Perineal Massage Research Articles

Third- and fourth-degree tears: A review of the current evidence for prevention and management.

Third- and fourth-degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third- and fourth-degree tears relative to countries of similar economic development. We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third- and fourth-degree perineal tears in Australian maternity centres. We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Twenty-six systematic reviews were identified. The most common risk factors reported in the literature for third- and fourth-degree tears included primiparity, mother's ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births. Third- and fourth-degree perineal tears are associated with immediate and long-term implications for women and health systems. Evidence-based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do.

A systematic review of clinical practice guidelines on uncomplicated birth.

Clinical practice guidelines on uncomplicated birth provide clinical practice guidance and help to reduce unnecessary, non-evidence-based and potentially harmful intrapartum care practices. Little is known about the trustworthiness and consistency of these guidelines. To appraise guidelines relevant to uncomplicated birth, and summarise consensus and non-consensus recommendations. Eight literature databases and the websites of guideline development institutions and organisations of obstetricians, gynaecologists and midwives were searched from January 2008 to October 2018. Guidelines that: reported in Chinese or English; labelled guideline, or recommendation, or consensus, or practice parameter, or position paper/stand; with uncomplicated birth being the primary objectives or comprised chapter(s); and were the most recently published or updated versions. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesised consensus and non-consensus recommendations using the content analysis approach. Eleven guidelines met the inclusion criteria. The WHO and NICE guidelines were deemed to have the highest methodological quality. Twenty-three discrepant recommendations and 39 groups of unanimous recommendations (containing 113 individual ones) were identified, among which 14 recommendations including eating and drinking as desired, prophylactic uterotonics, routine amniotomy and episiotomy were included in five or more guidelines. Perineal massage, uterine massage, active or expectant management at the third stage and use of hands-on or hands-poised technique were identified as the main discrepant recommendations. Two guidelines with higher methodological quality and key clinical guideline recommendations, including both consensus and non-consensus ones, on uncomplicated birth were identified. Clinical guidelines of uncomplicated birth agree and disagree on several key recommendations.

Effect of Perineal Massage with Ostrich Oil on the Episiotomy and Lacerations in Nulliparous Women: A Randomized Controlled Clinical Trial.

Background:Perineal lacerations resulting from vaginal delivery may cause short and long complications, which lead to some problems in women after the delivery. Ostrich oil is safe for use in skincare and beauty products. The aim of this study was to examine the effect of perineal massage with Ostrich oil on the episiotomy and lacerations in nulliparous women.Materials and Methods:This single-blind randomized controlled trial was conducted on 77 nulliparous women referred to Razi Hospital in Qazvin (Iran) from May to December 2018. After screening of potential participants, 80 out of 105 pregnant women were selected by convenience sampling and were assigned into the intervention and control groups by block randomization technique. In the intervention group, participants received a perineal massage with Ostrich oil in the active phase and the second stage of labor. The rates of episiotomy and perineal laceration were compared between the two groups. Data were analyzed using Chi-square, t-test and Mann-Whitney.Results:Perineal massage with Ostrich oil in the intervention group significantly decreased the rate of episiotomy compared to the control group (χ2 = 18.32, df = 1, p < 0.001). However, there was no statistically significant difference in perineal lacerations between the two groups.Conclusions:The results revealed that perineal massage with Ostrich oil could be recommended as an effective, safe, and inexpensive method to improve the rate of episiotomy in vaginal delivery. Perineal massage can be performed by midwives in the first and second stages of labor.

Perineal Travmayı Azaltmaya Yönelik Alternatif Yöntemler

Episiotomy, one of the causes of perineal trauma, is one of the world’s leading obstetric surgical practices that have increased significantly during the 20th century. The American Gynecology and Obstetric Union 2016 does not recommend the routine application of episiotomies during spontaneous vaginal deliveries and recommends it in cases where a rapid delivery of the fetus is required, in operative vaginal deliveries and in shoulder dystocia cases. In current studies, the episiotomy frequency in the world varies between 50% and 95% for nulliparas and 6-20% for multiparas. In our country, studies on the frequency of episiotomy are limited, but the application frequency of episiotomy is 90-99% for nulliparas and 50% -75% for multiparas in those studies. Today, much current evidence suggests that limited episiotomy is more protective than routine episiotomy in terms of perineal trauma. In this respect, there are various applications in the literature aimed at reducing the incidence of perineal trauma. These applications include perineal massage, warm application to the perineum, birth positions, hand maneuvers and push out. These methods are methods that reduce perineal trauma. The practitioners of these methods are midwives and obstetric and gynecological nurses who have a very important role and responsibility at/ during the vaginal birth. For this reason, this review study was carried out in order to increase the sensitivity to the subject and to guide health professionals by drawing attention to the alternative methods in order to reduce perineal traumas such as episiotomies and lacerations in accordance with the related current literature.

