Association Between Placental Location and Neonatal Outcomes in Manual Fundal Pressure-Assisted Vaginal Deliveries: A Retrospective Cohort Study

Abstract Purpose: Manual fundal pressure (MFP) is globally used to assist vaginal deliveries during the second stage of labor; however, there is insufficient evidence on the risk factors in MFP-assisted vaginal deliveries for adverse neonatal outcomes. The aim of the present study was to investigate the association between placental location and neonatal outcomes in MFP-assisted vaginal deliveries.Methods: The present was a single-center observational study using a cohort of all MFP-assisted vaginal singleton deliveries from 2016 to 2020. Placental location was divided into two categories: posterior-lateral and anterior-fundal. The primary outcome was a neonatal adverse composite including umbilical artery blood pH <7.2, Apgar score <7 at 5 min, neonatal intensive care unit admission and neonatal resuscitation. We used logistic regression models to investigate the association between placental location and neonatal outcomes. Results: We extracted 522 MFP-assisted deliveries among 5053 vaginal deliveries. The proportion of posterior-lateral and anterior-fundal placentation was 239 (45.8%) and 283 (54.2%), respectively. The crude prevalence of neonatal composite outcome for posterior-lateral and anterior-fundal placentation was 69 (28.9%) and 112 (39.6%), respectively. The prevalence of neonatal composite outcome in the anterior-fundal group was significantly higher than that in the posterior-lateral group. Multivariable logistic regression analysis found that the prevalence of neonatal adverse outcome in the anterior-fundal group was significantly higher compared with the posterior-lateral group (adjusted odds ratio, 1.55; 95% confidence interval, 1.05–2.28).Conclusion: Anterior-fundal placentation was significantly associated with an increased risk of neonatal adverse outcomes compared to posterior-lateral placentation in MFP-assisted vaginal deliveries.