Takmaz et al. enrolled 39 women where the fundal pressure maneuver was applied and 47 women who delivered spontaneously without the maneuver. The authors found that the Kristeller maneuver is associated with a higher risk of levator ani muscle defects, and in particular a significantly higher anteroposterior hiatal diameter during rest, Valsalva maneuver, and pelvic floor muscle contraction. In 2012, we published an article that evaluated the effects of uterine fundal pressure on pelvic floor function 3 months after vaginal delivery. We enrolled 522 primiparous women divided into two groups: 297 women received the Kristeller maneuver with different indications (fetal distress, failure to progress, mother exhaustion), and 225 women constituted the control group. We did not find significant differences in terms of urinary or anal incontinence, genital prolapse, and pelvic floor strength, whereas mediolateral episiotomies, dyspareunia, and perineal pain were significantly higher in the Kristeller group. These data seem to confirm the role of episiotomies in developing perineal pain in the puerperium.
