The Kristeller Maneuver (Fundal Pressure): Youssef et al. (2019), Ultrasound in Obstetrics & Gynecology
Banned in the UK. Doubles the risk of major pelvic floor injury.
Kristeller is fundal pressure applied during second-stage labour. Banned in the UK, not recommended by WHO. Youssef et al. found women who underwent Kristeller had 28.4% incidence of levator ani muscle avulsion (a major pelvic floor injury) vs 14.1% in matched controls. Independent risk factor (OR 2.5).
The Kristeller Maneuver is fundal pressure: a clinician pushing down on the upper part of the uterus during the second stage of labour to speed delivery. The procedure has been associated with uterine rupture, third- and fourth-degree perineal tears, shoulder dystocia, and major pelvic floor injury. The UK banned the practice. WHO does not recommend it.
Youssef and colleagues published a 2019 case-control study in Ultrasound in Obstetrics & Gynecology that used four-dimensional transperineal ultrasound to compare women who had received the Kristeller maneuver against matched controls. Women in the Kristeller group had a 28.4 percent incidence of levator ani muscle avulsion (a tear of one of the main pelvic floor muscles, often missed clinically), compared with 14.1 percent in the control group.
After multivariate analysis, Kristeller emerged as an independent risk factor with an odds ratio of 2.5. The procedure is often performed without explicit consent. Many women describe being startled when it happens because they were not told it was coming.
28.4%
Pelvic floor injury, Kristeller group
14.1%
Same injury, matched controls
OR 2.5
Independent risk factor
Banned
In the UK
Why it matters
A procedure that doubles the risk of a major pelvic floor injury, often performed without consent, is banned in the UK and not recommended by WHO. The US continues to use it.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.