The Kristeller manoeuvre (fundal pressure during the second stage) is associated with which specific perineal complication that has led to its abandonment in modern obstetric practice?
- A Uterine inversion
- B Increased risk of 3rd and 4th degree perineal tears ✓
- C Bladder injury
- D Shoulder dystocia resolution failure
Correct answer: B. Increased risk of 3rd and 4th degree perineal tears
Explanation
Fundal pressure (Kristeller manoeuvre) applied during the second stage is associated with increased rates of severe perineal lacerations (3rd and 4th degree), levator ani muscle injuries, and anal sphincter defects. It is also associated with uterine rupture, fetal asphyxia, and maternal rib fractures. Contemporary evidence has led to recommendations against its use; the primary perineal complication that led to this change is severe perineal tears.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.