fellow HEA, RM, RGN (Associate Professor), Allan House, BSc, MBBS, MRCP, MRCPsych, DM (Professor), Alireza Akbarzadeh Baghban, PhD (Associate Professor) (2015)

An evaluation of the quality of care for women with low risk pregnancy: The use of evidence-based practice during labour and childbirth in four public hospitals in Tehran. Midwifery. 2015 ➡ Display this record
➡ episiotomy ; fundal pressure ; oxytocin

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There was no evidence that the selective uterine fundal pressure maneuver is unsafe for both mother and two babies during the second stage of the first twin delivery.

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Suzuki S (2015)

Selective uterine fundal pressure maneuver during the second stage of the first twin delivery at near term. J Matern Fetal Neonatal Med. 2015 ➡ Display this record
➡ fundal pressure

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If fundal pressure is found to have a measurable beneficial effect, this gentle approach can be promoted as a replacement for the uncontrolled methods currently in use. If it is not found to be useful, fundal pressure can be discouraged.

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Hofmeyr GJ, Singata M, Lawrie T, Vogel JP, Landoulsi S, Seuc AH, Gülmezoglu AM (2015)

A multicentre randomized controlled trial of gentle assisted pushing in the upright posture (GAP) or upright posture alone compared with routine practice to reduce prolonged second stage of labour (the Gentle Assisted Pushing study): study protocol. Reprod Health. 2015 Dec ➡ Display this record
➡ fundal pressure

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Fundal pressure is still commonly performed in our delivery rooms proving that Italian obstetric attitude is still anchored to traditional practices.

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Zanconato G, Cavaliere E, Cherubini G, Bortolami O, Mantovani E, Iacovella C, Franchi M. (2014)

Fundal pressure (Kristeller maneuver) during labor in current obstetric practice: assessment of prevalence and feto-maternal effects. Minerva Ginecol. 2014 ➡ Display this record
➡ guidelines ; fundal pressure ; informed consent

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Although fundal pressure maneuver shortens the duration of the second stage of labor among primiparous women, it should not be used except when indicated, and under strict guidelines owing to its adverse maternal and fetal outcomes.

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Moiety FM, Azzam AZ (2014)

Fundal pressure during the second stage of labor in a tertiary obstetric center: a prospective analysis. J Obstet Gynaecol Res. 2014 ➡ Display this record
➡ fundal pressure

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Since uterine fundal pressure may potentially cause serious injury to either the mother and/or neonates, the indications for application need to be clearly elucidated, and obstetric care providers also need comprehensive education and training.

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Unichi Hasegawa , Akihiko Sekizawa , Isamu Ishiwata, Tomoaki Ikeda, Katsuyuki Kinoshita (2014)

Uterine rupture after the uterine fundal pressure maneuver. Journal of Perinatal Medicine. 43(6) · November 2014 ➡ Display this record
➡ fundal pressure

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2996

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Shigeki Matsubara (2014)

Uterine fundal pressure: is it really a culprit of poor maternal and neonatal outcome? J Obstet Gynaecol Res. Volume 40, Issue 7. July 2014. Pages 1956-1956 ➡ Display this record
➡ fundal pressure

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In our conclusion we made it clear that this maneu ver could be beneficial if applied by the right person, at the right time and on the right woman. Consideration of the risks would even make its application more valuable. Thus, our data are far from being pessimistic regarding this maneuver.

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Fady M. Shawky Moiety, Amal Z. Azzam (2014)

Response to ’Uterine fundal pressure: is it really a culprit of poor maternal and neonatal outcome?’ by Shigeki Matsubara. J Obstet Gynaecol Res. 2014 ➡ Display this record
➡ fundal pressure

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Use of the ergonomic 3-chamber inflatable abdominal belt system reduced the incidence of risks associated with vaginal labor.

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Acanfora L, Rampon M, Filippeschi M, Marchi M, Montisci M, Viel G, Cosmi E. (2013)

An inflatable ergonomic 3-chamber fundal pressure belt to assist vaginal delivery. Int J Gynaecol Obstet. 2013 ➡ Display this record
➡ fundal pressure

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Clinical case of a primiparous woman with vaginal and intestinal lesions (intussusception and gangrene) after vaginal misoprostol administration and fundal pressure during delivery.

