Incidence Of Episiotomy Research Articles

Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10 Years: A Mixed-Methods Study.

To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives. Mixed-methods study. A tertiary university public maternity hospital, Paris, France. All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician-gynaecologists and midwives. Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi-structured interview with 20 obstetricians and midwives, with an interview guide. Obstetric anal sphincter injuries. The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10-year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09-1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS. Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.

Ensuring ethical maternal care: Addressing episiotomy trends in Pakistan.

Madam, The use of routine episiotomies, particularly those performed without consent, is a concerning and escalating trend during childbirth in Pakistan. An Episiotomy is a surgical incision in the pelvic floor to enlarge the vaginal opening during labour. The incision is performed under local anaesthetic with scissors. It is deemed necessary only under certain conditions: abnormal progression of labour, suspected foetal distress, vacuum or forceps childbirth, and shoulder dystocia.1,2 Despite the WHO’s recommendation of an episiotomy rate of less than 10% to be considered safe, the rates are disproportionately high in Pakistan. This prompts the need for improved maternal care that is responsible, accountable, and consensual.3 The need for respectful maternal care is crucial in Pakistan. A study conducted in Rawalpindi analysed data from 124798 deliveries and found an 80% incidence of routine episiotomies during normal vaginal deliveries in primigravida cases.3 Another cross-sectional study conducted in Karimabad on 235 patients, also revealed an alarming prevalence of episiotomies, with a rate of 78%.4 These rates differ significantly from those of other countries, such as 17% in New Zealand and 36.5% in Norway, underscoring the potential overuse of episiotomies beyond medical need in Pakistan. Cultural beliefs and a lack of adequately trained staff likely exacerbate this disparity.2,3 Furthermore, increasing episiotomy rates can adversely impact emotional well-being, cause perineal trauma, difficulty in breastfeeding, infection, and delayed healing.2 The intensity of these impacts and the high incidence of episiotomy highlight the need for comprehensive reforms in maternal care practices to ensure the safety and well-being of women. To address this issue, it is imperative to adopt a multifaceted approach that prioritizes informed consent and aims to curb the increasing trend of episiotomies. A commonly presumed benefit of an episiotomy is the prevention of advanced tears; yet, a randomized control trial on 676 patients found no association between decreased use of episiotomy and significant prevalence of severe tears.5 This stresses the need to shift to a policy of selective episiotomies like that implemented in Vietnam. The approach encompasses allocating a budget for routine training of staff, regularly recording rates of episiotomy/tears and including updated guidance about the use of episiotomies within the curriculum.2 Furthermore, when performing an episiotomy patients must be fully informed and individually consented, written or verbal. Opt-out consent may apply in emergencies.1 Such interventions can help ensure higher maternal care standards within Pakistan.

Antenatal Anovaginal Distance, a Potential Indicator of Perineal Damage during Pregnancy.

Perineal injuries, including episiotomies and spontaneous tears, are common complications during childbirth, often leading to significant discomfort and prolonged recovery for women. This retrospective observational cohort study aimed to explore the relationship between antenatal anovaginal distance (AVD) and the incidence of perineal injuries in a cohort of pregnant women evaluated for pelvic floor health at 28 to 32 weeks of gestation. Conducted at the University Hospital of Padua over 18 months, the study included 416 women who underwent vaginal delivery at term. Based on AVD, the study participants were divided into two groups: AVD-N group, which included 252 patients with AVD ≥ 2 cm, and the AVD-R group, which included 164 with AVD < 2 cm. The results of the pelvic floor assessment and those related to childbirth were then examined in relation to AVD (reduced vs. normal). The study found that women with reduced AVD were more likely to experience perineal injuries. Specifically, the incidence of episiotomy and severe perineal tears (3rd and 4th degree) was significantly higher in the reduced AVD group (p < 0.05). Furthermore, a lower AVD was associated with increased perineal muscle hypertonicity and a higher likelihood of operative delivery with episiotomy. Logistic regression analysis confirmed that reduced AVD was an independent risk factor for perineal injuries, regardless of other maternal or neonatal characteristics. These results suggest that AVD measurement during pregnancy may help identify women at higher risk of perineal trauma, enabling more personalized obstetric care to mitigate these outcomes.

