Prevention Of Perineal Trauma Research Articles

Obstetric perineal trauma: a modern view of the problem. A prospective study

Trauma to the perineum during childbirth is still a common obstetric problem. The question of etiology and risk factors is still extremely debatable. The high risk of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of this complication of childbirth, which seems to be the main reserve for reducing future pelvic floor insufficiency and associated pathological conditions.
 Background. Perineal trauma during childbirth is still a common problem in obstetrics. Also, a high percentage of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of perineal trauma during childbirth, which is relevant today.
 Aim. To identify the main predictors of the risk of developing obstetric perineal injury.
 Materials and methods. We conducted a prospective randomized study between September 2020 and January 2022, which included 110 pregnant women. The observation of the patients began from the day of the first visit to the antenatal clinic and throughout pregnancy and the postpartum period, much attention was paid to a comprehensive perineological examination.
 Results. In group 1, a large number of grade I and II tears (n=37, 33% and n=24, 29%) were noted, and grade III tears were completely absent. In group 2, there were grade III perineal tears, the frequency was (n=5, 2.1%), but still their number was inferior to grade I and II tears (n=10, 26% and n=15, 14%). In group 3, the analysis showed a low frequency of perineal tears of I and II degrees (n=8, 11% and n=17, 18%) and a number of tears of degree III comparable to group 2 (n=8, 2.6%). Episiotomy in all groups was carried out in the range from 7 to 9%, strictly according to obstetric indications.
 Conclusion. According to the data obtained, the most significant clinical and anamnestic predictors of obstetric perineal trauma were: frequent abortions in anamnesis, chronic diseases of the ENT organs and the urinary system, vaginal dysbiosis (nonspecific vaginitis, bacterial vaginosis), changes in the pH of the vaginal environment, low tone of the perineum, the presence of scar on the perineum.

Perineal management: Midwives’ confidence and educational needs

ObjectiveThe overall aim of this study was to collate information to inform the updating of a perineal management educational programme for midwives. This paper explores midwives' confidence and educational needs in managing the woman's perineum during the second stage of labour, focusing on future quality initiatives to improve midwives' experiences and expertise in the prevention of perineal trauma during birth. DesignA mixed-methods sequential exploratory design was used. Participants and SettingMidwives and clinical midwife managers assisting with births in the labour ward of a large urban university stand-alone maternity hospital in the Republic of Ireland with approximately 9,000 births per year participated in the study. MeasurementsA questionnaire and two focus groups were used to collect the data. FindingsFifty-two midwives from a total of 64 eligible labour ward midwives completed the questionnaire, a response rate of 81.2%. Midwives indicated that perineal management workshops did not cover prevention of perineal trauma, and mainly focused on suturing and repair of the perineum. The majority of midwives (85%) indicated that they would like further education on the prevention of perineal trauma. Higher levels of confidence in making a decision to perform an episiotomy, infiltrating the perineum and at performing an episiotomy were reported in experienced midwives. Midwives want improved and additional education in the management of women's perinea during the second stage of labour and made various recommendations regarding the content, format, timing and frequency of the workshop. Suggestions for further education included techniques for preventing perineal trauma during labour and birth and how to perform an episiotomy. Key conclusionsThis study provides key insights into midwives' confidence and educational needs in relation to managing the woman's perineum during the second stage of labour. The findings from this study demonstrates the appetite of midwives for additional education in the area of perineal management, particularly prevention strategies. Implications for practiceMidwives play an essential role in reducing the rates of perineal trauma through regular education. It is therefore important that midwives keep up to date with the best available evidence. Updating existing perineal management educational programmes that are tailor made to midwives' needs could not only improve clinical skills and perineal protection techniques but also midwives' confidence in decision making. The overall aim is to reduce perineal trauma in women having a spontaneous vaginal birth.