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Dasari P., Sagili H, Udupi G. (2012)

Unusual complication of vaginal delivery: is misoprostal the cause? BMJ Case Rep. 2012 ➡ Display this record
➡ fundal pressure ; misoprostol (Cytotec)

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Valsalva Maneuver (https://en.wikipedia.org/wiki/Valsalva_maneuver) duration during fetal expulsion in labor negatively affects fetal acid-base equilibrium and potentially the wellbeing of the neonate.

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Lemos A, Dean E, de Andrade AD. (2011)

The Valsalva maneuver duration during labor expulsive stage: repercussions on the maternal and neonatal birth condition. Rev Bras Fisioter. 2011 Jan-Feb;15(1):66-72. ➡ Display this record
➡ iatrogeny ; baby’s health ; fetal distress ; episiotomy ; fundal pressure

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The primary outcome was rate of caesarean deliveries, whereas secondary outcomes included rate of fundal pressure manoeuvres, duration of labour from application of analgesia, dose of anaesthetic and short-term maternal and neonatal outcome between two groups.

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Skrablin S., Grgic O., Mihaljevic S., Blajic J. (2011)

Comparison of intermittent and continuous epidural analgesia on delivery and progression of labour. J Obstet Gynaecol. Volume 31, 2011 - Issue 2, p. 134-138. ➡ Display this record
➡ c-section/caesarean ; duration of labour ; fundal pressure ; epidural

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Les résultats de santé materno-fœtale ne font pas partie des conclusions finalement...

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Application of fundal pressure on a delivering woman was ineffective in shortening the second stage of labor.

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Olus Api, Muge Emeksiz Balcin, Vedat Ugurel, Murat Api, Cem Turan, Orhan Unal (2010)

The effect of uterine fundal pressure on the duration of the second stage of labor: A randomized controlled trial ➡ Display this record
➡ duration of labour ; fundal pressure

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3018

➡ Display this record

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Api O, Api M. (2010)

Is it time to relinquish fundal pressure maneuver? Arch Gynecol Obstet. 2010 Apr;281(4):779-80. ➡ Display this record
➡ fundal pressure

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Application of uterine fundal pressure in a delivering woman was not only ineffective in shortening the second stage of labor but added to the risks during parturition.

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Mahendru R (2010)

Shortening the second stage of labor? J Turk Ger Gynecol Assoc. 2010 ➡ Display this record
➡ duration of labour ; perineal/vaginal tears ; incontinence/prolapsus ; fundal pressure

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Etude constatant les effets néfastes de l’expression abdominale lors de la phase d’expulsion comprenant ➡ more…

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Limiting perineal trauma during delivery is important for the resumption of sexual intercourse after childbirth. Routine episiotomy and fundal pressure should be avoided to prevent perineal trauma.

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Rathfisch G., Dikencik B.K., Kizilkaya Beji N., Comert N., Tekirdag AI, Kadioglu A. (2010)

Effects of perineal trauma on postpartum sexual function. J Adv Nurs. 2010 ➡ Display this record
➡ iatrogeny ; sexuality ; obstetric and gynecologic violence obstetric violence, obstetrical violence ; perineal/vaginal tears ; pain ; dyspareunia ; scars ; episiotomy ; fundal pressure ; deontology ; informed consent

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3011

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Tongate S., Gibbs JD. (2010)

Nurses, physicians and disagreements about fundal pressure: how we used evidence to change practice. Nurs Womens Health. 2010 ➡ Display this record
➡ fundal pressure

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Treaty of obstetrics. A large place has been made to physiology to normality in daily practice.

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Loïc Marpeau, Collège National des Gynécologues et Obstétriciens Français (CNGOF), Collège national des Sages-femmes, Association française des sages-femmes enseignantes françaises (2010)

TRAITÉ D’OBSTÉTRIQUE. Elsevier Masson ➡ Display this record
➡ midwifery training ; physiology ; placenta previa/accreta ; position during labor ; premature baby ; guidelines ; public health ; maternal health ; baby’s health ; amniotomy ; episiotomy ; exams during labor ; fundal pressure ; instrumental delivery ; active management of labor ; pain medication ; oxytocin ; IV ; epidural ; rupture of membranes ; vaginal examination ; 3rd stage of labor ; dystocy ; eclampsia (pre-) ; breech presentation ; brachial plexus (birth injury) ; informed consent

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Uterine fundal pressure maneuver during the second stage of labor increased the risk of severe perineal laceration.