Evaluation of the Effectiveness of Obstetric Lubricant Gel in Labor in Nulliparous and Primiparous Women: A Randomized Controlled Study

Aim: Our hypothesis was that lubricating gels used at the beginning of the active phase of labor could reduce the incidence of episiotomies and shorten the duration of labor. This study aims to investigate and confirm this theory with a randomized controlled trial. Material and Methods: A prospective randomized controlled trial was conducted at obstetrics and gynecology department of a university hospital between January 2017 and April 2017. The study included 102 nulliparous and 93 primiparous singleton pregnancies. 50 primiparous women and 47 nulliparous patients were randomly assigned to the obstetric gel group. Obstetric gel was applied to participants in the study groups at the beginning of the active phase of labor. Outcomes were episiotomy rates and duration of labor. Results: Episiotomy rates were significantly lower in nulliparous obstetric gel group (36.1% and 63.6%, p=0.005). The duration of the active phase of the first and second stage of labor was significantly lower in the obstetrical gel groups compared to the control groups in both parities (150 ± 86 and 203. 5 ± 134, p=0.021, 28.8 ± 18.2 and 62.6 ± 53.8, p

Analysis of episiotomy incidence and risk factors in vaginal deliveries: a single-center

IntroductionEpisiotomy is a surgical procedure involving the enlargement of the posterior vagina to facilitate the delivery of the baby. This study aims to further investigate the associated risk factors for episiotomy and the specific indications for its use in spontaneous labor. MethodologyThis institutional-based cross-sectional study was conducted among 349 vaginal births with a ratio of 1:4 from January 2020 to December 2020. We recruited study participants using consecutive sampling techniques. The sample size was calculated with a hypothesis test for two population proportions (one-sided test formula). Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables. ResultsIn our multivariate analysis, it was found that pregnant women who underwent instrumental delivery (P-value=.00; OR=25.63; 95% CI: 5.76–114.0) and those with fetal birth weight >3,000 grams (P-value=.00; OR=11.31; 95% CI: 3.96–32.32) had the highest risk of undergoing an episiotomy. Subsequently, the duration of the second stage of labor >30 minutes (P-value=.049; OR=16.34; 95% CI: 1.01–264.48) was associated with a slightly increased risk of episiotomy. Fetal head circumference >34 cm was not found to be risk of an increased risk of episiotomy in this study. However, pregnant women aged >30 years (P-value=.049; OR=0.306; 95% CI: 0.94–0.99) showed a reduced risk of episiotomy. ConclusionThe prevalence of episiotomy practice in this study exceeds the recommended threshold set by the World Health Organization (WHO). Instrumental delivery, high birth weight, and prolonged second-stage labor emerged as significant factors influencing episiotomy practice. Hence, further interventions are warranted to mitigate the prevalence of episiotomy practice.

Effects of Perineal Warm Compresses during the Second Stage of Labor on Reducing Perineal Trauma and Relieving Postpartum Perineal Pain in Primiparous Women: A Systematic Review and Meta-Analyses.

Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.

Perineal Massage and its Effects on the Incidence of Episiotomy and Perineal Trauma during Second Stage of Labor

Perineal Massage and its Effects on the Incidence of Episiotomy and Perineal Trauma during Second Stage of Labor

Influence of Entonox (mixture of 50% nitrous oxide and 50% oxygen) on physiological labor and neonatal outcome in own material.

The aim of the study was to compare maternal and neonatal outcome of delivery with inhaled anesthesia to delivery without pain control. Authors performed retrospective analysis of 260 term deliveries. In the study group (130 women) a mixture of nitrous oxide and oxygen was used. The control group included 130 patients who used no pain relief during delivery. In nulliparas the pain assessment in 11-points scale was similar in both groups, but the labor was longer (350 ± 152 vs 228 ± 113 minutes; p < 0.001 for the first stage and 46 ± 37 vs 18 ± 18 minutes; p < 0.001 for the second stage), episiotomy incidence was higher (81.4% vs 41.9%; p < 0.001) and perineal laceration lower (2.3% vs 25.7%; p < 0.001) in the study group. In multiparas the pain assessment was lower in the study group (5 vs 7 points; p = 0.006), oxytocin was administered more frequently (45.5% vs 21.4%, p = 0.011), but labor duration was the same in both groups. Episiotomy was more frequent (61.4% vs 37.5%, p = 0.02), but there was no difference in perineal laceration. Apgar score was the same in the study and control group. We found that Entonox prolongs labor significantly and increases frequency of episiotomy in primiparas with no clear analgesic effect. Offering Entonox to the patients giving birth for the first time is thus questionable. In multiparas it has a good analgesic effect but increases probability of episiotomy with no significant influence on perineal tear, what seems not very high cost of decreased pain related to delivery.

