1
|
Zhang D, Bo K, Montejo R, Sánchez-Polán M, Silva-José C, Palacio M, Barakat R. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials. Acta Obstet Gynecol Scand 2024; 103:1015-1027. [PMID: 38140841 PMCID: PMC11103147 DOI: 10.1111/aogs.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens' health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear. MATERIAL AND METHODS A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted. RESULTS Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%). CONCLUSIONS PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.
Collapse
Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Norway
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Montse Palacio
- BCNatal, Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain
- Hospital Universitario Clinic, Barcelona, Spain
| | - Rubén Barakat
- AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
| |
Collapse
|
2
|
Okeahialam NA, Sultan AH, Thakar R. The prevention of perineal trauma during vaginal birth. Am J Obstet Gynecol 2024; 230:S991-S1004. [PMID: 37635056 DOI: 10.1016/j.ajog.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 08/29/2023]
Abstract
Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%. The incidence of obstetrical anal sphincter injury is approximately 3%, with a significantly higher rate in primiparous than in multiparous women (6% vs 2%). Obstetrical anal sphincter injury is a significant risk factor for the development of anal incontinence, with approximately 10% of women developing symptoms within a year following vaginal birth. Obstetrical anal sphincter injuries have significant medicolegal implications and contribute greatly to healthcare costs. For example, in 2013 and 2014, the economic burden of obstetrical anal sphincter injuries in the United Kingdom ranged between £3.7 million (with assisted vaginal birth) and £9.8 million (with spontaneous vaginal birth). In the United States, complications associated with trauma to the perineum incurred costs of approximately $83 million between 2007 and 2011. It is therefore crucial to focus on improvements in clinical care to reduce this risk and minimize the development of perineal trauma, particularly obstetrical anal sphincter injuries. Identification of risk factors allows modification of obstetrical practice with the aim of reducing the rate of perineal trauma and its attendant associated morbidity. Risk factors associated with second-degree perineal trauma include increased fetal birthweight, operative vaginal birth, prolonged second stage of labor, maternal birth position, and advanced maternal age. With obstetrical anal sphincter injury, risk factors include induction of labor, augmentation of labor, epidural, increased fetal birthweight, fetal malposition (occiput posterior), midline episiotomy, operative vaginal birth, Asian ethnicity, and primiparity. Obstetrical practice can be modified both antenatally and intrapartum. The evidence suggests that in the antenatal period, perineal massage can be commenced in the third trimester of pregnancy to increase muscle elasticity and allow stretching of the perineum during birth, thereby reducing the risk of tearing or need for episiotomy. With regard to the intrapartum period, there is a growing body of evidence from the United Kingdom, Norway, and Denmark suggesting that the implementation of quality improvement initiatives including the training of clinicians in manual perineal protection and mediolateral episiotomy can reduce the incidence of obstetrical anal sphincter injury. With episiotomy, the International Federation of Gynecology and Obstetrics recommends restrictive rather than routine use of episiotomy. This is particularly the case with unassisted vaginal births. However, there is a role for episiotomy, specifically mediolateral or lateral, with assisted vaginal births. This is specifically the case with nulliparous vacuum and forceps births, given that the use of mediolateral or lateral episiotomy has been shown to significantly reduce the incidence of obstetrical anal sphincter injury in these groups by 43% and 68%, respectively. However, the complications associated with episiotomy including perineal pain, dyspareunia, and sexual dysfunction should be acknowledged. Despite considerable research, interventions for reducing the risk of perineal trauma remain a subject of controversy. In this review article, we present the available data on the prevention of perineal trauma by describing the risk factors associated with perineal trauma and interventions that can be implemented to prevent perineal trauma, in particular obstetrical anal sphincter injury.
Collapse
Affiliation(s)
| | - Abdul H Sultan
- Croydon University Hospital, London, United Kingdom; St George's University of London
| | - Ranee Thakar
- Croydon University Hospital, London, United Kingdom; St George's University of London.
