Kristeller handle
The Kristeller handgrip (synonym: Kristeller maneuver, kristellern ) is a method with which the birth of the child can or should be accelerated by synchronous pressure on the roof of the uterus ( fundus uteri ) during the expulsion phase . The handle may only be used during the last labor pains when the child's head is visible; It is viewed critically among obstetricians and midwives : the pressure on the upper abdomen is often perceived as unpleasant by the woman giving birth and is associated with medical risks. The World Health Organization ( WHO) does not recommend the use of the Kristeller handle: WHO experts therefore have serious concerns that mother and baby could be harmed by this procedure. At the congress of the German Society for Gynecology and Obstetrics in 2010, warnings were given in several places against the Kristellern because of the significant risks: Since there is still little scientifically founded knowledge about the procedure, the measure appears more like a hectic act of desperation in a complicated birth.
The method is named after the gynecologist Samuel Kristeller (1820–1900), who described it in 1867.
Indications
- Occurrence of a dangerous situation for the unborn child ( hypoxia )
- Ease of pressing when the mother is exhausted i. S. a shortening of the late expulsion period
- Head development in the context of Bracht's maneuver in breech position
- Facilitating delivery using vacuum extraction or forceps
- Altered / delayed course of labor under epidural anesthesia
- (even if the cervix is incomplete) to support other measures such as amniotomy , creation of an internal cardiotocogram (CTG), blood micrographs and caesarean section .
Absolute contraindications
- Wedging of the child's shoulder behind the maternal pubic bone ( shoulder dystocia , there is a risk of a lesion of the brachial plexus )
- Not fully opened cervix and / or head not at least pelvic floor / pelvic outlet
Relative contraindications
- Fundus placenta (placenta in the fundus uteri )
- insufficient labor
- Condition after caesarean section
- Labor storm, threatened uterine rupture
Complications / risks
- Avulsion of the levator ani muscle on the pubic bone ( levator avulsion)
- Liver tear ( rupture of the liver )
- Breaking of the maternal ribs ( rib fractures )
- Detachment of the placenta (premature placenta detachment)
- Tearing the uterus ( uterine rupture )
- Occurrence of dams and cracks Vaginal
- Brain damage (in the newborn)
- Arm paralysis (in newborns)
literature
- Alexander Strauss: Obstetrics Basics. Springer Verlag, Heidelberg 2006, ISBN 978-3-540-25668-7 .
- World Health Organization : WHO recommendations: intrapartum care for a positive childbirth experience . 2018, ISBN 978-92-4-155021-5 , http://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/
