The Association Between Kristeller Maneuver and Pelvic Floor Trauma After Vaginal Delivery

The Association Between Fundal Pressure in Second Stage of Labor (Kristeller Maneuver) and and Pelvic Floor Trauma After Vaginal Delivery

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.

Inclusion Criteria:

• First delivery
• Term pregnancy (37-41w)

Exclusion Criteria:

• Instrumental vaginal delivery
• Multifetal pregnancy
• Previous vaginal or cesarean delivery
• Refused consent and uncooperative patient for effective Valsalva maneuver
• Handicap in lithotomy position
• Women without regular and active contractions
• Epidural analgesia