| |
Collapse
|
3
|
Milka W, Paradowska W, Kołomańska-Bogucka D, Mazur-Bialy AI. Antenatal perineal massage - risk of perineal injuries, pain, urinary incontinence and dyspereunia - a systematic review. J Gynecol Obstet Hum Reprod 2023; 52:102627. [PMID: 37414371 DOI: 10.1016/j.jogoh.2023.102627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Natural childbirth is associated with the risk of damage to the perineum - a tears or a episiotomy. Adequate preparation of the woman for childbirth is essential to minimize the occurrence of perinatal injuries. AIM The aim of the review is to assess and analyze the impact of APM (antental perineal massage) on perinatal perineal injuries and the development of pelvic pain and other complications in postpartum women, such as dyspareunia, urinary (UI), gas (GI), and fecal incontinence (FI). METHODS PubMed, Web of Science, Scopus and Embase were searched. Three authors independently searched databases and selected articles for inclusion and exclusion criteria. Next one author did Risk of Bias 2 and ROBINS 1 analyze. FINDINGS Of 711 articles, 18 publications were left for the review. All 18 studies examined the risk of perineal injuries (tearing and episiotomy), 7 pain in postpartum period, 6 postpartum urinary, gas/fecal incontinence and 2 described dyspareunia. Most authors described APM from 34 weeks of pregnancy until delivery. There were different techniques and times for doing APM procedures. DISCUSSION APM has many benefits for women during labor and the postpartum period (e.g. lower rate of perineal injuries and pain). However, it can be observed that individual publications differ from each other in the time of massage, the period and frequency of its performance, the form of obtaining instruction and control of patients. These components may affect the results obtained. CONCLUSION APM can protects the perineum from injuries during labor. It also reduces risk of fecal and gas incontinence in postpartum period.
Collapse
Affiliation(s)
- Weronika Milka
- Student of Physiotherapy, Jagiellonian University Medical College, Krakow, Poland
| | - Weronika Paradowska
- Student of Physiotherapy, Jagiellonian University Medical College, Krakow, Poland
| | - Daria Kołomańska-Bogucka
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Master of Physiotherapy, Jagiellonian University Medical College, Skawińska 8, Krakow 31-066, Poland
| | - Agnieszka I Mazur-Bialy
- Prof. UJ, Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, Krakow 31-066, Poland.
| |
Collapse
|
4
|
He R, Wang X, Nian S, Wang X, Zhang L, Lu Y. The effect of pelvic floor muscle training and perineal massage in late pregnancy on postpartum pelvic floor function in nulliparas: A randomised controlled clinical trial. Complement Ther Med 2023; 77:102982. [PMID: 37657664 DOI: 10.1016/j.ctim.2023.102982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To evaluate the effects of pelvic floor muscle training (PFMT) and perineal massage during late pregnancy on postpartum pelvic floor function in nulliparas. DESIGN Randomised controlled trial. SETTING The Peking University First Hospital, a teaching hospital in China. PARTICIPANTS Two-hundred nulliparas were included. INTERVENTIONS Nulliparas were randomised into four groups in a 1:1:1:1 ratio. Group A, control; group B, perineal massage; group C, pelvic floor muscle training (PFMT); group D, perineal massage and PFMT. The intervention group received the corresponding intervention from 34 weeks of gestation until delivery. MEASUREMENTS Changes in pelvic floor function from 34 weeks of gestation to 6 weeks postpartum were assessed using pelvic floor electromyography (EMG), pelvic organ prolapse quantitation (POP-Q), and pelvic floor distress inventory-20 (PFDI-20). RESULTS Those with PFMT (groups C and D) had a smaller decline in pelvic floor EMG of fibre II than those without PFMT (groups A and B) [- 0.2 (- 7.1, 11.3) µV vs 6.1 (- 0.2, 15.2) µV, P = 0.040]. The same scenario was observed in the pelvic floor EMG of fibre I. The Aa point measurement differences of those with PFMT (groups C and D) were smaller than those without PFMT (groups A and B) [0.0 (0.0, 2.0) cm vs 1.0 (0.0, 3.0) cm, P = 0.006]. The same result was observed for point Ba. No difference was observed in EMG and POP-Q in nulliparas with (groups B and D) or without perineal massage (groups A and C). No differences were observed in PFDI-20 scores. KEY CONCLUSIONS PFMT during late pregnancy enhanced pelvic floor EMG, while perineal massage alone or PFMT combined with perineal massage did not. IMPLICATIONS FOR PRACTICE PFMT in late pregnancy enhances pelvic floor function.
