Muller-Hillis maneuver: value in predicting dystocia - Tips from Other Journals

Date: March, 1994

The Muller-Hillis maneuver has traditionally been used to screen for dystocia during labor. As first described by Muller in 1886, the method requires an examiner to determine descent of the presenting part while an assistant applies fundal pressure. In the contemporary version, modified by Hillis in 1930, only one operator is needed to apply the fundal pressure and assess the pelvic station achieved on descent. Although the maneuver is widely used in clinical practice, it has not been prospectively studied. Thorp and colleagues examined the value of the maneuver in predicting dystocia during labor.

Muller-Hillis maneuvers were performed on 106 patients in active labor by a single perinatologist at a university medical center. Patient selection was based on availability of the physician. Labor was defined as cervical effacement of at least 90 percent and regular uterine contractions. Only women with singleton pregnancies in cephalic presentations with no known medical or obstetric complications were assessed. Staff members were unaware of the results of the assessment. Following delivery, an independent evaluator correlated the predictions made by the maneuver with the actual delivery outcomes.

Of the 106 patients, 25 (23.6 percent) were assessed as having no descent (positive test result) during the Muller-Hillis maneuver. No significant differences existed between patients with no descent and those with descent in terms of outcome of labor or demographic or obstetric variables such as age, race, maternal weight, gestational age or parity. Even when parity was considered in the analysis, lack of descent failed to predict an increased risk of abdominal delivery, use of forceps or vacuum extractor, prolonged second stage, need for oxytocin or abnormal progress during labor.

Although it is difficult to accurately assess a maneuver that depends on subjective assessment made by a single clinician during labor, the authors believe this study provides evidence that the Muller-Hillis maneuver does not predict dystocia. The authors seriously challenge the use of this maneuver in clinical practice and call for its use to be discontinued. (Obstetrics and Gynecology, October 1993, vol. 82, p. 519.)

EDITOR'S NOTE: With increasing emphasis on effective and efficient clinical practice, many established protocols and practices are being challenged. Objective studies of utility such as this one may be difficult to carry out but are essential. As a result of this study, clinical judgments based on the Muller-Hillis maneuver must be regarded as unreliable. - Anne D. Walling, M.D.

COPYRIGHT 1994 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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