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Matsuo K, Shiki Y, Yamasaki M, Shimoya K. (2009)

Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration. Arch Gynecol Obstet. 2009 ➡ Display this record
➡ perineal/vaginal tears ; fundal pressure

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3017
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The specified role of fundal pressure is understudied and still remains controversial in the management of the second stage of labor and would be interesting especially in nulliparous women with fetal distress.

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Hoogsteder PH, Pijnenborg JM. (2009)

Comment on: The effect of uterine fundal pressure on the duration of the second stage of labor: A randomized controlled trial. Acta Obstet Gynecol Scand. 2009 ➡ Display this record
➡ fundal pressure

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3016

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Api O, Api M. (2009)

Uterine fundal pressure and duration of the second stage of labor: A randomized controlled trial. Acta Obstet Gynecol Scand. Volume 88, Issue 11. November 2009. Pages 1297-1298. ➡ Display this record
➡ fundal pressure

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There are no medically validated indications for fundal pressure. The traumatic experience of the patients and their entourage and the existence of complications, rare but serious, justify the abandonment of this use.

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Haute Autorité de Santé, France (2007)

L’expression abdominale durant la 2e phase de l’accouchement. Recommandations de bonne pratique. Haute Autorité de Santé, France. ➡ Display this record
➡ fundal pressure

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Cette RPC a été émise suite à une saisine du collectif CIANE (https://ciane.net).

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Description of fundal pressure and its presumed indications following the description of a fundal pressure with serious maternal consequences during normal delivery (directed push for non-anesthetized patient, without fetal emergency or committed expulsive reflex).

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Susan Labhart (2006)

Manœuvre de Kristeller. Hebamme.ch 3/2006 ➡ Display this record
➡ ethics ; midwifery training ; traumatism ; deontology ; informed consent ; pain ; fundal pressure

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909

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L’accouchement reste le plus grand pourvoyeur d’incontinence… Les forceps ou l’expression abdominale (« un geste que l’on devrait proscrire ») peuvent provoquer des dégâts périnéaux importants.

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Hélène Grillon (2004)

L’incontinence urinaire : priorité à la prévention. 2e Semaine nationale de l’incontinence, 24-28 mai. Le Quotidien du Médecin, 25/05/2004 ➡ Display this record
➡ fundal pressure ; instrumental delivery ; forceps delivery ; incontinence/prolapsus

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841

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Eviter l’expression abdominale traumatisante et dangereuse.

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Bicheron F. (2004)

Communiqué du conseil national de l’ordre des Sages-Femmes. PRATIQUE DE LA VENTOUSE. Publication électronique.(http://www.ordre-sages-femmes.fr/) ➡ Display this record
➡ fundal pressure ; epidural ; instrumental delivery ; vacuum extraction (ventouse)

easy

851

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Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women.

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Buhimschi CS, Buhimschi IA, Malinow AM, Kopelman JN, Weiner CP. (2003)

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour. BJOG. 2002 May;109(5):520-6. ➡ Display this record
➡ maternal age ; fundal pressure

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842

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Fundal pressure is used in France for 50% of deliveries, according to a survey of “Institut des mamans”

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Institut des mamans (2003)

Pratique obstétricales et frustrations des mamans: quelle réalité. Enquête. ➡ Display this record
➡ attendance ; survey ; physiology ; induction of labor ; post-term pregnancy ; episiotomy ; exams during labor ; fundal pressure ; epidural

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850

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Spontaneous rupture of the unhealed uterus during labor is rare. Early detection and immediate surgery are the mainstay of care.

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Pan HS, Huang LW, Hwang JL, Lee CY, Tsai YL, Cheng WC. (2002)

Uterine rupture in an unscarred uterus after application of fundal pressure. A case report. J Reprod Med. 2002 Dec;47(12):1044-6. ➡ Display this record
➡ fundal pressure

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Uterine ruptures associated with: syntocinon, forceps, and abdominal expression.

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Vangeenderhuysen C, Souidi A. (2002)

Uterine rupture of pregnant uterus: study of a continuous series of 63 cases at the referral maternity of Niamey (Niger). Med Trop (Mars). 2002;62(6):615-8. ➡ Display this record
➡ maternal age ; fundal pressure ; oxytocin ; forceps delivery ; hormones

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839

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Fundal pressure is a very old practice that persists. Very little scientifically documented, can be very dangerous for the mother and the child, well known in the judicial annals.