Mothers' awareness and acceptability of antenatal perineal massage: a cross-sectional study

Mothers' awareness and acceptability of antenatal perineal massage: a cross-sectional study

1201: Effect of antepartum perineal massage on perineal tears during first vaginal delivery

1201: Effect of antepartum perineal massage on perineal tears during first vaginal delivery

Effect of Perineal Massage on the Rate of Episiotomy

Objective: Women frequently experience perineal damage after a vaginal delivery. This study aimed to investigate the effect of perineal massage (PM) during labor on the need for episiotomies. Materials and methods: The study is a double-blind randomized clinical trial conducted with 99 patients (n=49 controls; n=50 cases). Participants comprised of nulliparous pregnant women aged from 18 to 35 years in the 37th-42nd week of gestation, who referred to the Um-al-Banin Hospital of Mashhad from July to October 2018, for vaginal delivery and were in the active stage of labor. Allocation to study groups was based on a random allocation list generated by a software application. PM was performed for the cases in the active stage four times, each lasting for two minutes at intervals of half an hour. The massage was continued at the beginning of the second stage of labor for ten minutes. Control women received routine care. The delivery was practiced by a midwife who was blinded to the study groups and the performance or non-performance of massage. Data were analyzed in SPSS software version 16. Results: The need for episiotomy was significantly lower in the PM group than in the control group (p = 0.05). Spontaneous perineal tears were significantly higher in mothers of the PM group (p = 0.05. The spontaneous tear degree in the 20 mothers who did not require episiotomy (p = 0.5) and the degree of perineal tear in mothers who needed an episiotomy (n = 79; p = 0.1) were not significantly different in the two groups. In the PM group members who did not require episiotomy (n = 14) and the mother underwent a spontaneous tear, first-degree tears were more frequent than second-degree ones. The median duration of the active stage of labor until the stage completion was lower in the PM group than in the control group, although the difference did not reach statistical significance (p = 0.3). The median of the second stage duration in the control and intervention groups were 55 and 45 minutes, respectively, where the difference was significant (p = 0.002), and the median time of completion of the active stage until delivery in the PM group had reduced. Conclusion: PM had a significant impact on the reduction of the need for episiotomies and the duration of the second stage of labor. Thus, it can be suggested as a safe, simple, low-cost, and effective technique to reduce the perineal damage during delivery.

EFFECTIVENESS OF PERINEAL MASSAGE DURING PREGNANT WOMEN ON PERINEAL LASERATION

Women are entrusted with the task of becoming a mother who will later give birth to superior quality babies as the next generation to strengthen the nation's pillar towards a moral and dignified life and build a noble civilization. One indicator of improving maternal health is the reduction in maternal mortality associated with improving the quality of childbirth assistance. The Maternal Mortality Rate in Indonesia in 2015 reached 161 / 100,000 live births, still quite high from the target of 102 / 100,000 live births. Maternal mortality in Indonesia is still dominated by three main causes of death, namely bleeding, hypertension in pregnancy and infection. One of the main causes of bleeding is a tear in the birth canal, including the perineal laceration. Birth road tears are experienced by 85% of women giving birth. One preventive effort that can be done to prevent tears in the perineum during labor is perineal massage. Perineal massage aims to increase blood flow and increase the elasticity of the perineum. Increased perineal elasticity will prevent the occurrence of perineal tears and episiotomy. This study is an analytical study with a quasi-experimental design and prospective direction of investigation. The study population was all third trimester pregnant women in the working area of ​​the Kalasan Sleman Health Center. The sampling technique used a purposive sampling method that is sampling according to the considerations and criteria set by the researcher, the sample amounted to 40 pregnant (20 controls and 20 treatments). The results of the Mann Whitney SPSS 23 statistical analysis showed a 2-tailed significance value of 0.433> 0.05 which means Ha was rejected, thus there were no significant differences between the two groups. Whereas the mean treatment rank is 19.30 and the mean rank control is 21.70, which means there are differences in the average between the two groups.

