LA MANOVRA DI MUELLER-HILLIS MODIFICATA SECONDO MARCH COME INDICE PROGNOSTICO DI PARTO VAGINALE NEL SECONDO STADIO DEL TRAVAGLIO

INTRODUCTION Predictability of anomalies in the second stage of labor has always been a debated purview in Midwifery, mostly about what concerns cephalopelvic disproportion. In 1885/1886 Mueller described a maneuver to perform before labor that was about performing a fundal pressure by an assistant and assessing the presented part descent compared to ischial spines during vaginal exploration. In 1930 Hillis made it practicable by only one practitioner. Prospective studies on Mueller-Hillis maneuver weren’t performed until 1993. The first one was carried out by M. John Thorp, who did not found any consistent evidence about its usefulness. Afterwards in 1996 Michael J. March published a study which affirmed positive predictive value of the modified maneuver of 100%. AIM OF THE STUDY The aim of this thesis is to assess if March modified Mueller-Hillis maneuver can nowadays be used as prognostic index of second stage labor anomalies, eventually supplemented by symphysis practicability. MATERIALS AND METHODS Questionnaires were given to ICP Ospedale dei Bambini V. Buzzi and Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Mangiagalli e Regina Elena delivery room midwives, doctors and medical students in order to investigate their knowledge about Mueller-Hillis maneuver and the existence of its possible historical record in clinical practice. Mueller-Hillis maneuver was performed on a convenience sample of laboring women, other data of them have been collected from their medical records in order to achieve second stage of labor evaluation. RESULTS Most health workers, even declared not to know this maneuver, regularly check presented part descent at full dilatation and refers to this information such clinical validity that makes them modify their care. March and modified Mueller-Hillis maneuver outcomes seem to be affected by parity, medical induction of labor, cervix dilatation at somministration of epidural analgesia; while negative outcomes are associated with extrapelvic level of presented part at the beginning of second stage of labor, second stage duration increase and operative or cesarean delivery.