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Fundal pressure during the second stage of labour
Cochrane Reviews, 10/19/09

Verheijen EC et al. – The review authors found no trials on the more widely used manual fundal pressure. There was only one controlled trial studying fundal pressure by inflatable belt. It involved 500 women who had epidural analgesia and were in the second stage of labour. The methodological quality of the trial was good. The number of women experiencing spontaneous vaginal births was similar with or without applying fundal pressure. The trial did not provide sufficient evidence to determine any safety issues of the manoeuvre for the baby, measured as low Apgar scores, low arterial fetal cord pH, or admission to the neonatal unit. Blinding was not possible with this intervention. It may have been perceived that the belt was 'doing the work' so that the women pushed less hard and the midwives encouraged them less enthusiastically. The number of women with an intact perineum increased with use of the belt but also anal sphincter tears increased, all but one associated with an instrumental delivery.

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