Collapse
Affiliation(s)
- RuiJu He
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| | - XiaoXiao Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| | - SongWen Nian
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| | - XiaoQing Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| | - Ye Lu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| |
Collapse
|
5
|
Marcos-Rodríguez A, Leirós-Rodríguez R, Hernandez-Lucas P. Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 162:802-810. [PMID: 36808391 DOI: 10.1002/ijgo.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Numerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage. OBJECTIVE To determine the efficacy of perineal massage during the second stage of labor to prevent perineal damage. SEARCH STRATEGY Systematic search in PubMed, Pedro, Scopus, Web of Science, ScienceDirect, BioMed, SpringerLink, EBSCOhost, CINAHL, and MEDLINE with the terms Massage, Second labor stage, Obstetric delivery, and Parturition. SELECTION CRITERIA The articles must have been published in the last 10 years; the perineal massage was administered to the study sample; and the experimental design consisted of randomized controlled trial. DATA COLLECTION AND ANALYSIS Tables were used to describe both the studies' characteristics and the extracted data. The PEDro and Jadad scales were used to assess the quality of studies. MAIN RESULTS Of the 1172 total results identified, nine were selected. Seven studies were included in the meta-analysis and indicated a statistically significant decreased number of episiotomies in perineal massage. CONCLUSIONS Massage during the second stage of labor appears to be effective in preventing episiotomies and reducing the duration of the second stage of labor. However, it does not appear to be effective in reducing the incidence and severity of perineal tears.
Collapse
Affiliation(s)
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Ponferrada, Spain
| | - Pablo Hernandez-Lucas
- Functional Biology and Health Sciences Department, University of Vigo, Pontevedra, Spain
| |
Collapse
|
6
|
Zhang D, Ruchat SM, Silva-Jose C, Gil-Ares J, Barakat R, Sánchez-Polán M. Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5139. [PMID: 37568541 PMCID: PMC10419719 DOI: 10.3390/jcm12155139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Cesarean delivery may increase the need for anesthesia administration, thereby causing potential risks to both maternal and fetal health. This article aimed to investigate the effect of physical activity during pregnancy on the type of delivery, the duration of labor, and the use of epidurals (registration No.: CRD42022370646). Furthermore, 57 RCTs (n = 15301) were included showing that physical activity could decrease the risk of cesarean section (z = 3.22, p = 0.001; RR = 0.87, 95% CI = 0.79, 0.95, I2 = 37%, Pheterogeneity = 0.004), and 32 RCTs (n = 9468) showed significant decreases in instrumental delivery through performing physical activity (z = 3.48, p < 0.001; RR = 0.84, 95% CI = 0.76, 0.93, I2 = 0%, Pheterogeneity = 0.63). A significant decrease in the 15 RCTs' (n = 4797) duration of first stage labor was found in physically active pregnant women (z = 2.09, p = 0.04; MD = -62.26, 95% CI = -120.66, -3.85, I2 = 93%, Pheterogeneity < 0.001) compared to those not active. Prenatal physical activity could decrease the risk of cesarean section and instrumental delivery and the duration of first stage labor.
Collapse
Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois, Trois-Rivières, QC G8T 0A1, Canada
| | - Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Javier Gil-Ares
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| |
Collapse
|
7
|
Cao X, Yang Q, Wang Q, Hu S, Hou L, Sun M, Lai H, Wu C, Wu Y, Xiao L, Luo X, Tian J, Ge L, Luo C. PFMT relevant strategies to prevent perineal trauma: a systematic review and network meta-analysis. Arch Gynecol Obstet 2023; 308:387-401. [PMID: 36107230 DOI: 10.1007/s00404-022-06769-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most women suffer from perineal trauma during childbirth, whether it is natural tears or episiotomy. OBJECTIVES To perform a systematic review and network meta-analysis investigating the effectiveness of different PFMT relevant strategies in the prevention of perineal trauma. SEARCH STRATEGY PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG DATABASE, and ClinicalTrials.gov were searched for citations published in any language from inception to 1 July 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of PFMT relevant prevention strategies for preventing perineal trauma during childbirth. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA). MAIN RESULTS Of 12 632 citations searched, 21 RCTs were included. Comparing with usual care, "PFMT combine with perineal massage" and PFMT alone showed more superiority in intact perineum (RR = 5.37, 95% CI: 3.79 to 7.60, moderate certainty; RR = 2.58, 95% CI 1.34-4.97, moderate certainty, respectively), episiotomy (RR = 0.26, 95% CI 0.14-0.49, very low certainty; RR = 0.63, 95% CI 0.45-0.90, very low certainty, respectively), and OASIS (RR = 0.35, 95% CI 0.16-0.78, moderate certainty; RR = 0.49, 95% CI 0.28-0.85, high certainty, respectively). "PFMT combine with perineal massage" showed superiority in reducing perineal tear (RR = 0.41, 95% CI 0.20-0.85, moderate certainty). CONCLUSIONS In view of the results, antenatal "PFMT combine with perineal massage" and PFMT were effective strategies for the prevention of perineal trauma.
