Materials and Methods
This case-control study (NCT03752879) was conducted at the urogynecology
unit of the University Hospital in Istanbul, Turkey. The study protocol
was approved by the instutional ethical committee (IRB No: 2019-7/22).
Written informed consent for the study was obtained at hospitalization
of nulliparas, who were the nominee for vaginal delivery. The study
population included nulliparous women over 18 years old, with 37 and 42
weeks of singleton cephalic presentation gestation. Potential
participants were excluded if they were multiparous, had a history of
instrumental delivery, chronic intestinal disease (Crohn’s disease,
ulcerative colitis), anal incontinence, surgery to anal canal.
Oxytocin and a prostaglandin E2 pessary was used for induction of labour
and oxytocin was used for augmentation during the first and second stage
of delivery if necessary. None of the patients received spinal/epidural
analgesia and a mediolateral episiotomy was performed if necessary. For
the fundal pressure group, pressure was applied manually by an
obstetrician during the second stage of delivery while the fetal heart
rate was being monitored. The obstetrician pressed on the uterine fundus
at a 30–45° angle to the maternal spine, in the direction of the
pelvis, and a longitudinal direction with each uterine contraction until
delivery of the fetal head.