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J Matern Fetal Neonatal Med. 2019 Aug;32(15):2598-2607. doi: 10.1080/14767058.2018.1441278. Epub 2018 Feb 21.

Kristeller maneuvers or fundal pressure and maternal/neonatal morbidity: obstetric and judicial literature review.

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a Department of Obstetrics and Gynaecology , GVM Care & Research Santa Maria Hospital , Bari , Italy.
b International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics , Moscow Institute of Physics and Technology, State University , Moscow , Russia.
c Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , "Sapienza" University of Rome , Rome , Italy.
d Department of Obstetrics and Gynecology , Vito Fazzi Hospital , Lecce , Italy.
e Department of Obstetrics and Gynaecology 2 , AOU Policlinico , Bari , Italy.



A significant amount of data concerning maternal-fetal damage arising from the exertion of Kristeller maneuvers (KMs) or fundal pressure (FP) go unreleased due to medicolegal implications.


For this reason, the paper gathers information as to the real magnitude of litigation related to FP-induced damages and injuries. The authors have undertaken a research in order to include general search engines (PubMed-Medline, Cochrane, Embase, Google, GyneWeb) and legal databases (De Jure, Italian database of jurisprudence daily update; Westlaw, Thomson Reuters, American ruling database and Bailii, UK Court Ruling Database).


Results confirm said phenomenon to be more wide ranging than it appears through official channels. Several courts of law, both in the United States of America (USA) and in European Union (EU) Member States as well, have ruled against the use of the maneuver itself, assuming a stance conducive to a presumption of guilt against those doctors and healthcare providers who resorted to KMs or FP during deliveries. Given how rife FP is in mainstream obstetric practice, it is as if there were a wide gap between obstetric real-life and what official jurisprudence and healthcare institutions-sanctioned official practices are.


The authors think that it would be desirable to draft specifically targeted guidelines or recommendations on maneuvers during vaginal delivery, in which to point out exactly what kinds of maneuvering techniques are to be absolutely banned and what maneuvers are to be allowed, and under what conditions their application can be considered appropriate.


Fundal pressure; Kristeller maneuvers; indemnity

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