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.