Strengths and limitations
To the best of our knowledge, this case control study was the first to evaluate the association between fundal pressure and OASI immediately after birth with TPUS. Homogeneity of obstetric applications, documentation of fundal pressure indications and numbers were the strength of the present study. Major limitation of this study was the relatively small sample size. Lack of a standardized protocol for the application of fundal pressure and multiplicity of practitioners of fundal pressure were the another limitations. More frequent use of mediolateral episiotomy in fundal pressure group may obscure the effect of fundal pressure on anal sphincter.