A systematic literature review on pushing down technique during second stage of labour on maternal and neonatal outcome

Abstract

Background:Maternal pushing during the second stage of labour is an important and indispensable contributor to the involuntary expulsive force developed by uterus contraction. Currently, there is no consensus on an ideal strategy to facilitate these expulsive efforts and there are contradictory results about the influence on mother and fetus. Objectives: To evaluate the benefits and possible disadvantages of different kinds of techniques regarding maternal pushing/breathing during the expulsive stage of labour on maternal and fetal outcomes. Search methodsPublished, original-research articles fromPubMed, CINAHL, Web of Science, and Scopus databases. Studies using a crossover design and those published in abstract form only were not eligible for inclusion. We considered the following comparisons.Result: 20 studies in total. Theresults come from studies with a high or unclear risk of bias, especially selection bias and selective reporting bias.Timing of pushing with epidural is consistent in that delayedpushing leads to a shortening of the actual time pushing and increaseof spontaneous vaginal delivery at the expense of an overalllonger duration of the second stage of labour and double the risk of alow umbilical cord pH (based only on one study). Nevertheless, there was no difference in the caesarean and instrumental deliveries,perineal laceration and episiotomy, and in the other neonatal outcomes (admission to neonatal intensive care, five-minute APGAR scoreless than seven and delivery room resuscitation) between delayed and immediate pushing. Furthermore, the adverse effectson maternalpelvic floor is still unclear.Therefore, there is insufficientevidence to justify routine use of any specific timing of pushing since thematernal and neonatal benefits and adverse effects of delayedand immediate pushing are not well established.