الفهرس 
Management of Second Stage of LaborOnly 14 pages are availabe for public view
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Abstract
A review of the potential risks, benefits, and alternative approaches to the use of fundal pressure during the second stage of labor should be undertaken by members of the perinatal team and should then serve as a basis for routine clinical practice. Prospective interdisciplinary collaboration can result in a safe, reasonable policy for fundal pressure and thus decrease the likelihood of adverse maternal-fetal outcomes and subsequent litigation.
A nation wide review in 1990 found that 84% of US. institution practiced fundal pressure but only 48% of them documented that practice in the medical records, so fundal pressure is world wide to expedite delivery during the second stage of labour. The most frequent indication is non reassuring fetal heart rate and maternal exhaustion (Simpson and Knox; 2001 - Kline-Kaye and Miller-Slade; 1990).
A decrease in the number of experienced teaching physicians coupled to increase medico legal concern has reduced the number of practioners skilled in operative vaginal delivery (Bofill et al;1996).
Also several reports link birth trauma (intracranial hemorrhage) with the wide use of vacuum, forceps and even the caesarean section perhaps explaining why 84% of American institutions use the fundal pressure despite a variabl absence of objective study (Towner et al;1999).
This a randomized controlled trial study was conducted at Ain Shams University Maternity hospital. Subjects included in this study were 320 women in the second stage of labor These cases had been divided into two groups.
The first group (I) consisted of 160 women in which fundal pressure was performed upon them.
The second group (II) consisted of 160 women in which we did not use the fundal pressure, so we used the second group as a control group to compare between many items mentioned in details in our study. The most important of them were the time of the second stage of labor, the condition of the newborn and the condition of the mother.
The selected patients were subjected to full history taking, Clinical examination, and all these data were collected in a detailed collecting data sheet.
The present study showed that there was significant decrease in the time of the second stage of labor ,we also found that there was significant difference between both groups according to Apgar scores after one minute .
With no significant differences in the other parameters including the condition of the newborn (Apgar score after 5 minutes - signs of trauma for fetus) or the condition of the mother (Temperature - Blood loss - Trauma - Atony - Need for blood transfusion).
Neonatal outcome was good in both groups with no cord PH lower than 7.2 , mean HCO3 and the base excess values were also within the normal ranges .Therefore, the use of fundal pressure dose not seem to have an adverse effect on the short term neonatal outcome as reported before (Buhimschi et al ;2002)
This study found that a lower mean pO2 and a higher mean pCO2 might be caused by umbilical cord compression or functional alternations in the placental intervillous space increasing risk of fetal hypoxemia and asphyxia , but intrauterine pressure increased related to the use of fundal pressure , and it may have been different between doctors (Sampson et al; 2001).
In this study , we found that there was significant difference between both groups regarding pain which might be aggravated by uterine contractions .
There was significant difference between both groups regarding the systolic and diastolic blood pressure.
We recommend that further studies is to be done on a larger number of cases and for longer periods of follow up. And to use standardized fundal pressure maneuver (an inflatable obstetric belt).
Also we should investigate the relationship between intrauterine pressure and the application of standardized fundal pressure.