Benefits of a prenatal physical preparation program on the condition of the perineum and Apgar scores at birth

Background/Aim: The practice of physical activities among pregnant women remains a significant health challenge in the Democratic Republic of Congo. The aim of this study was to examine the influence of prenatal physical preparation on the state of the perineum and Apgar scores at birth. Methods: This experimental study included 89 pregnant women, with 38 of them subjected to an 8-month prenatal physical preparation program that involved weekly sessions of 45 min of low to moderate intensity. The remaining 51 pregnant women did not participate in the program and served as a control group. The variables of interest, including episiotomy, perineal tear, intact perineum, and Apgar scores, were measured, and the chi-square statistical test was used to compare the two study groups. P-values &lt;0.05 were considered statistically significant. Results: The present study reveals that the women in labor in the experimental group (EG) had fewer perineal tears and less episiotomy compared to the control group (CG). Specifically, the incidence of perineal tear was significantly lower in the EG (5.3%) than in the CG (27.5%) with a P-value of 0.001, while the incidence of episiotomy was also significantly lower in the EG (7.9%) than in the CG (25.5%) (P=0.032). Furthermore, a significant number of women in the EG (86.8%) had an intact perineum compared to those in the CG (47%) (P=0.001). Conclusion: The delivery parameters of pregnant women who followed a prenatal physical preparation program underwent significant changes compared to those who did not participate in the program. These findings suggest that the program should be continued to improve the care of women who have given birth.

Investigating antenatal pelvic floor training using a vaginal balloon device in Czech women

Background/Aims A vaginal balloon device for antenatal pelvic floor training may reduce the incidence of negative outcomes from vaginal birth on women's pelvic health. This study's aims were to investigate the effect of antenatal vaginal training on birth-induced levator ani muscle avulsion and to analyse the relationship between use of a balloon device for training and the duration of the second stage of labour, incidence of episiotomy and birth-induced perineal trauma. Methods In this prospective cohort intervention study, 123 nulliparous women were divided into two groups: 64 training with the device antenatally (intervention) and 59 women receiving normal antenatal care (control). Clinical data were collected 10 weeks after birth and differences in the incidence of levator ani muscle avulsion, episiotomy, perineal tears and other birth injuries, as well as the duration of the second stage of labour, were assessed using two-tailed tests. Results Training with the device was not associated with a reduction in the incidence of levator ani muscle avulsions (P=0.82), and the device did not shorten the duration of the second stage of labour (P=0.63). However, it was associated with a reduction in the frequency of episiotomies (cases: 34% vs controls: 59%; P=0.007). There was no significant difference in the incidence of perineal tears (P=1.00) or other birth injuries (P=0.50). An obstetric anal sphincter injury occurred in only one case, in a woman in the control group. Conclusions The use of an antenatal training device in nulliparous women with cephalic vaginal birth at term is not associated with better pelvic health outcomes. However, it may reduce the frequency of episiotomies.

Mode of vaginal delivery in breech presentation and perinatal outcome.