Perineal trauma: incidence and its risk factors

Perineal trauma can lead to short- and long-term complications for the mother. The purpose of this study was to determine the incidence of perineal trauma and its related factors. In this cross-sectional study, the maternal, neonatal, obstetric and childbirth information for all women who delivered in Kashan city hospitals was studied. Data were analysed using the Chi-square test, the t-test and logistic regression. The incidence of perineal trauma was 84.3%. Ninety-five percent of the primiparous women and 43.9% of the multiparous women had an episiotomy ([p value<.001], AOR = 24.4). The chance of birth trauma in the cases of younger maternal age, increasing gestational age, induction of labour, fundal pressure, Iranian nationality and nulliparity are increased. The incidence of perineal trauma in this study was high and should be minimised with a limited use of an episiotomy. It is recommended that midwives and obstetricians pay more attention to the women at risk.Impact StatementWhat is already known on this subject? Perineal trauma is common in vaginal delivery. Scientific literature shows several predictors of perineal trauma such as maternal age, parity, induction of labour, gestational age and birth weight, etc.; although in other studies some of these variables were not associated with perineal trauma. Considering that the findings about the factors associated with birth injuries are controversial, we decided to assess the incidence of perineal trauma and its risk factors during childbirth.What the results of this study add? This study indicated a high incidence of perineal trauma and agrees with the existing literature that maternal age, parity, the induction of labour, gestational age, fundal pressure and nationality are associated with perineal trauma; however, other factors were not found as predictors in our study.What the implications are of these findings for clinical practice and/or further research? Our results agreed with the existing literature regarding some predictors of perineal trauma but not for birth weight, foetal distress, second stage duration, hospital type, etc. This data could be used to implement protocols for reducing the rate of a routine episiotomy, considering too the high risk women for the prevention of perineal trauma.

Perineal massage in labour and prevention of perineal trauma: randomised controlled trial

Objective: To determine the effects of perineal massage in the second stage of labour on perineal outcomes.Design: Randomised controlled trial.Participants: At 36 weeks' gestation, women expecting normal birth of a...

Randomized trial of perineal massage during pregnancy: Perineal symptoms three months after delivery

Objective: The aim of this study was to evaluate the effect of perineal massage performed during pregnancy on perineal symptoms 3 months after delivery. Study Design: Pregnant women from 5 hospitals in the province of Quebec, Canada, participated in this single-blind, randomized, controlled trial. All participants received oral and written information on the prevention of perineal trauma. Women in the experimental group were taught the perineal massage technique and were asked to perform a 10-minute perineal massage daily from the 34th through 35th weeks of pregnancy until delivery. Participants completed a self-administered questionnaire on perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, flatus, and stool at the time of enrollment and 3 months after delivery. Results: Among participants without a previous vaginal birth there were no differences between the massage (n = 283) and the control (n = 289) groups with respect to perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, gas, or stool 3 months post partum. Among women with a previous vaginal birth more women in the massage group (n = 187) than in the control group (n = 190) were free of perineal pain (93.6% vs 85.8%; P = .01) but the frequencies of dyspareunia and incontinence of urine, gas, or stool were similar in the 2 groups. Conclusions: Perineal massage during pregnancy neither impairs nor substantially protects perineal function at 3 months post partum. (Am J Obstet Gynecol 2000;182:76-80.)

Prevention of Perineal Trauma by Perineal Massage During Pregnancy: A Pilot Study

Although the performance of perineal massage by a woman or her partner during the last weeks of pregnancy may help to prevent perineal trauma at delivery, the technique has never been evaluated rigorously. This study examined the feasibility of a randomized, controlled trial, and more specifically assessed the participation rate, the acceptability of the intervention, and whether or not an attending physician could remain blind to participants' groups. The pilot study was a single-blinded, randomized, controlled trial. Nulliparous women, 32 to 34 weeks pregnant, were recruited from June 8 to July 31, 1992, at the offices of family physicians and obstetricians who practice at the Hôpital du Saint-Sacrement in Quebec City. Women assigned to the intervention group practiced daily 10-minute perineal massage and completed a diary, and those in the control group had standard care. Women and attending physicians completed a questionnaire about the aspect of blindness. Among the 174 women who delivered during the study period, 104 (59.8%) were approached by a midwife and 46 (26.4%) were randomized. Twenty (91.0%) of the 22 women in the massage group returned their perineal massage diaries. Based on the postpartum questionnaire, 20 women practiced the technique at least four times a week for three weeks or longer. No woman in the control group practiced massage. The attending physician was aware of the woman's group in only three instances (6.7%). Based on the results of this pilot study, a randomized, controlled trial to evaluate the efficacy of perineal massage in preventing perineal trauma at birth appears feasible.