The Effect of Perineal Massage on Perineal Status and Duration of Labor

&lt;pre&gt;Perineal rupture in postpartum mothers causes bleeding, pain, and high dependency on others after the birth. The preliminary study results showed that 68.81% of postpartum mothers experienced perineal rupture. The aim of this study was to determine the effect of perineal massage on perineal status and length of labor. It was quasi-experimental research with control group post-test only design. The population were all expectant mothers in the Yogyakarta Community Health Center. A sample of 60 respondents were divided into control and intervention groups using a random sampling method. The inclusion criteria were 20-35 years old, singleton pregnancy, spontaneous labor, and gestational age of 34-36 weeks. The study instrument used was an observation sheet. Data were analyzed using descriptive, t-test independent, Mann-Whitney’s, and linear regression test. Results. The results showed that perineal massage affects perineal status (p &amp;lt; 0.001) and the duration of stage I and stage II of labor (p &amp;lt; 0.001). Perineal massage affects perineal status and the duration of labor in the Yogyakarta City Community Health Center.&lt;/pre&gt;

Perineal massage and training reduce perineal trauma in pregnant women older than 35years: a randomized controlled trial.

The aim of this study was to evaluate the effectiveness of perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) prevention educational program in pregnant women above the age of 35 years to prevent perineal tear and episiotomy. A randomized parallel assignment study involved two groups of pregnant women at the obstetrics outpatient clinic 4weeks prior to their due date. The first group (n = 200) was educated to do digital perineal massage and pelvic floor muscle training and received an educational PFD prevention program. The second group (n = 200) received only the prevention education program. Occurrence of perineal laceration was reported at time of delivery as a primary outcome. Statistical analysis was done using the IBM SPSS computer program (Statistical Package for the Social Sciences; IBM Corp, Armonk, NY, USA), release 22 for Microsoft Windows. Delivery was significantly less complicated by perineal tear, episiotomy and postnatal pain in the first than in the second group (p < 0.05). Grades of perineal tear were mostly of first and second degree in the first group compared with the second group. We found a significantly lower need for analgesia and fewer ampoules required during the hospital stay in the first group (p < 0.001, 0.002, respectively). Performing antenatal digital perineal massage and PFMT in addition to health education is recommended to reduce perineal complications.

PENGARUH PIJAT PERINEUM PADA KEHAMILAN TRIMESTER III TERHADAP ROBEKAN PERINEUM PRIMIGRAVIDA DI PUSKESMAS JAGIR SURABAYA

Abstract : Perineal rupture may occur spontaneously (ruptured) or deliberately (episiotomy). An attempt to Flex the perineum perineum massage among others who haven't performed in clinics jagir. The objective of this research was to find out the effect of perineal massage during the third trimester of pregnancy on the prevention of primigravida perineal rupture in Community Health Center in Jagir -Surabaya. The research design was Quasi-experimental with post-test only group model. The population was all pregnant mothers - of primigravida physiologic category of the third trimester - who delivered at Community Health Center in Jagir Surabaya with its sample of 20 respondents, that is, 10 respondents of the treatment group and 10 respondents of the control group. The independent variable was perineal massage, and the dependent variable was perineal rupture. The data collection was carried out using SOP and partographic sheet / medical record. The data were analyzed by Mann Whintney test with α = 0.05. The Result of the research showed that almost all respondents (80.0%) did not experience perineal rupture in treatmen group and most (60.0%) of those respondents experiencing torn perineum were suffering from perineal tear in control group. The result of the statistic test using Mann Whitney showed p = 0.001 &lt;α = 0.05, then Ho was refused, meaning there was effect of perineal massage during the third trimester pregnancy on the prevention of primigravida perineal rupture at Community Health Center in ​​Jagir surabaya. Respondents who do the massage the perineum almost everything does happen rips therefore massage the perineum can Flex the perineum so as not happening rips the perineum. Therefore it was suggested that the health workers encourage the pregnant mothers to have perineal massage treatment during theperiod of maternity preparation.

Obstetric Anal Sphincter Injuries at Vaginal Delivery: A Review of Recently Published National Guidelines.

Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries. The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery. Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on "The Management of Third- and Fourth-Degree Perineal Tears," American College of Obstetricians and Gynecologists on "Prevention and Management of Obstetric Lacerations at Vaginal Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair." These guidelines were summarized and compared in terms of prevention and management of OASISs. Quality of evidence was also reviewed based on method of reporting for each guideline. This published evidence reflects the differences between the national recommendations on the prevention and management of OASISs. Especially, as for the prevention of OASIS, routine use of episiotomy is not recommended, whereas warm perineal compresses and perineal massage during the second stage of labor seem to have a protective role. In the management of OASIS, special care is needed during the repair process of the torn anorectal mucosa and the internal and external anal sphincter. The postoperative use of broad-spectrum antibiotics, oral laxatives, and analgesia is also recommended. Summarized guidelines can have an impact on special care in prevention and management of OASIS; this may support the reduction of morbidity associated with that entity.