To compare a perinatal outcome in breech presentation depending on different modes of vaginal breech delivery (VBD). Over the course of 13 years (2005-2018), perinatal outcome of newborns was compared among 98 singleton pregnancies (64 term pregnancies and 34 preterm pregnancies) completed with VBD divided into six groups depending on the mode of delivery used (Bracht, Müller, Thiessen, classical arm release, Mauriceau-Levret-Veit-Smellie (MLVS), and Vermelin´s spontaneous vaginal delivery). Also, maternal demographic parameters were observed. Of 98 singleton pregnancies, the most frequently used mode was Thiessen (35.71%), followed by MLVS technique (25.51%), Bracht (22.45%), Vermelin (13.27%), classical arm release (2.04%) and Müller (1.02%). Newborns with Apgar score ≤ 7 at 5 min. were transferred to the neonatal intensive care unit (NICU), which included 15.31% of newborns (total 15 newborns: 1 term and 14 preterm newborns). The incidence of episiotomy was 63.27%. Seventy-point five percent of women included in the study were ≤ 35 years of age, and 37.76% were multiparas. Delivery was induced in 7.14% cases. Less- traumatizing actions during VBD have less harmful consequences and better perinatal outcome. Lower Apgar score was noted with the aggressiveness of the mode of VBD.

Perineal Massage for Prevention of Perineal Trauma and Episiotomy During Labor: A Systematic Review and Meta-Analysis.

Objective: Vaginal births are associated with a certain degree of trauma to the genital tract, with significant short-term and long-term morbidity. Awareness of morbidity following perineal trauma has led to application of different interventions during the late first stage and second stage of labour to prevent severe perineal trauma. This includes techniques such as perineal massage, warm and cold compresses, and perineal management techniques. Objective of this meta-analysis is to evaluate the effect of perineal massage during the late first stage and second stage of labour on the rate of episiotomy and risk of perineal trauma. Materials and methods: Electronic databases (PubMed, Scopus, Cochrane Library and Science Direct) were searched from inception until August 2021. We included randomized controlled trials (RCTs) which compares perineal massage during labor (i.e., intervention group) with a control group in women with singleton gestation and cephalic presentation at ≥36 weeks. The primary outcome was severe perineal trauma and the rate of episiotomy. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI). Results: Ten trials including 4,088 women were analyzed. Women with perineal massage during labor had a significantly lower incidence of severe perineal trauma (RR: 0.52, 95% CI 0.29- 0.94) compared to the control group. The incidence of episiotomy was lower in the perineal massage group (RR: 0.71, 95% CI 0.52-0.98 p < 0.01) but was statistically insignificant (P>0.05). Conclusion: The finding of meta-analysis showed that perineal massage during labor could be effective in reducing the risk of severe perineal trauma, such as third- and fourth-degree spontaneous lacerations during labor.

Hands-on vs hands-off technique for the prevention of perineal injury: a randomized clinical trial

Perineal trauma after vaginal delivery is common and is associated with severe morbidity, including incontinence, pelvic pain, and sexual dysfunction. Morbidity is mainly related to third- or fourthdegree lacerations. This study aimed to test the hypothesis that in nulliparous women with singleton pregnancies at term, hands-off technique during spontaneous vaginal delivery could reduce the rate of perineal laceration. This was a parallel-group, nonblinded, randomized clinical trial. Nulliparous women in spontaneous labor with singleton pregnancies and vertex presentation admitted to the labor and delivery room between 37 0/7 and 42 0/7 weeks of gestation were eligible, and were randomized in a 1:1 ratio to receive hands-off technique (intervention group) or hands-on technique during pushing in the second stage of labor. The primary outcome was perineal laceration (any degree). The effect of hands-off technique on each outcome was quantified as relative risk with 95% confidence interval. A total of 70 women were enrolled in the trial. Perineal lacerations (any degree) occurred in 15 of 35 (42.9%) women in the intervention group and 33 of 35 (94.3%) women in the control group (relative risk, 0.45; 95% confidence interval, 0.31-0.67). Hands-off technique was also associated with significantly decreased incidence of episiotomy (relative risk, 0.36; 95% confidence interval, 0.14-0.88), first-degree lacerations (relative risk, 0.41; 95% confidence interval, 0.20-0.87), and second-degree lacerations (relative risk, 0.43; 95% confidence interval, 0.19-0.99). There was no significant between-group difference in third- and fourth-degree lacerations, but the trial was not powered for these outcomes. In nulliparous women with singleton pregnancies at term, hands-off technique reduces the rate of perineal lacerations.

Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial.

