Maternal rib fracture after manual uterine fundal pressure

Abstract

Applying manual uterine fundal pressure is a maneuver performed to shorten the second stage of labor. This maneuver involves the application of manual pressure to the uppermost part of the uterus (uterine fundus) and directed towards the uterine axis. How often this maneuver is performed in routine obstetric practice is unclear; however, it is much more frequently performed in developing than developed countries. For example, this maneuver was performed in 4% of all vaginal births between 1994 and 1995 in the Netherland but was 'prevalent' in rural central Bangladesh. It has been established that the maneuver may cause adverse events for both mother and neonate, and maternal rib fracture has been reported. We hope to raise clinicians’ index of concern for this issue by reporting a recent case from Japan. Case report