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We want to investigate the association between fundal pressure in the second stage and the risk of levator ani muscle (LAM) injury.
We will recruit women immediately following their first vaginal delivery. Women who underwent Kristeller maneuver will be recruit as cases. For each case, a control (no fundal pressure) will be recruit matched by BMI, second stage duration and birthweight. All women will be invited to undergo a postpartum 3D transperineal ultrasound (TPUS). The main outcome measure will be the presence of LAM avulsion at 3D TPUS. TPUS results will be compared between cases and controls.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Case (Kristaller Group) | Group of kristeller maneuver applied in the second stage of labor due to clinical necessity. |
| |
| Control (no Kristaller Group) | The control group not required to kristeller maneuver |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fundal Pressure | Procedure | Fundal Pressure to assist the vaginal delivery to shorten the second stage of labor |
|
| Measure | Description | Time Frame |
|---|---|---|
| levator ani muscle (LAM) injury | The aim of the study is to investigate levator ani muscle (LAM) injury, loss of tenting, biometric measurements of LAM and genital hiatus after vaginal delivery and investigate the association between fundal pressure in the second stage of labor (Kristeller maneuver). All recruited women will be invited to undergo a transperineal 3D ultrasound (TPUS) scan at 24 hours after delivery. we will acquire two 3D volumes for each patient: one under maximum pelvic floor muscle contraction (PFMC) and the other under maximum Valsalva's maneuver. Ballooning" will diagnosed with a pelvic hiatal area of more than 25 cm2 during maximum Valsalva. A complete avulsion of the puborectalis muscle will diagnose if an abnormal insertion of the muscle will be detected on all three central slices. We will use a levator-urethral gap more than 2.5 cm to define an abnormal insertion. | 24 hour |
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Inclusion Criteria:
Exclusion Criteria:
biological female gender
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Over 18 years old ,term primiparous women with singleton pregnancies and vaginal delivery.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bezmialem Vakıf University Hospital | Istanbul | 34093 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32902763 | Derived | Takmaz T, Aydin S, Gorchiyeva I, Karasu AFG. The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage. Int Urogynecol J. 2021 Jul;32(7):1917-1924. doi: 10.1007/s00192-020-04523-x. Epub 2020 Sep 9. |
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| ID | Term |
|---|---|
| D007744 | Obstetric Labor Complications |
| D000071562 | Fractures, Avulsion |
| ID | Term |
|---|---|
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D050723 | Fractures, Bone |
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| D014947 | Wounds and Injuries |