Perineal massage increases elasticity of myofascial perineal tissue and decreases the burning and perineal pain during labour, thus optimising child birth, although an application protocol has not been standardised yet. The objective of this study is to determine the efficiency of massage in perineal tear prevention and identification of possible differences in massage application. Total of 90 pregnant participants were divided into three groups: perineal massage and EPI-NO® device group, applied by an expert physiotherapist, self-massage group, where women were instructed to apply perineal massage in domestic household, and a control group, which received ordinary obstetric attention. Results: The results showed significant differences among the control group and the two perineal massage groups in perineal postpartum pain. Correlations in perineal postpartum pain, labour duration and the baby’s weight were not statistically significant. Lithotomy posture was significantly less prevalent in the massage group than in the other two; this variable is known to have a direct effect on episiotomy incidence and could act as a causal covariate of the different incidence of episiotomy in the groups. Perineal massage reduces postpartum perineal pain, prevalence and severity of perineal tear during delivery.

Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study

BackgroundWhether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes.Methods This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid.ResultsThere were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group.Conclusions0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine.Trial registrationClinical Research Information Service with registration number ChiCTR2100045162. Registered 7 April 2021.

Perineal Body Length as a Predictor of Labor Progress

Background: Trauma to the genital tract does occur in about two thirds of women during the first and subsequent deliveries and the majority of these traumas require suturing. There is a continuous inverse relationship between the rate of episiotomy and the rate of spontaneous trauma. Perineal trauma is associated with a high prevalence of certain health problems. Perineal pain is the most significant with its impact on daily activities. Objective: The aim was to assess the relationship between the length of perineal body and mode of delivery, need for episiotomy and possibility of perineal and vaginal tears needing repair. Patients and Methods: This study was conducted at Maternity Hospital, Faculty of Medicine, Zagazig University. All patients were subjected to the following: Complete history taking, complete general examination and antenatal care. Procedure: The perineum was measured as the distance from the fourchette (the mid-point of the posterior edge of the vaginal interoitus at the muco-cutaneous junction) to the center of the anal orifice. Measurement was performed by trained research nurses using standard tape in dorsal lithotomy position. Results: This study showed that perineal tear, was present among 32.6% of the studied group.This study showed that need for episiotomy was 78.3%.The percentage of perineal tear was statistically lower among cases with perineal length > 4 cm than cases with perineal length 4 cm than cases with perineal length < 4 cm (64.7% and 86.2%). Women with shortened perineal body length (< 4 cm) had a higher chance of a perineal laceration. Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. The incidence of episiotomy and perineal tears were increased in patients with a perineal length of <4 cm.

The effect of epidural analgesia on maternal-neonatal outcomes: a retrospective study.

Epidural analgesia is commonly used for relieving labor pain incontemporary clinical practice. The rate of pregnant women who request epiduralanalgesia during labor has been increasing annually, leading to a debate on the effectof epidural analgesia on maternal or neonatal outcomes. The medical records of nulliparous women with a term singletonpregnancy from January to December 2019 at the Affiliated Hospital of ZunyiMedical University were retrospectively reviewed. The women were divided intothose who received epidural analgesia during delivery and those who did not receiveit. Maternal and neonatal outcomes were assessed. A total of 528 women met the inclusion criteria. The overall labor analgesiarate was 43.0% (227). Women with epidural analgesia had a significantly longersecond stage [34.5 (22.8-65.3) vs 27.0 (18.0-41.3) min, p < 0.001] and total durationof labor [698.5 (493.5-875.0) vs 489.5 (344.0-676.3) min, p < 0.001] compared withthose without epidural. There were no significant relationships between epiduralanalgesia and the normal vaginal delivery rate, the incidence of episiotomy, and otheradverse maternal or neonatal outcomes (p > 0.05). Epidural analgesia can prolong the second stage of labor, but this is no increased risk for both mother and neonate.

