Re: Fundal Pressure

From: Elrod, Darryl G MAJ 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL)
Tue Feb 28 15:32:11 2006

I remember in the Journal of Reproductive Medicine from about 7-8 years ago there was a nice review article of maneuvers for shoulder dystocia. In that article it stated that fundal pressure WAS indicated for performing one of the screw maneuvers. I had never read that anywhere else and have never read it since.

Title: Shoulder Dystocia: Rotational Maneuvers Revisited Authors: Patrick S. Ramsey, M.D., Kirk D. Ramin, M.D., and Charles S. Field, M.D.

Shoulder dystocia is an acute obstetric emergency that necessitates prompt, skillful intervention in order to prevent serious fetal trauma or death. Of the maneuvers described to deal with this difficult problem, rotational maneuvers are among the most ingenious. In spite of the effectiveness of these techniques, various technical deviations have led to the incorrect description and implementation of these maneuvers. This review of the rotational maneuvers used to counter shoulder dystocia gives particular attention to the techniques described originally. (J Reprod Med 2000;45:85#88)

I think this is the citation although I can't get to the full article online.

Glen

//SIGNED//

D. Glen Elrod, Maj., USAF, MC

Obstetrician/Gynecologist

Chief of Obstetrics

48 MDOS/SGOBO

RAF Lakenheath, England

Telephone DSN: 314-226-8130

Comm: +44 (0) 1638 52 8130

Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer.

-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Tuesday, February 28, 2006 7:09 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Fundal Pressure

Maybe it would be best to have no policy at all, i.e. remain silent (I learned that cool term from an attorney).

Garry

At Tue, 28 Feb 2006, Dr. Ainsworth wrote: >
>I have always been taught that fundal pressure was contraindicated
>because of the risk of uterine rupture and shoulder impaction at the
>time of shoulder dystocia, i.e., I do not use it. When this policy
came >through our perinatal, I objected to it because of the above.
>Medical-legally, I don't feel it should be used. I have no problem
with >suprapubic pressure for stabilizing the head when rupturing membranes,
>applying the scalp electrode, assisting with rotation of the shoulders
>in a shoulder dystocia and use it in those circumstances. This policy
>came from "corporate headquarters" and one other OB wants to keep it as
>it is. Any comments would be appreciated.
>
>POLICY/PROCEDURE SUMMARY/INTENT (EXPECTED OUTCOME): 1) To describe the
>appropriate use and application of fundal pressure by the RN. Fundal
>pressure may be useful in the following clinical circumstances:
>a. To ease the fetal head against the cervix to prevent cord prolapse
>during artificial rupture of membranes (AROM).
>b. To stabilize the fetal head to facilitate placement of a scalp
>electrode.
>c. To expedite delivery when fetal heart tones (FHTs) are

nonreassuring >and fetal head is crowning.
>d. To assist with outlet forceps or vacuum delivery when the fetal
head >crowning and the mother's pushing is ineffective.
>
>DEFINITION (S): 1) Fundal Pressure - The application of steady pressure
>on the fundus of the uterus.
>
>AFFECTED DEPARTMENTS/SERVICES (COLLABORATION): 1) Perinatal
>
>POLICY AND PROCEDURE: COMPLIANCE-KEY ELEMENTS
>
>I. POLICY
>
>A. Fundal pressure is to be performed by the RN upon the request of
the >physician in those situations where fundal pressure is appropriate and
>not contraindicated.
>B. Contraindications: Fundal pressure is contraindicated when there is
>a shoulder dystocia as it may lead to further impaction of the shoulder
>against the symphysis, or even catastrophic uterine rupture.
>C. Responsibility: Labor and Delivery Registered Nurses who can
>demonstrate knowledge of uterine anatomy and physiology and the forces
>of labor.
>
>II. PROCEDURE
>
>A. Apply gentle, steady pressure with one hand to the fundus at a
>30-degree to 45-degree angle to the maternal spine in the direction of
>the pelvis.
>B. If a higher elevation is needed to achieve proper positioning and
to >maintain proper body mechanics, stand on a footstool.
>C. Avoid perpendicular (direct downward) pressure on the maternal
>spine, which may cause direct vena caval compression and maternal
>hypotension. Pressure should not be applied in a longitudinal
>direction.
>
>III. DOCUMENTATION
>
>A. Who ordered the fundal pressure.
>B. Who applied the fundal pressure.
>C. In what manner was fundal pressure applied (e.g., number of hands,
>steady vs. intermittent pressure, amount of pressure).
>D. How long was fundal pressure applied.
>
>APPLICABLE STANDARDS OR REGULATORY REQUIREMENTS: None
>REFERENCES: 1) T. Benedetti, "Dystocia: Causes, Consequences, Correct
>Response," Contemporary OB/GYN, Vol. 36, Special Issue, Medical
>Economics Publishing, Montvale, NJ, Oct. 15, 1991, pp. 37-48. 2) V.
>Kline-Kaye and D. Miller-Slade, "The Use of Fundal Pressure During
>Second Stage Labor," Journal of Obstetric, Gynecologic, and Neonatal
>Nursing, Lippincott, Hagerstown, MD, Vol. 19:6, Nov./Dec. 1990, pp.
>511-517. 3) D.S. Penney and D.W. Perlis, "Shoulder Dystocia: When to
>Use Suprapubic or Fundal Pressure," MCN, The American Journal of
>Maternal/Child Nursing, Vol. 7:1, 1992, pp. 34-36. 4) K.R. Simpson
>and P.A. Creehan, AWHONN's Perinatal Nursing, Lippincott,

Philadelphia, >1996, Chapter 8, pp.160-166. 5) C. Rommal, "Risk Management Issues in
>the Perinatal Setting," Journal of Perinatal & Neonatal Nursing, Vol.
>10:3, Aspen Publishers, Inc., Gaithersburg, MD, Nov./Dec. 1996, pp.
>13-14.

--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA



use when must restrict search to only the ob-gyn-l forum...
Enter search keywords:
Returns per screen: Require all keywords:

Return to OB-GYN-L Mail a New Message to the Forum: ob-gyn-l@obgyn.net
Forum Administrator: geffrey.klein@obgyn.net
Report Technical Problems: webmaster@obgyn.net
Last Updated: Wed Jul 2 04:42:47 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.

home | medical professionals | women | industry | forums | international
e-mail | about us | advertising | our sponsors | contact us | disclaimer |

This information is provided for educational purposes only.
Please read the disclaimer. ©1996-2008, all rights reserved.
Do not reproduce without permission of MediSpecialty.com