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Simpson KR, Knox GE. (2001)

Fundal pressure during the second stage of labor. Review. MCN Am J Matern Child Nurs. 2001;26(2):64-70. ➡ Display this record
➡ fundal pressure

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755
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Risk factors for severe perineal tears: nulliparity, baby size, forceps, suction cup, fundal pressure, syntocinon.

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J. W. de Leeuw, P. C. Struijk, M. E. Vierhout, H. C. S. Wallenburg (2001)

Risk factors for third degree perineal ruptures during delivery. BJOG: An International Journal of Obstetrics and Gynaecology. Vol. 108 Issue 4 Page 383 April 2001 ➡ Display this record
➡ prevention ; perineal/vaginal tears ; incontinence/prolapsus ; episiotomy ; fundal pressure

• Group : Discussion of épisiotomy and obstetrical tears

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Les biais de cette étude, pour ce qui concerne l’effet protecteur supposé de l’épisiotomie pour ➡ more…

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Les tractions du bébé ou pressions sur l’utérus excessives peuvent être à l’origine de traumatismes du plexius braxial de l’enfant (centre nerveux des membres supérieurs).

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Buljina A, Zubcevic S, Catibusic F. (2000)

[Obstetrical injuries of the brachial plexus] [Article in Croatian] Buljina A, Zubcevic S, Catibusic F. ➡ Display this record
➡ dystocy ; fundal pressure

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568
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Fundal pressure multiplies by more than four the risk of rupture of anal sphincter. Sphincter tear at vaginal delivery is a serious complication, and it is frequently associated with anal incontinence. Special attention should be directed toward risk factors for this complication.

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Zetterstrom J, Lopez A, Anzen B, Norman M, Holmstrom B, Mellgren A. (1999)

Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol. 1999 Jul;94(1):21-8. ➡ Display this record
➡ evidence-based medicine/midwifery ; perineal/vaginal tears ; episiotomy ; fundal pressure

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853

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L’expression abdominale en cas de dystocie des épaules est associée à un taux de morbidité fœtale de 77%, laissant surtout des séquelles neurologiques et orthopédiques.

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Hankins GD. (1998)

Lower thoracic spinal cord injury--a severe complication of shoulder dystocia. Am J Perinatol. 1998 Jul;15(7):443-4. ➡ Display this record
➡ dystocy ; fundal pressure

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840

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Fundal pressure is associated with a second, longer phase and more severe tears in the perineum.

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Cosner KR. (1996)

Use of fundal pressure during second-stage labor. A pilot Study. J Nurse Midwifery. 1996 Jul-Aug;41(4):334-7. ➡ Display this record
➡ perineal/vaginal tears ; fundal pressure

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854

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L’expression abdominale en cas de dystocie des épaules laisse trop souvent un bébé gisant flasque et sans voix.

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Penney DS, Perlis DW. (1992)

Shoulder dystocia: when to use suprapubic or fundal pressure. MCN Am J Matern Child Nurs. 1992 Jan-Feb;17(1):34-6. ➡ Display this record
➡ dystocy ; fundal pressure

hard

855

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Plus de 80% des sages-femmes de Floride utilisent l’expression abdominale.

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Kline-Kaye V, Miller-Slade D. (1990)

The use of fundal pressure during the second stage of labor. J Obstet Gynecol Neonatal Nurs. 1990 Nov-Dec;19(6):511-7. ➡ Display this record
➡ fundal pressure

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Des pressions excessives sur le crâne du bébé peuvent entraîner des dommages neurologiques: hypertonie utérine, forceps, expression abdominale.

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Amiel-Tison C, Sureau C, Shnider SM. (1988)

Cerebral handicap in full-term neonates related to the mechanical forces of labour. Baillieres Clin Obstet Gynaecol. 1988 Mar;2(1):145-65. ➡ Display this record
➡ fundal pressure ; instrumental delivery ; forceps delivery

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857

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Les dystocies des épaules vraies sont rares, mais hautement morbides. Associé à l’expression abdominale le taux de séquelles neurologiques et orthopédiques atteint 77%.

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Gross SJ, Shime J, Farine D. (1987)

Shoulder dystocia: predictors and outcome. A five-year review. Am J Obstet Gynecol. 1987 Feb;156(2):334-6. ➡ Display this record
➡ dystocy ; fundal pressure ; morbidity

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