Effectiveness of Perineal Massage in the Second Stage of Labor in Preventing Perineal Trauma

OBJECTIVE: This study was aimed to investigate the effect of perineal massage in the second stage of labor in prevention perineal traumas during childbirth.STUDY DESIGN: This observational study was conducted with 171 nulliparous women delivered by vaginally between January 2017 and May 2019. All the patients managed by the selective episiotomy principle. All the patients were divided into two groups: the perineal massage group and the control group. The perineal massage was performed during the second stage of labor until the baby's head was birth. The control group received routine labor care. In the case of threatening tears in any patient and at the preference of the midwife, mediolateral episiotomy was performed. Following childbirth, the perineum and vagina were examined for perineal tears and episiotomy by the midwives.RESULTS: The length of the second stage of labor was significantly lower in the massage group (36±19 minute) compared with the control group (46±25 minute, p=0.024). Twenty-five women (28.8%) in the massage group had intact perineum after vaginal birth, compared with five (6.0%) in the control group (p=0.003). The rate of first- and second-degree perineal tears are higher in the massage group [28 patients (32.2%) and 9 patients (10.3%), respectively] than in the control group [10 patients (11.9%) and 5 patients (6.0%), respectively, p&lt;0.001]. The incidence of episiotomy was significantly lower in the massage group (25 patients, 28.7%) than in the control group (64 patients, 76.1%, p&lt;0.001). CONCLUSION: Perineal massage should be considered a routine intervention to reduce the incidence of perineal trauma.

'Please Squeeze': A novel approach to perineal guarding at the time of delivery reduced rates of obstetric anal sphincter injury in an Australian tertiary hospital.

Over the last decade the incidence of obstetric anal sphincter injuries (OASIS) has been steadily increasing locally and internationally. Investigations into reducing rates, and the long-term complications, of OASIS are required. To determine if applying a new method of perineal guarding at the time of delivery reduces the incidence of OASIS at an Australian tertiary hospital. A retrospective audit was performed for the three years prior to and following mandatory introduction of a new method of perineal guarding. The novel 'Please Squeeze' technique involved placement of the accoucheur's thumb and index finger just above the line of the posterior fourchette at crowning and bringing them firmly one centimetre postero-medially to reduce tension. Demographic data were extracted from the unit's obstetric database (ObstetriX). There were 9453 deliveries prior to, and 9805 deliveries following commencement of 'Please Squeeze', with no difference in the incidence of caesarean (30.4% vs 30.3% P=0.87) or forceps (6.3% vs 5.8% P=0.14) between groups. The incidence of primiparas (P=0.005), ventouse (P<0.001) and spontaneous vaginal deliveries (SVD) (P=0.005) between groups. There was a clinically important 20% reduction in the incidence of OASIS across all vaginal deliveries from 3.5% to 2.8% (P=0.006). In SVD, there was a 20% decrease in OASIS from 2.4% to 2.2% (P=0.02), and a 14% decrease in OASIS with assisted vaginal delivery from 8% to 7.3% (P=0.002). The incidence of episiotomy increased 16% (P<0.001). The novel 'Please Squeeze' perineal guarding method contributed to a reduced incidence of OASIS in an Australian tertiary hospital.

Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials.

Most vaginal births are associated with trauma to the perineum. The morbidity associated with perineal trauma can be significant, especially when it leads to third- and fourth-degree perineal tears. We hypothesized that antenatal perineal massage could decrease the incidence of perineal trauma, particularly severe perineal tears and other postpartum complications. We searched four different databases from inception until August 2019 for the available trials. We included randomized controlled trials (RCTs) which assessed the effect of antenatal perineal massage (intervention group) versus control group (no antenatal perineal massage) in perineal trauma patients. Data were extracted from eligible studies and meta-analyzed using RevMan software. Primary outcomes were the risk of episiotomies and perineal tears. Secondary outcomes were perineal pain, second stage of labor duration, wound healing, anal incontinence, and Apgar scores at 1 and 5min. Eleven RCTs with 3467 patients were analyzed. Women who received antenatal perineal massage had significantly lower incidence of episiotomies (RR = 0.79, 95% CI [0.72, 0.87], p < 0.001) and perineal tears (RR = 0.79, 95% CI [0.67, 0.94], p = 0.007), particularly the risk of third- and fourth-degree perineal tears (p = 0.03). Better wound healing and less perineal pain were evident in the antenatal perineal massage group. Antenatal perineal massage reduced the second stage of labor duration (p = 0.005) and anal incontinence (p = 0.003) with significant improvement in Apgar scores at 1 and 5min (p = 0.01 and p = 0.02). Antenatal perineal massage is associated with a lower risk of severe perineal trauma and postpartum complications.