Effect of fundal pressure on maternal to fetal microtransfusion at the time of cesarean delivery

Aim:  To determine if fundal pressure at the time of cesarean delivery increases the amount of transplacental microtransfusion from mother to infant. Methods:  Pregnant women undergoing cesarean delivery were randomized to the standard uterine fundal pressure at the time of hysterotomy versus no fundal pressure. Babies of patients randomized to no fundal pressure were delivered with either vacuum or forceps. The proportion of placental alkaline phosphatase between maternal and cord blood was then determined and compared between the groups. Results:  Eighty-four women were randomized into two groups (44 in the pressure and 40 in the no pressure groups). There was no difference between the groups in demographic variables, or indications for cesarean. There was no difference in percentage of umbilical cord blood placental alkaline phosphatase between the pressure and no pressure groups (0.06 ± 0.2 vs 10 ± 0.29 IU, P = 0.43). Conclusions:  Fundal pressure at the time of cesarean delivery does not increase the amount of transplacental microtransfusion, suggesting that modifying the method of cesarean would not decrease the chances of vertical transmission in HIV positive pregnant women.