{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:23:21Z","timestamp":1783445001393,"version":"3.54.6"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Fundal pressure during the second stage of labor is widely practiced but understudied. Violent fundal pressure can cause maternal and fetal injuries. Many providers believe the maneuver is effective. Administrative efforts to ban fundal pressure are unsuccessful and only drive the procedure to an underground practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>In this single\u2010center, open\u2010label, randomized trial, nulliparous women with term singleton cephalic pregnancy under epidural analgesia were assigned to receive gentle manual fundal pressure (GMFP) or routine labor care. The GMFP was designed not to exceed a maximum of 120\u2009mmHg. Women were randomized after 30\u2009min of pushing in the second stage of labor. The primary outcome was the time from randomization to delivery. Secondary outcomes were mode of delivery, episiotomy, perineal laceration, cord blood pH, and other maternal and fetal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between July 2023 and January 2024, 164 women were randomized to GMFP (<jats:italic>n<\/jats:italic>\u2009=\u200982) or to routine care (<jats:italic>n<\/jats:italic>\u2009=\u200982). The time from randomization to vaginal delivery did not show statistical significance between the fundal pressure group and the control group (mean [SD], 46.3 [33.3] vs. 55.9 [45.8] min; <jats:italic>p<\/jats:italic>\u2009=\u20090.13). Significantly fewer women in the fundal pressure group had operative vaginal deliveries (4 of 82 [4.9%]) than women in the control group (13 of 82 [15.9%]; relative risk [RR] 0.308, 95% confidence interval [CI] 0.105\u20130.904; <jats:italic>p<\/jats:italic>\u2009=\u20090.021). Similarly, mediolateral episiotomy was performed in fewer women in the fundal pressure group (6 of 82 [7.32%]) than in the control group (16 of 82 [19.51%], RR 0.375, 95% CI 0.154\u20130.910; <jats:italic>p<\/jats:italic>\u2009=\u20090.022). Other maternal and fetal outcomes were similar in the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>GMFP resulted in a nonsignificant reduction in the second stage of labor and a significant reduction in operative vaginal delivery and episiotomy without an increase in adverse outcomes. Fundal pressure during the second stage of labor deserves further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15130","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T18:27:06Z","timestamp":1744828026000},"page":"1357-1365","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Gentle fundal pressure to facilitate vaginal delivery: A randomized clinical trial"],"prefix":"10.1111","volume":"104","author":[{"given":"Qing","family":"Guo","sequence":"first","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Du","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Feng","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruifen","family":"Jiao","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Xie","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingwei","family":"Li","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean V.","family":"Coonrod","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Arizona College of Medicine  Phoenix Arizona USA"},{"name":"Valleywise Health\/District Medical Group  Phoenix Arizona USA"},{"name":"Creighton University School of Medicine Phoenix Campus  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5544-5002","authenticated-orcid":false,"given":"Thomas Q.","family":"Zheng","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Maternal\u2010Fetal Medicine, Hebei Provincial Center for Obstetric Quality Control, Shijiazhuang Obstetrics and Gynecology Hospital  Shijiazhuang China"},{"name":"Department of Obstetrics and Gynecology University of Arizona College of Medicine  Phoenix Arizona USA"},{"name":"Valleywise Health\/District Medical Group  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"e_1_2_12_2_1","first-page":"297","article-title":"Kristeller's procedure\u2013expressio fetus, its genesis and contemporary application","volume":"79","author":"Waszynski E","year":"2008","journal-title":"Ginekol Pol"},{"key":"e_1_2_12_3_1","article-title":"Fundal pressure during the second stage of labor","volume":"3","author":"Hofmeyr GJ","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2022.06.010"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2016-0023"},{"key":"e_1_2_12_6_1","first-page":"1044","article-title":"Uterine rupture in an unscarred uterus after application of fundal pressure. 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