Comparison of Maternal and Neonatal Outcomes of Spontaneous versus Directed Pushing Techniques in the Second Stage of Labour
DOI:
https://doi.org/10.51985/Keywords:
Directed pushing, Maternal outcomes, Neonatal outcomes, Perineal trauma, Spontaneous pushingAbstract
Objective: To compare the maternal and neonatal outcomes of spontaneous and directed methods of pushing during the second stage of the labour.
Study Design and Setting: This Prospective comparative study was conducted at the Department of Obstetrics and Gynecology, PAF Hospital Islamabad, over three months.
Methodology: After approval from the Ethical Review Committee (ERC Ref No: ERC/FPGMI/OBG/11/2026). A total of 60 singleton term pregnancies were included and equally divided into two groups (n = 30 each). Group A performed spontaneous pushing, whereas Group B performed directed pushing using the Valsalva. Maternal outcomes were length of second stage of labour, episiotomy, perineal trauma and maternal fatigue. Neonatal outcomes consisted of one minute Apgar score and NICU admission. Independent sample t-test was used for continuous variables. Chi-square test or Fisher’s exact test was used for categorical variables where appropriate, P-value =0.05 was considered statistically significant.
Results: The duration of second stage was significantly shorter in spontaneous group (38 ± 10 min) vs directed group (45 ± 12 min) (p = 0.002). Episiotomy (26.7% vs 43.3%, p = 0.041), perineal trauma (13.3% vs 26.7%, p = 0.048), and maternal fatigue (16.7% vs 36.7%, p = 0.031) were significantly lower in spontaneous group. No significant difference was observed in Apgar score 7: 6.7% vs 13.3%, p = 0.337; NICU admission: 3.3% vs 10.0%, p = 0.296.
Conclusion: Associated with better maternal outcomes and without jeopardizing the safety of the neonate, Spontaneous pushing was associated with shorter second stage of labour, lower episiotomy rate, reduced perineal trauma, and decreased maternal fatigue, without significant differences in neonatal outcomes
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