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Reproductive Health
Published in: Reproductive Health 1/2021

Open Access 01-12-2021 | Care | Review

The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis

Authors: Elise Farrington, Mairead Connolly, Laura Phung, Alyce N. Wilson, Liz Comrie-Thomson, Meghan A. Bohren, Caroline S. E. Homer, Joshua P. Vogel

Published in: Reproductive Health | Issue 1/2021

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Abstract

Background

Uterine fundal pressure involves a birth attendant pushing on the woman’s uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities.

Methods

The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity.

Results

Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4–27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women’s self-report).

Conclusions

The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.
Appendix
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Metadata
Title
The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis
Authors
Elise Farrington
Mairead Connolly
Laura Phung
Alyce N. Wilson
Liz Comrie-Thomson
Meghan A. Bohren
Caroline S. E. Homer
Joshua P. Vogel
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
Reproductive Health / Issue 1/2021
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-021-01148-1

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Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries

Research

Contraceptive use among sexually active female adolescents in Ethiopia: trends and determinants from national demographic and health surveys

Research

Decomposing the urban–rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa