Author/Editor     Štinek, Jerneja; Mivšek, Ana Polona; Prelec, Anita
Title     Pritisk na fundus med drugo porodno dobo
Translated title     Fundal pressure during the second stage of labour
Type     članek
Vol. and No.     Letnik 47, št. 1
Publication year     2013
Volume     str. 74-82
ISSN     1318-2951 - Obzornik Zdravstvene Nege
Language     slv
Abstract     Uvod: Pritisk na fundus v drugi porodni dobi se pogosto izvaja za pomoč ob iztisu otroka, čeprav so njegovi učinki slabo raziskani. Namen prispevka je predstaviti pozitivne in negativne vplive tega manevra na mater in otroka. Metode: Pregled in analiza znanstvenih raziskav je bila izvedena na podlagi literature, najdene v COBIB.SI in tujih bazah podatkov: Medline, CINAHL, ScienceDirect, PubMed, Cochrane Collaboration, Wiley Online Library in Springer Link, in sicer s ključnimi besedami: pritisk, fundus, druga porodna doba, zastoj ramen, poškodbe maternice oz. fundal pressure, second stage of labour, shoulder dystocia, uterine rupture. Iskanje je vrnilo 152 zadetkov; uporabljenih je bilo sedem raziskav. Kriteriji za izbor so bili: objava v časovnem obdobju od leta 1996 do 2011, dostopnost celotnih besedil v slovenščini ali angleščini, navajanje pozitivnih in negativnih posledic pritiska na fundus med drugo porodno dobo vaginalnega poroda oz. indikacije in kontraindikacije ter metode za izvedbo manevra. Raziskave so bile ovrednotene glede na metodološko kakovost in analizirane glede na vzorec, raziskovane parametre ter rezultate. Rezultati: Raziskav na danem področju ni veliko in večina le-teh vsebuje pomanjkljive podatke za kritično interpretacijo rezultatov. Vseeno izvedene raziskave kažejo, da manever ni učinkovit oz. lahko celo škodi - pri otroku lahko povzroči poškodbo brahialnega pleksusa, pri materi rupturo maternice, zlom reber, poveča možnost za hujše poškodbe presredka, obenem pa ne vpliva na dolžino druge porodne dobe. Diskusija in zaključek: V slovenskem prostoru bi bilo potrebno manever redno dokumentirati, raziskati pogostost uporabe in evalvirati njegove posledice. Dognanja bi bila podlaga za smernice, ali naj se pritisk na fundus sploh izvaja in v katerih primerih ter pristojnost babic.Introduction: Though the role of fundal pressure is still understudied and remains controversial, it is frequently used as an obstetric technique to assist spontaneous vaginal delivery and avoid prolonged second stage of labour. The purpose of the article is to identify the prone factors of the useof uterine fundal pressure maneuver and to evaluate its obstetrical outcomes. Methods: The literature review and meta-synthesis of scientific studies were performed using the COBIB.SI and databases of Medline, CINAHL, ScienceDirect, PubMed, Cochrane Collaboration, Wiley Online Library in Springer Link with the following keywords and phrases: fundal pressure, second stage of labour, shoulder dystocia, uterine rupture. 152 pertinent articles were found and seven studies were analysed. Included in the review were the papers published from 1996 till 2011, with the entire text available online, either in English or Slovene. All the texts were related to the effectiveness and safety of the manoeuvre. The studies were evaluated and analysed for their methodological quality and on the basis of the sample, research parameters and results. Results: There is little evidence to demonstrate that the use of fundal pressure is effective to improve maternal and/or neonatal outcomes. Moreover, there may be some adverse maternal/fetal effects, such as brachial plexus injuries (the baby), rupture of uterus or broken ribs (the mother) and increased possibility of serious perineal ruptures. There is also a scarcity of literature substantiating that fundal pressure dicreases the duration of the second stage of labour. Discussion and conclusion: It is commendable that accurate and thorough documentation be kept of all the manouvers performed in Slovenian hospitals. It is necessary to determine the incidence rate of the manouver and evaluate its effect on maternal and neonatal outcomes and whether fundal pressure benefits counterbalance the harms. Evidence-based clinical practice guidelines could thus be developed for future practice and midwives' responsibility.
Keywords     druga porodna doba
aktivno vodenje
pritisk na fundus
trajanje iztisa ploda
porodne poškodbe
vloga babice
second stage of labour
active management
fundal pressure
length of expulsion
intrapartum injuries
midwife's role