Collapse
Affiliation(s)
- Xiao Cao
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qiuyu Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Shasha Hu
- Department of Obstetrics and Gynecology, First Hospital of Lanzhou University, Lanzhou, China
| | - Liangying Hou
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mingyao Sun
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Honghao Lai
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Cailiang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai, China
| | - Yu Wu
- Department of Obstetrics and Gynecology, First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory of Gynecologic Oncology of Gansu Province, Lanzhou, China
| | - Lin Xiao
- Evidence-Based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaofeng Luo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medicine Science, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Long Ge
- Department of Social Medicine and Health Management, and Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Chenling Luo
- Evidence-Based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China.
| |
Collapse
|
8
|
Lucena da Silva M, Andressa Bastos Primo de Sousa Santos T, Wane Carvalho Leite L, Emanoel Chaves da Silva C, Oliveira do Nascimento A, Teixeira Alves A, Driusso P, da Costa Cunha K. The effectiveness of interventions in the prevention of perineal trauma in parturients: A systematic review with meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 283:100-111. [PMID: 36827751 DOI: 10.1016/j.ejogrb.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
AIM To investigate the effectiveness of interventions to prevent the occurrence of perineal trauma in parturients. METHODS A bibliographic search was carried out in Cochrane Library, MEDLINE via PUBMED, LILACS via Virtual Health Library (VHL), Embase, Scopus, CINAHL, Scielo, Web of Science, and PEDro databases. Randomized clinical trials evaluating the effects of any intervention to prevent perineal trauma during pregnancy and/or childbirth were included. There were no temporal or language restrictions. The risk of bias assessment was performed using the Revised Cochrane Risk-of-bias Tool for Randomized Trials. RESULTS Fifty studies, with a total of 17,221 participants, were included in this meta-analysis. No intervention during childbirth was effective for the prevention of perineal trauma (RR = 1.07, 95% CI [0.98.1.18], p < 0.01, I2 = 83%) when compared to no intervention. However, a lower risk of perineal laceration was verified with techniques performed during pregnancy, when compared to no intervention (RR = 0.81, 95% CI [0.71, 0.93], p = 0.05, I2 = 47%). Among them, highlight the effects of perineal massage in preventing lacerations (RR = 0.69, 95% CI [0.54, 0.87], p < 0.01) when compared to no intervention. CONCLUSIONS The techniques performed during pregnancy, especially perineal massage, are associated with a lower risk of perineal laceration.
Collapse
Affiliation(s)
- Marianne Lucena da Silva
- Universidade Federal de Jataí, UFJ - Campus Riachuelo, Rua Riachuelo n° 1530 - Setor - Samuel Grahan, Jataí - GO, 75804-020, Jataí, Goiás, Brazil
| | | | - Lindely Wane Carvalho Leite
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| | - Carlos Emanoel Chaves da Silva
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| | - Alef Oliveira do Nascimento
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| | - Aline Teixeira Alves
- Universidade de Brasília, Universidade de Brasília, Faculdade de Ceilândia, Campus Universitário - Centro Metropolitano, Ceilândia Sul, Brasília-DF. CEP: 72220-275, Brazil.