Prevention and Management of Obstetric Perineal Lacerations

Vaginal deliveries vary widely in the trauma they may introduce to the pelvic floor as does the management of such trauma. Labor, operative deliveries, lacerations, and episiotomies all present unique risk factors for both acute and long-term pelvic floor complications. Of these risk factors, perineal lacerations are the most commonly encountered event that women experience during vaginal childbirth. This review attempts to analyze obstetric perineal lacerations, their management, and potential prevention strategies to enhance pelvic floor health. With standardized management based on evidence based strategies and care during both delivery and postpartum, clinicians can decrease higher order lacerations and their possible sequela. This review contains 12 figures, 1 table and 36 references Key Words: episiotomy, laceration, laceration repair, obstetric, operative delivery, perineal massage, prevention, pudendal block

Análise crítica sobre a utilização do Epi-No na gestação e parto

Atualmente são reportados métodos que poderiam favorecer o alongamento e prevenir as lesões do assoalho pélvico no parto vaginal, como a massagem perineal e o balão Epi-No. Esse dispositivo é bem aceito pelas pacientes, mas seus resultados para prevenção de episiotomias e lesões perineais são controversos. O objetivo desse estudo foi avaliar o propósito, método, frequência, ensino/orientação e resultados da utilização do Epi-No durante a gestação e parto. Foi elaborada uma revisão narrativa com levantamento de bibliografia disponível sobre o uso do Epi-No nas bases de dados PUBMED, BVS e SciELO em português e inglês. 837 artigos foram encontrados, nos quais apenas 9 atenderam aos critérios de inclusão. Informações desses artigos foram sintetizadas em quadros que contemplaram os aspectos considerados pertinentes. Fatores como o tempo, período, posicionamento e processo de ensino/orientação devem ser melhor descritos e padronizados para que seja possível investigar a eficácia de seu uso nos desfechos perineais no parto vaginal.

PENGARUH PIJAT PERINEUM SELAMA MASA KEHAMILAN TERHADAP KEJADIAN RUPTURA PERINEUM SPONTAN DI PMB SHINTA NUR ROCHMAYANTI, SSiT., M.Kes

Some of the factors that cause perineal rupture consist of maternal factors, fetal factors, and helper factors. A method of reduce perineal rupture is a perinel massage to promote heatlh, blood flow and elasticity of the perineum. Based on preliminary study at PMB Shinta Nur Rochmayanti, SSiT., M.Kes from June to September of 2017 there were 20 births per month, and 70% had spontaneous birthrate while 30% had no perineal rupture. The purpose of this study was to determine the effect of perineal massage during pregnancy on the incidence of Rupture Perineum during delivery at the Midwives Practice Midwife Shinta Nur Rochmayanti, SSiT., M.Kes year 2018. The objektive of this study was to determine the effect of perineal massage on the incidence of perineal rupture in pregnant period during childbirth in independent practice of midwifery in PMB Shinta Nur Rochmayanti, SSiT., M.Kes year 2018.This study is Quasi Experimental study with Post Test Only Control Group Design method. The study was conducted in midwife Mandiri Practice (PMB) Shinta Nur Rochmayanti, SSiT., M.Kes Surabaya in 2018 with subject of 28 pregnant women 36 weeks pregnancy consisting of 14 intervention group and 14 control group. The study was conducted from December 2017 until April 2018, then the data were analyzed by Chi Square test. The incidence of Rupture Perineum in the intervention group after perineal massage was only 14,3% while in the control group 64,3%. The results showed that there was an effect of perineal massage during pregnancy on the incidence of perineum rupture (p &lt;0.05). This study concluded that perineal massage during pregnancy affects the incidence of perineal rupture at delivery.Keywords: perineal massage, pregnant periode, perineal rupture

PG - 29: Effect of Perineal Massage in the Second Stage of Labour, on The Incidence of Episiotomy and Perineal Tears

PG - 29: Effect of Perineal Massage in the Second Stage of Labour, on The Incidence of Episiotomy and Perineal Tears

Systematic review of pelvic floor interventions during pregnancy.

