Critical appraisal of the role of applying uterine fundal pressure in labour: First, do no harm

Abstract

Aim: Fundal pressure during labour is a frequently used manoeuvre for expediting delivery in cases of fetal distress, dystocia and maternal exhaustion. It is often underreported and therefore challenging to accurately estimate its prevalence. It remains a highly controversial topic, having been abandoned in many countries due to its potentially harmful consequences. Still, some health care professionals consider it safe and effective in life-threatening obstetric emergencies. Our objective was to evaluate the evidence behind the merits and drawbacks of its implementation into clinical practice. Methods: This is a critical review based on utilising high-quality references on whether it is justifiable to insist on using fundal pressure in contemporary obstetrics. Results: Fundal pressure is understudied with significant variations worldwide. Reports documenting of any substantial benefit are sparse in the literature. Nevertheless, there is a clear association with various adverse outcomes. An increasing number of experts suggest that fundal pressure should be relinquished. Conclusions: Unless future randomised controlled trials change our views on traditional methods for shortening labour when needed, practitioners should be extra vigilant in avoiding dubious techniques, as deviation from national guidelines could jeopardise aspirations for optimal intrapartum care. In the time being, fundal pressure should be limited for research purposes only within well-designed studies.