Introduction
The Credé Maneuver, named after the German obstetrician Carl Siegmund Franz Credé, is a technique used in obstetrics to assist in the delivery of the placenta or to help express urine from the bladder.
Historical Background
Dr. Carl Credé developed this maneuver in the 19th century, and it has since been a significant contribution to the field of obstetrics. Originally, Credé’s work focused on the prevention of neonatal ophthalmia, but his maneuver has found its relevance in various obstetric procedures.
How to Perform Crede’s Maneuver
- Verify the advice to perform Crede’s maneuver.
- Gather necessary equipments such as gloves, bedpan/urinal.
- Confirm the patient’s identity as per hospital’s protocol.
- Explain the procedure to the patient to reduce fear and anxiety.
- For bedridden patients – place patient in fowler’s position and correctly position the bedpan or urinal. Make sure the patient is comfortable to promote relaxation.
- Place your palms flat on the patient’s abdomen just below the navel. Then apply gentle firm pressure and move downwards towards the symphysis pubis. Perform this technique several times to stimulate voiding reflex.
- Next, apply final pressure directly over the bladder.
Method and Application
Delivering the Placenta
The Credé Maneuver is primarily used to aid in the delivery of the placenta following childbirth. This is particularly useful in cases where the placenta does not detach on its own. The procedure involves the following steps:
- The practitioner places a hand on the lower abdomen, just above the pubic bone, and applies gentle but firm pressure downwards and backwards.
- This pressure helps to stimulate uterine contractions, which in turn can assist in the expulsion of the placenta.
Expressing Urine
In urology, the Credé Maneuver is also used to help patients who have difficulty in voiding their bladder. The steps include:
- The practitioner or patient places both hands over the bladder area.
- They then apply gentle, consistent pressure downwards to assist in the expulsion of urine.
Considerations and Cautions
While the Credé Maneuver can be beneficial, it is crucial to use it correctly to avoid complications. In the context of placental delivery, improper application can lead to uterine inversion or damage. For bladder expression, it should be performed carefully to prevent injury to the bladder or urethra.
Nursing Care of Patients Undergoing the Credé Maneuver
The Credé Maneuver is a technique used in various medical fields, including obstetrics and urology, to aid in the expulsion of the placenta after childbirth and to assist patients in voiding their bladder. This document provides a comprehensive guide for nurses on the appropriate care and management of patients undergoing the Credé Maneuver.
Indications for the Credé Maneuver
Placental Delivery
In obstetrics, the Credé Maneuver is predominantly used to facilitate placental detachment and expulsion following childbirth. It is especially useful in instances where the placenta does not separate naturally.
Urine Expression
In urology, the Credé Maneuver helps patients who encounter difficulties in bladder voiding. This may be due to various conditions such as neurogenic bladder, spinal cord injuries, or certain post-surgical situations.
Procedure
Delivering the Placenta
The practitioner places a hand on the lower abdomen, just above the pubic bone, and applies gentle but firm pressure downwards and backwards. This pressure helps to stimulate uterine contractions, which can assist in the expulsion of the placenta.
Expressing Urine
The practitioner or patient places both hands over the bladder area and then applies gentle, consistent pressure downwards to assist in the expulsion of urine.
Nursing Care Considerations
Pre-Procedure Preparation
- Assess patient history and condition to ensure the Credé Maneuver is suitable.
- Obtain informed consent from the patient or their legal guardian.
- Explain the procedure to the patient, including its purpose and what they can expect to feel.
- Ensure the patient is in a comfortable and appropriate position for the procedure.
During the Procedure
- Monitor the patient’s vital signs, including heart rate, blood pressure, and respiratory rate.
- Observe the patient for any signs of discomfort or distress and provide reassurance as needed.
- Ensure that the practitioner performs the maneuver with gentle and consistent pressure to avoid complications.
- In the case of placental delivery, closely monitor the amount of bleeding and the condition of the uterus.
Post-Procedure Care
- Continue to monitor the patient’s vital signs and overall condition.
- Assess the patient for any complications such as bleeding, uterine inversion, or bladder injury.
- Provide appropriate pain relief and comfort measures.
- Educate the patient on signs of complications and when to seek further medical attention.
Potential Complications and Management
For Placental Delivery
- Uterine Inversion: Improper application of the maneuver can lead to this serious complication. Immediate medical intervention is required.
- Excessive Bleeding: Monitor the patient closely and be prepared to administer medication or interventions as needed.
For Urine Expression
- Bladder or Urethral Injury: Ensure the pressure applied is gentle and consistent to avoid injury.
- Urinary Tract Infections: Maintain sterile technique and educate the patient on hygiene practices.
REFERENCES
- Capezuti, E., Zwicker, D., & Mezey, M. (2007). Evidence-Based Geriatric Nursing Protocol for Best Practice (3rd ed.). Springer Pub. Co.
- Lee AHX, Phillips AA, Squair JW, et al. Alarming Blood Pressure Changes During Routine Bladder Emptying in a Woman with Cervical Spinal CordInjury (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798923/). Spinal Cord Ser Cases. 2017 Dec 28;3:17101.
- Ummu, Crede’s Maneuver |Indication |How To Perform, December 28, 2023, https://nurseship.com/credes-maneuver/
- Quevado J, Smith J, Cuccurullo S. Neurogenic Bowel & Bladder. In: Maitin IB, Cruz E. eds. CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw Hill; 2014.
- Singh R, Rohilla RK, Sangwan K, et al. Bladder Management Methods and Urological Complications in Spinal Cord Injury Patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051121/. Indian J Orthop. 2011 Mar;45(2):141-7.
- Taweel WA, Seyam R. Neurogenic Bladder in Spinal Cord Injury Patients (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467746/). Res Rep Urol. 2015 Jun 10;7:85-99.
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