CClinicalTrials.gg
CompletedNCT03752879Updated May 28, 2020

The Association Between Kristeller Maneuver and Pelvic Floor Trauma After Vaginal Delivery

An observational study in Labor Complication and Avulsion, sponsored by Bezmialem Vakif University. Completed at 1 site in Turkey. Open to female participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2020-05-28.

Sponsored by Bezmialem Vakif University · Observational

Study type
Observational
Model
Case-control
Time perspective
Prospective
Enrollment
86
Ages
18 Years and older
Sex
Female
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Study summary

We want to investigate the association between fundal pressure in the second stage and the risk of levator ani muscle (LAM) injury.

Read the detailed description

We will recruit women immediately following their first vaginal delivery. Women who underwent Kristeller maneuver will be recruit as cases. For each case, a control (no fundal pressure) will be recruit matched by BMI, second stage duration and birthweight. All women will be invited to undergo a postpartum 3D transperineal ultrasound (TPUS). The main outcome measure will be the presence of LAM avulsion at 3D TPUS. TPUS results will be compared between cases and controls.

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Conditions studied

  • Labor Complication
  • Avulsion

Keywords

  • Kristeller maneuver,LAM avulsion,3D transperineal ultrasoun
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Who can participate

Ages eligible
18 Years and older
Sexes eligible
Female
Accepts healthy volunteers
Yes
Sampling method
Non-probability sample

Study population

Over 18 years old ,term primiparous women with singleton pregnancies and vaginal delivery.

Inclusion criteria

  • First delivery
  • Term pregnancy (37-41w)

Exclusion criteria

Exclusion Criteria:

  • Instrumental vaginal delivery
  • Multifetal pregnancy
  • Previous vaginal or cesarean delivery
  • Refused consent and uncooperative patient for effective Valsalva maneuver
  • Handicap in lithotomy position
  • Women without regular and active contractions
  • Epidural analgesia
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Study design

Observational model
Case-control
Time perspective
Prospective
Enrollment
86 participants (actual)
Patient registry
No

Groups and cohorts

  • Case (Kristaller Group)

    Group of kristeller maneuver applied in the second stage of labor due to clinical necessity.

    Procedure: Fundal Pressure

  • Control (no Kristaller Group)

    The control group not required to kristeller maneuver

Interventions

  • ProcedureFundal Pressure

    Fundal Pressure to assist the vaginal delivery to shorten the second stage of labor

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What researchers measure

Primary outcomes

  1. levator ani muscle (LAM) injury

    The aim of the study is to investigate levator ani muscle (LAM) injury, loss of tenting, biometric measurements of LAM and genital hiatus after vaginal delivery and investigate the association between fundal pressure in the second stage of labor (Kristeller maneuver). All recruited women will be invited to undergo a transperineal 3D ultrasound (TPUS) scan at 24 hours after delivery. we will acquire two 3D volumes for each patient: one under maximum pelvic floor muscle contraction (PFMC) and the other under maximum Valsalva's maneuver. Ballooning" will diagnosed with a pelvic hiatal area of more than 25 cm2 during maximum Valsalva. A complete avulsion of the puborectalis muscle will diagnose if an abnormal insertion of the muscle will be detected on all three central slices. We will use a levator-urethral gap more than 2.5 cm to define an abnormal insertion.

    Time frame: 24 hour

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Study locations

1 site
  • Bezmialem Vakıf University Hospital
    Istanbul, 34093, Turkey
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References and documents

Publications

  • Takmaz T, Aydin S, Gorchiyeva I, Karasu AFG. The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage. Int Urogynecol J. 2021 Jul;32(7):1917-1924. doi: 10.1007/s00192-020-04523-x. Epub 2020 Sep 9. PubMed 32902763 ↗

Individual participant data

Plan to share: No

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Registry details

Key details

Study ID
NCT03752879
Lead sponsor
Bezmialem Vakif University
Responsible party
Sponsor
First posted
Nov 26, 2018
Start date
May 18, 2019
Primary completion
Jul 18, 2019
Completion
Oct 18, 2019
Last update
May 28, 2020

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in May 2020. You cannot join it, but the record below documents what was studied.

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