Pelvic floor interventions during pregnancy could reduce the impact of pregnancy and delivery on the pelvic floor. To determine the effects of pelvic floor interventions during pregnancy on childbirth-related and pelvic floor parameters. PubMed, Embase, and LILACS were searched for reports published during between 1990 and 2016 in English, Spanish, or Portuguese. The search terms were "pregnancy," "pelvic floor muscle training," and related terms. Randomized controlled trials with healthy pregnant women were included. Baseline and outcome data (childbirth-related parameters, pelvic floor symptoms) were compared for three interventions: EPI-NO (Tecsana, Munich, Germany) perineal dilator, pelvic floor muscle training, and perineal massage. A total of 22 trials were included. Two of three papers assessing EPI-NO showed no benefit. The largest study investigating pelvic floor muscle training reported a significant reduction in the duration of the second stage of labor (P<0.01), and this intervention also reduced the incidence of urinary incontinence (evaluated in 10 trials). Two of six trials investigating perineal massage reported that a lower rate of perineal pain was associated with this intervention. Pelvic floor muscle training and perineal massage improved childbirth-related parameters and pelvic floor symptoms, whereas EPI-NO showed no benefit.

PENGARUH PIJAT PERINEUM TERHADAP TINGKAT KECEMASAN PADA IBU HAMIL PRIMIGRAVIDA TRIMESTER III

Physical changes and psychology in pregnancy is one stressor in pregnancy. Preliminary studies showed that 98% of pregnant women experience anxiety third trimester. As a result of the pregnancy is maternal anxiety will experience periods of abnormal labor so as to improve maternal and infant mortality. Objective: This study aimed to determine the effect of perineal massage in primiparous mothers anxiety in the third trimester to the third trimester pregnant women in the BPS. Istiqomah, S.Keb.Bid. Methods: This research is pre-experimental design with a population statistical comparison group of pregnant women in the third trimester of BPS. Istiqomah. S.Keb.Bid premises sample of 20 pregnant women were divided into 10 groups of 10 samples of treated and control groups. Sampling nonprobality sample with quota sampling technique. The instrument of this study using a questionnaire anxiety. Results: Of the 10 treatment group gained 9 (90%) of the study subjects experienced a lower level of anxiety while the control group of 10 4 (40%) of research subjects experienced lower levels of anxiety and test results Mann - Whitney was obtained p = 0.005 (p &lt; 0.05), which means there is perineal massage effect on the level of anxiety in the third trimester pregnant women. Conclusion: There is the effect of perineal massage on the level of anxiety in the third trimester pregnant women with p = 0.005

Effectiveness of Virgin Coconut Oil and Virgin Olive Oil on Perineal Laceration

Perineal massage is one of the way to reduce maternal morbidity and reduce the risk of bleeding caused by laceration of the perineum. Not only Virgin Olive Oil, but also Virgin Coconut Oil becomes the alternative thing that easily absorbed by the skin. This study aims to examine the effect of Virgin Coconut Oil and Virgin Olive Oil on perineal massage on the degree of perineal laceration. This research was Quasi experimental designs, with the subjects were pregnant women with gestational age ≥34-35 weeks. The data used the Mann-Whitney test and tested 2 proportions to assess the effectiveness of the essential oils used. The result showed that there was influence of perineal massage with perineal laceration (p &lt;0,05). Therefore, there is influence of VCO and VOO on perineal massage against the perineal laceration event. Further research is needed to assess the determinants of perineal laceration with different variables or interventions.

Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial.

The study aimed to evaluate the effectiveness of antenatal perineal massage (APM) in reducing perineal trauma and post-partum morbidities. A randomized controlled trial of 108 primigravidae at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was conducted from January 2013 to May 2014. The intervention group received APM, while the control group did not receive APM. Women who received APM were significantly more likely to have an intact perineum after childbirth [27/53 (50.9%) vs 16/55 (29.1%); RR: 1.75; 95% CI: 1.07-2.86; P = 0.02]. The incidence of episiotomy was lower in the intervention group [20/53 (37.7%) vs 32/55 (58.2%); RR: 0.65; 95% CI: 0.43-0.98; P = 0.03; NNT = 5]. Women who received APM were significantly less likely to develop flatus incontinence [4/53 (8.3%) vs 13/55 (26.0%); RR: 0.32; 95% CI: 0.11-0.91; P = 0.03]. However, the incidences of premature rupture of membranes, preterm labor and birth asphyxia were similar between the two groups (P > 0.05). APM reduces the incidence of episiotomy and increases the incidence of women with an intact perineum after vaginal delivery. It also reduces the risk of flatus incontinence after childbirth without increased maternal or neonatal complications. Women should therefore be counseled on the likely benefits of APM and the information provided during antenatal care. Obstetricians should consider the technique as routine prenatal care for nulliparous women so as to reduce the incidence of perineal trauma during vaginal birth.