ABSTRACT
OBJECTIVE: To investigate the association between application of fundal pressure during the second stage of labor (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury. METHODS: This was a prospective case-control study of women recruited immediately after their first vaginal delivery in our university hospital between March 2014 and September 2016. Women who underwent the Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched for body mass index, use of epidural analgesia, duration of second stage of labor and birth weight. All women were invited to undergo four-dimensional (4D) transperineal ultrasound (TPU) 3-6 months postpartum. The main outcome measure was the presence of LAM avulsion on 4D-TPU. TPU results were compared between cases and controls. Multivariate logistic regression analysis was performed to identify independent risk factors for LAM avulsion. RESULTS: During the study period, 134 women in the Kristeller maneuver group and 128 women in the control group underwent TPU assessment. Women who underwent the Kristeller maneuver had a higher prevalence of LAM avulsion than did controls (38/134 (28.4%) vs 18/128 (14.1%); P = 0.005). In addition, women in the Kristeller-maneuver group had a larger hiatal area on maximum Valsalva maneuver and a greater increase in hiatal area from rest to maximum Valsalva. On multivariate logistic regression analysis, use of the Kristeller maneuver was the only independent factor associated with LAM avulsion (odds ratio, 2.5 (95% CI, 1.29-4.51)). CONCLUSION: The Kristeller maneuver is associated with an increased risk of LAM avulsion when applied in women during their first vaginal delivery. This should be taken into account when deciding to use fundal pressure to accelerate the second stage of labor and when counseling women following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Subject(s)
Anal Canal/injuries , Labor Stage, Second , Pelvic Floor Disorders/epidemiology , Pressure/adverse effects , Adult , Anal Canal/diagnostic imaging , Case-Control Studies , Delivery, Obstetric/methods , Female , Humans , Italy/epidemiology , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/etiology , Pelvic Floor Disorders/etiology , Pregnancy , Pregnancy Outcome , Prospective Studies , Risk FactorsABSTRACT
This investigation included the determination of Na, K, Ca, Mg and Zn in lens and aqueous humor of cataract patients. Along with the development of senile cataract the Na concentration increased, while the K concentration diminished. In the cataractous eye lenses the concentration of Ca and Zn were higher than in normal transparent lenses. The concentrations of the investigated elements, except for Zn, were higher in lenses than in aqueous humor of the same patients. The concentration of Na and Zn in aqueous humor decreased as compared to the values for normal healthy persons. The Ca and K concentrations in aqueous humor were similar to the values for healthy persons. Investigations of electrolyte composition of the lens would be valuable for understanding the genesis and developmental mechanism of senile cataract.
