Significance of the problem: Fundal pressure during the second stage of labour for improving maternal and fetal

outcomes. It involves using the hands (manual fundal pressure) to push on the upper part of the uterus and down toward the birth canal. This study will be a significant endeavour if a fundal pressure is needed to be applied during labor. This study will also be beneficial to the nursing students, nurse practitioners and OB gynes because by understanding the application of fundal pressure, they will be guided whether they will be valid to put fundal pressure during labor. It will also serve as a future reference for researchers on the effectiveness of fundal pressure.

Scope and Limitation: This study focuses on the effectiveness of fundal pressure during second stage of labor. The study will be condected at _______________________. The respondents are the________. The reaerchers will conduct the study in _____months/weeks. *Kelsey di ko alm.. wla ka naming cnabe kung san at cno mga respondets.

DEFINITION OF TERMS: y Fundus: The bottom of or part farthest from the opening of a sac or hollow organ. Fundus of uterus: The part of the uterus above the orifices of the fallopian tubes. Pressure: The application of continuous force by one body on another that it is touching; compression.

Kelsey ito ung mga other infos n nakuha ko: Application of Suprapubic Pressure and Fundal Pressure by RNs in Obstetrical Nursing Practice It was the advisory opinion of the Board that the RN may NOT apply fundal pressure during the second stage of labor including, but not limited to, the following clinical circumstances: a) in the presence of a non-reassuring fetal heart rate pattern, b) maternal exhaustion, or c) in instances of shoulder dystocia. Under specified conditions, it is within the scope of RN practice for a labor and delivery RN to perform fundal pressure and suprapubic pressure when stipulations for safe practice are present, as listed below. The performance of such pressures is not within the scope of LPN practice. It is the advisory opinion of the Board that a RN may apply suprapubic pressure during the vaginal delivery of a fetus with suspected shoulder dystocia or breech delivery. A RN may apply gentle fundal pressure for the purposes of preventing the upward displacement of the presenting part during fetal scalp electrode placement, and during an amniotomy when the vertex presentation is not ballotable. A RN, who is scrubbed and is a member of the surgical team, may apply fundal pressure during a cesarean section. As referenced above, the Board advises that stipulations for safe practice include, but are not limited to, the following: 1. The RN is educationally prepared and clinically competent in the performance of the procedures. The educational preparation should include, but not be limited to, instruction in the application of and rationale for the procedures and how the procedures differ. The educational preparation for performance of pressures is directed by a licensed health care professional, such as a licensed physician with substantial specialized knowledge, judgment and skill related to obstetrics, or an ARNP designated nurse midwife, or a RN with documented clinical knowledge and competency in the application of pressure. 2. For each RN expected to perform pressures, the facility maintains written documentation of each RNs initial and continued competency to perform pressures. 3. The RN practices according to Kentucky Nursing Laws, generally accepted standards of care, and evidence based practice. 4. A licensed physician or an ARNP designated nurse midwife is present in the room and directing the performance of pressure. 5. All necessary resources are available. 6. The facility/agency has detailed policies and procedures in place addressing all aspects of this issue to include, but not be limited to, specific guidelines/criteria for these procedures and a mechanism of data collection for quality control.

7. The facilitys policy and procedures is reviewed and approved by the Departments of Nursing and Medicine both initially and at planned periodic intervals. 8. The labor and delivery RN documents the performance of pressure and the results of its application in the maternal medical record. It is inappropriate for a RN to perform suprapubic pressure or fundal pressure when the application of these technical procedures is beyond the parameters of the RNs education, capabilities or experiences. Although the determination of medical procedures and patients medical status is a medical decision, the RN has the right and the obligation to question orders and decisions that are contrary to acceptable standards and to refuse to participate in procedures that may result in harm to the patient.

Tignana mo din to: http://www.springerlink.com/content/m25485628872u3p9/ Fundal pressure during the second stage of labour for improving maternal and fetal outcomes Fundal pressure involves using the hands (manual fundal pressure) to push on the upper part of the uterus and down toward the birth canal. It is used during the second stage of labour to shorten the labour and assist in vaginal birth, either as routine practice or because of complications such as fetal distress, failure to progress, maternal exhaustion, or medical conditions where prolonged pushing is contraindicated, for example if the mother has heart disease. Also an inflatable girdle has been used in research settings to provide fundal pressure. Potential risks with its use include uterine rupture, anal sphincter damage, newborn fractures or brain damage, and increased blood transfusion between the mother and her unborn baby. This may be important with rhesus factor or when the mother has HIV, hepatitis B or other viral disease. The review authors found no trials on the more widely used manual fundal pressure. There was only one controlled trial studying fundal pressure by inflatable belt. It involved 500 women who had epidural analgesia and were in the second stage of labour. The methodological quality of the trial was good. The number of women experiencing spontaneous vaginal births was similar with or without applying fundal pressure. The trial did not provide sufficient evidence to determine any safety issues of the manoeuvre for the baby, measured as low Apgar scores, low arterial fetal cord pH, or admission to the neonatal unit. Blinding was not possible with this intervention. It may have been

perceived that the belt was 'doing the work' so that the women pushed less hard and the midwives encouraged them less enthusiastically. The number of women with an intact perineum increased with use of the belt but also anal sphincter tears increased, all but one associated with an instrumental delivery.