Association between placental location and neonatal outcomes in manual fundal pressure‐assisted vaginal deliveries: A retrospective single‐center study in Japan. Issue 7 (9th May 2022)

• Record Type: Journal Article
• Authors: Kamijo, Kyosuke; Shigemi, Daisuke; Kaszynski, Richard H.; Nakajima, Mikio
• Is Part Of: Journal of obstetrics and gynaecology research. Volume 48:Issue 7(2022)
• Page Start: 1691
• Page End: 1697
• Publication Date: 2022-05-09
• Subjects: fundal pressure -- outcome -- placenta -- ultrasound -- vaginal delivery; Gynecology -- Periodicals; Obstetrics -- Periodicals; 618.1005
• DOI: 10.1111/jog.15268
• Languages: English
• ISSNs: 1341-8076

Abstract

Abstract: Aim: Manual fundal pressure (MFP) is still used to assist vaginal deliveries during the second stage of labor in predominantly lower‐middle income countries; however, there is insufficient evidence on the risk factors in MFP‐assisted vaginal deliveries for adverse neonatal outcomes. The aim of the present study was to investigate the association between placental location and neonatal outcomes in MFP‐assisted vaginal deliveries. Methods: The present study was a single‐center retrospective cohort study in patients with all MFP‐assisted vaginal singleton deliveries from January 2016 to December 2020. Placental location was divided into two categories: posterior‐lateral and anterior‐fundal. The primary outcome was a neonatal adverse composite including umbilical artery blood pH <7.2, Apgar score <7 at 5 min, neonatal intensive care unit admission and neonatal resuscitation. We used multivariable logistic regression models to investigate the association between placental location and neonatal outcomes. Results: We extracted 522 MFP‐assisted deliveries among 5053 vaginal deliveries. The proportion of posterior‐lateral and anterior‐fundal placentation was 239 (45.8%) and 283 (54.2%), respectively. The crude prevalence of neonatal composite outcome in the anterior‐fundal group was significantly higher than that in the posterior‐lateral group (39.6% vs. 28.9%; p = 0.013). Multivariable logistic regression analysis found that the prevalence of neonatal adverse outcome in the anterior‐fundal group was significantly higher compared with the posterior‐lateral group (adjusted odds ratio, 1.52; 95% confidence interval, 1.04–2.23). Conclusion: Anterior‐fundal placentation was significantly associated with an increased risk of neonatal adverse outcomes compared to posterior‐lateral placentation in MFP‐assisted vaginal deliveries.