| | - Patrícia Driusso
- Universidade Federal de São Carlos, Rodovia Washington Luís, km 235 - SP-310. São Carlos, CEP 13565-905, São Paulo, Brazil
| | - Katiane da Costa Cunha
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| |
Collapse
|
9
|
Zang Y, Hu Y, Lu H. Effects of different techniques during the second stage of labour on reducing perineal laceration: An overview of systematic reviews. J Clin Nurs 2023; 32:996-1013. [PMID: 35253295 DOI: 10.1111/jocn.16276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 12/28/2022]
Abstract
AIM AND OBJECTIVE To summarize the evidence on the effects of different techniques during the second stage of labour on reducing perineal laceration depending on available systematic reviews to provide optimal evidence for decision-making. BACKGROUND Preventing perineal laceration has been considered an important part of improving women's health. Various techniques have been used to prevent perineal laceration during the second stage of labour. However, systematic reviews evaluating the effects of different techniques on reducing perineal laceration show inconsistent results. DESIGN Overview of systematic reviews. METHODS Five English and four Chinese databases were systematically searched for relevant systematic reviews and meta-analyses published between 1 January 2016 and 31 August 2021. The quality of the included reviews was assessed by the AMSTAR 2 tool. A narrative synthesis was conducted to report the results of moderate-to-high quality systematic reviews. The overview was reported according to the PRISMA statement. RESULTS Eighteen reviews were included, of which four reviews had moderate-to-high methodological quality. Perineal massage and warm compresses significantly decreased the incidence of third- or fourth-degree perineal laceration (moderate-quality evidence). Hands-off technique had no impact on perineal laceration (low-to-moderate quality evidence). Ritgen's manoeuvre could reduce the incidence of first-degree perineal laceration but increase the incidence of second-degree perineal laceration (very low-quality evidence). Spontaneous pushing (low-quality evidence) and delayed pushing (moderate-quality evidence) had no impact on the incidence of third- or fourth-degree perineal laceration. Upright positions did not increase the risk of third- or fourth-degree perineal laceration (very low- to low-quality evidence) but increased the risk of second-degree perineal laceration for women without epidural analgesia (low-quality evidence). CONCLUSIONS Perineal massage and warm compresses could be the better choice for preventing perineal laceration in the second stage of labour. RELEVANCE TO CLINICAL PRACTICE Midwives and obstetricians could use perineal massage and warm compresses to prevent perineal laceration and should consider women's preferences and experience with perineal techniques.
Collapse
Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Yinchu Hu
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
10
|
Álvarez-González M, Leirós-Rodríguez R, Álvarez-Barrio L, López-Rodríguez AF. Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial. Medicina (B Aires) 2022; 58:medicina58101485. [PMID: 36295645 PMCID: PMC9609828 DOI: 10.3390/medicina58101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed.
Collapse
Affiliation(s)
- María Álvarez-González
- Faculty of Health Sciences, University of León, Astorga Ave. 15, 24401 Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Faculty of Health Sciences, University of León, Astorga Ave. 15, 24401 Ponferrada, Spain
- Correspondence:
| | - Lorena Álvarez-Barrio
- Faculty of Health Sciences, University of León, Astorga Ave. 15, 24401 Ponferrada, Spain
| | - Ana F. López-Rodríguez
- Faculty of Health Sciences, University of León, Astorga Ave. 15, 24401 Ponferrada, Spain
| |
Collapse
|
11
|
Effect of Prenatal Perineal Massage on Postpartum Perineal Injury and Postpartum Complications: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3315638. [PMID: 35872935 PMCID: PMC9303122 DOI: 10.1155/2022/3315638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
Background The efficacy of perineal massage is controversial. The study was aimed at comparing the effects of perineal massage on perineal injury and complications. Methods PubMed, Embase, the Cochrane Library, and ISI Web of Science were searched for literature on the relationship between prenatal perineal massage and postpartum perineal injury and complications until April 2022. Indicators included postpartum perineal tears, perineotomy, postpartum perineal pain, natural labour, and postpartum incontinence. Finally, RevMan5.4 software was used to analyze the extracted data. Results A total of 6487 subjects in 16 studies were included, with 3211 who received perineal massage and 3276 did not. There was no significant difference in 1-2 degree perineal tearing between the intervention group and the control group (RR = 0.96, 95% CI [0.90, 1.03], P = 0.30), and there was no heterogeneity between studies (P = 0.62, I2 = 0%), indicating publication bias. Compared with the control group, prenatal perineal massage significantly reduced the incidence of 3-4 degree perineal tears (RR = 0.56, 95% CI [0.47, 0.67], P < 0.00001), and there was no heterogeneity between studies (P = 0.16, I2 = 30%), indicating publication bias. Compared with the control group, prenatal perineal massage reduced the risk of lateral perineal resection (RR = 0.87, 95% CI [0.80, 0.95], P = 0.001), and there was no heterogeneity between studies (P = 0.14, I2 = 31%), and there was no publication bias. Compared with the control group, prenatal perineal massage reduced the risk of postpartum pain at 3 months (RR = 0.64, 95% CI [0.51, 0.81], P = 0.0002). There was no significant heterogeneity among studies (P = 0.23, I2 = 31%). Conclusion Compared with no prenatal perineal massage, prenatal perineal massage can reduce the risk of perineal injury, the incidence of lateral perineal resection, and the incidence of long-term pain.
