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Kristeller's grip is a maneuver performed during labor, which involves pressure on the bottom of the uterus. Although the Kristeller grip was developed in the 19th century, some doctors still use it today. All indications are that it will not change quickly. As experts from the Polish Gynecological Society argue, despite the fact that Kristeller's maneuver is associated with complications, introducing a legal prohibition of its performance is not the right solution. Check what Kristeller's grip looks like and what are the possible complications of this maneuver.

Kristeller's grasp , or Kristeller's maneuver, is a maneuver performed during labor, involving pressure on the bottom of the uterus. Even though theKristeller's gripwas developed in the 19th century, some doctors still use it today. All indications are that it will not change quickly. As experts from the Polish Gynecological Society argue, although Kristeller's maneuver is associated with complications, introducing a legal prohibition of its performance is not the right solution.

Kristeller's grip - what does it look like and what is it used for?

The maneuver involves two-handed pressure on the area of ​​the uterine floor along its longitudinal axis towards the pelvic floor during the birth of the fetal head and shoulders. As the specialists from the Polish Gynecological Society explain¹, the procedure begins with the delivering supine position, the person performing the procedure stands on the side. The uterus is positioned with the hands along the axis of the birth canal, and then the hands are placed on the bottom of the uterus so that the edge of the little fingers faces the pelvis and the entire hand embraces the bottom or top of the uterine sides, with the thumbs positioned on the front surface of the uterus. After placing the hands, massage the uterus through the abdominal wall, then, along with the contraction of the uterine muscle, gradually increase pressure directed towards the pelvis in the axis of the birth canal. The pressure should last 5-8 seconds, if necessary, after a 1-3-minute break, it can be repeated. The purpose of Kristeller's maneuver is to increase the pressure inside the uterus, which leads to shorter delivery times when the pressure force is not sufficient to ensure the progress of labor.

Kristeller's grab should properly be performed as described above. However, this is not always the case in delivery rooms. This is what the report showson the frequency of using Kristeller's grip in Poland, which was attended by over 1060 women giving birth naturally in Poland in 2004-2014 (of which 334 gave birth in 2014) ¹

The doctor tried to throw himself at me and push the child out of me, but I pushed him for so long and "fought" with him that he gave up.

I had the bearing pressed out. The doctor threw himself on my stomach, the midwife pulled the umbilical cord, and I cried, begging for mercy, because the pain was worse than giving birth.

In two births, I struggled not to get the placenta out. Managed to. I gave birth to the placenta on my own. But the attempts to give me violent "help" were constant, attempts to persuade me, frightening, scoffing, etc.

I had the bearing pressed out. The doctor leaned against my stomach and pressed it hard until he finally got his !!!

The doctor did not attack my stomach, but rather pushed the baby out of it. If it weren't for him, my son would have been treated with forceps or he would have suffocated because his pulse was vanishing.

Kristeller's grab, or maybe another maneuver?

The same report shows that among women giving birth in 2014, 22.14 percent it is certain that a Kristeller grip was used. Another 7.14 percent. reports that it is uncertain whether the maneuver was used, which means that there was a situation in the delivery room that is not clear from the point of view of the woman, and thus the woman may suspect that this maneuver was used. And 70.66 percent. the respondents were sure that Kristeller's grip was not used. This means that nearly every third woman giving birth in 2014 experienced a behavior that gave her reason to suspect that the Kristeller grip was used .³

Kristeller's grip - more harm than good

Kristeller's grip was named by prof. dr. hab. Troszyński, an expert in the field of gynecology and obstetrics, "especially brutally". Also American doctors, incl. Dr. Awoniyi Awonugi from Wayne State University (USA) and Dr. Nahli Merhi from Saint Joseph Medical Center in Joliet (Illinois, USA) believe that it is harmful and is associated with numerous complications that can occur in both mother and child.

As reported by Fundacja Rodzić po Humanku, research has shown that pressure may accelerate childbirth, but does not shorten the second stage of labor.

This is confirmed by numerous studies. According to the Rodzić po Human Foundation² Foundation, the analysis of studies on the use of pressure on the bottom of the uterus in the second stage of labor (Kristeller's procedure) did not show any benefits associated with this effect,while it has proved their harmfulness. Studies have shown that not all women experience pressure build-up in the uterine cavity as a result of external pressure. The pressure may accelerate the delivery of a child, but it does not shorten the second stage of labor. Some studies even show a tendency to extend this period.

Kristeller's grip - complications

The most common maternal complications listed are: ³

  • damage to the cervix, perineum and anal sphincter
  • uterine eversion (displacement of its inner surface through the cervical canal outside the uterine cavity)
  • stomach pains
  • rib fracture
  • liver rupture
  • uterine rupture
  • premature separation of the placenta
  • haemorrhage, including into the abdominal cavity, and consequently even death

The most common negative consequences for a child after the Kristeller treatment are: ³

  • bone fractures
  • brachial plexus damage
  • increased risk of shoulder dystocia, especially in cases of fetal macrosomia
  • lower Apgar score
  • death

Increased fetal bradycardia and hypoxia are also associated with increased intrauterine pressure associated with mechanical pressure, which may lead to neurological disorders in the further development of the child.

Important

Position of the Polish Gynecological Society on the Kristeller grip

According to the experts of PTG, the Kristeller's maneuver in modern obstetrics is not recommended, but it is also not forbidden and, under justified conditions, may be allowed to be performed by experienced obstetricians. Its correct application may allow to avoid unnecessary obstetric surgeries, which, like any procedure, are associated with the occurrence of complications. There is no doubt that if the procedure is performed incorrectly, unskillfully, without proper intuition, complications can occur.

In the opinion of PTG experts, the administrative ban on performing procedures, which have been present in obstetric practice for years, is not the right solution. You should, however, teach the rules of their proper application with proper qualifications.

Source:

1.Report on the study on the frequency of using the Kristeller grip in Poland, www.lepszyporod.pl/wp-content/uploads/2015/04/chwyt.pdf

2. www.rodzicpoludzku.pl/Wiedza-o-porodzie/Prożenie-II-okresu-porodu-w-swietle-badan-naukowych.html

3. The position of the Team of Experts of the Polish Gynecological Society on Kristeller's maneuver, Gynecologyand Practical Perinatology 2016, vol. 1, nr 2

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Childbirth