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The effect of Kristeller maneuver on maternal and neonatal outcome

Gokhan Acmaz, Evrim Albayrak, Gokalp Oner, Murvet Baser, Gulsum Aykut, Gulender Tas Tekin, Gokmen Zararsiz, Iptisam Ipek Muderris.

Abstract
Objective: The use of fundal pressure in management of the second stage of labor is controversial. The aim of this study was both to evaluate the effectiveness of fundal pressure in shortening the second stage of labor and to examine the re- lated neonatal and maternal outcomes.
Materials and Methods: Patients were randomly allocated to Kristeller maneuver (KM) intervention group (n = 145) and control group (n = 140). Umbilical artery blood gas analysis, creatinine kinase (CK), CK with myocardial specific isoform, aspartate amino transferase, alanine amino transferase, lactate dehydrogenase and lactic acid were assessed. Vaginal laceration, cervical laceration, length of episiotomy and vagina before and after delivery and duration of the second stage of labor in minutes were recorded. Neonatal information included: Infant birth weight, Apgar scores, babies requiring pediatric help, and admission to neonatal intensive care units (NICU) were examined.
Results: KM leads to elongation of episiotomy incision. Vaginal lacerations were similar between control and intervention groups; however the cervical laceration rate was higher in intervention group. Gestational week, Apgar scores, birth weight, NICU admission, babies requiring pediatrician help or healthy babies were not different between the two groups.
Conclusions: The possibility of lacerations to the perineum and cervix is increased by using KM. On the other hand, fundal pressure seems safe for the fetus.

Key words: Kristeller maneuver, neonatal outcome, obstetrical outcome, perineal laceration, second stage of labor



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