Premium
What's a proper push? T he V alsalva manoeuvre revisited
Author(s) -
Mulder Femke E. M.,
Shek Ka L.,
Dietz Hans P.
Publication year - 2012
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.2012.01446.x
Subject(s) - medicine , descent (aeronautics) , surgery , urology , physics , meteorology
In daily practice, the V alsalva manoeuvre is used to assess pelvic organ prolapse, virtually always without standardisation of pressure. We undertook a study to determine maximum pressures reached and pressures required to obtain 80% of maximal pelvic organ descent, to investigate the need for such standardisation. Clinical data and ultrasound data sets of 75 women seen for urodynamic testing were reviewed retrospectively, with three V alsalva manoeuvres registered per patient. Maximum rectal pressures generated during V alsalva were 107 cm H 2 O on average (range, 45–190 cm H 2 O ). Ninety‐seven percent of all women managed to reach pressures ≥60 cm H 2 O . On average, 80% of maximal bladder neck descent was reached at 56 cm H 2 O , 80% of maximal pelvic organ descent at 38 cm H 2 O . Our results imply that virtually all patients were able to generate pressures resulting in ≥80% of maximal pelvic organ descent. This implies that standardisation of V alsalva pressures for prolapse assessment may be unnecessary.