Collapse
|
12
|
Benítez-Andrades JA, García-Ordás MT, Álvarez-González M, Leirós-Rodríguez R, López Rodríguez AF. Detection of the most influential variables for preventing postpartum urinary incontinence using machine learning techniques. Digit Health 2022; 8:20552076221111289. [PMID: 35832475 PMCID: PMC9272055 DOI: 10.1177/20552076221111289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background Postpartum urinary incontinence is a fairly widespread health problem in today’s society among women who have given birth. Recent studies analysing the different variables that may be related to Postpartum urinary incontinence have brought to light some variables that may be related to Postpartum urinary incontinence in order to try to prevent it. However, no studies have been found that analyse some of the intrinsic and extrinsic variables of patients during pregnancy that could give rise to this pathology. Objective The objective of this study is to assess the most influential variables in Postpartum urinary incontinence by means of machine learning techniques, starting from a group of intrinsic variables, another group of extrinsic variables and a mixed group that combines both types. Methods Information was collected on 93 patients, pregnant women who gave birth. Experiments were conducted using different machine learning classification techniques combined with oversampling techniques to predict four variables: urinary incontinence, urinary incontinence frequency, urinary incontinence intensity and stress urinary incontinence. Results The results showed that the most accurate predictive models were those trained with extrinsic variables, obtaining accuracy values of 70% for urinary incontinence, 77% for urinary incontinence frequency, 71% for urinary incontinence intensity and 93% for stress urinary incontinence. Conclusions This research has shown that extrinsic variables are more important than intrinsic variables in predicting problems related to postpartum urinary incontinence. Therefore, although not conclusive, it opens a line of research that could confirm that the prevention of Postpartum urinary incontinence could be achieved by following healthy habits in pregnant women.
Collapse
Affiliation(s)
| | - María Teresa García-Ordás
- SECOMUCI Research Group, Escuela de Ingenierías Industrial e Informática, Universidad de León, León, Spain
| | | | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, Universidad de León, Ponferrada, Spain
| | | |
Collapse
|
13
|
Álvarez-González M, Leirós-Rodríguez R, Álvarez-Barrio L, López-Rodríguez AF. Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial. J Clin Med 2021; 10:jcm10214934. [PMID: 34768453 PMCID: PMC8584327 DOI: 10.3390/jcm10214934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- María Álvarez-González
- Faculty of Health Sciences, Universidad de León, Astorga Ave. s/n, 24401 Ponferrada, Spain; (M.Á.-G.); (A.F.L.-R.)
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, Astorga Ave. s/n, 24401 Ponferrada, Spain;
| | - Lorena Álvarez-Barrio
- Faculty of Health Sciences, Universidad de León, Astorga Ave. s/n, 24401 Ponferrada, Spain; (M.Á.-G.); (A.F.L.-R.)
- Correspondence:
| | - Ana F. López-Rodríguez
- Faculty of Health Sciences, Universidad de León, Astorga Ave. s/n, 24401 Ponferrada, Spain; (M.Á.-G.); (A.F.L.-R.)
| |
Collapse
|
14
|
Gomes Lopes L, Maia Dutra Balsells M, Teixeira Moreira Vasconcelos C, Leite de Araújo T, Teixeira Lima FE, de Souza Aquino P. Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 157:248-254. [PMID: 34270799 DOI: 10.1002/ijgo.13826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/31/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear. OBJECTIVE To investigate the effectiveness of PFMT in the prevention of perineal laceration. SEARCH STRATEGY Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery. SELECTION CRITERIA We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations. DATA COLLECTION AND ANALYSIS We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R. MAIN RESULTS Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration. CONCLUSION Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.
Collapse
Affiliation(s)
- Lia Gomes Lopes
- Nursing Department, Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | | | | |
Collapse
|
15
|
The Effects of the Pilates Method on Pelvic Floor Injuries during Pregnancy and Childbirth: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136995. [PMID: 34208859 PMCID: PMC8297105 DOI: 10.3390/ijerph18136995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
The perineal injuries suffered during childbirth have a great impact on the quality of life of the female population. Evidence suggests that the Pilates method is used by pregnant women to improve the physical and psychological outcomes of pregnancy. The aim of this study was to investigate the influence of the Pilates Method during pregnancy on the incidence and degree of intrapartum perineal trauma. A quasi-experimental study was carried out between November 2018 and December 2019 at different health centers in two health districts. Participants were 72 pregnant women attending the antenatal program, who were assigned to a Pilates group or a control group (48 and 24 pregnant women, respectively). The main outcome measurement was perineal trauma during childbirth. After participating in the Pilates program, the women in the experimental group were significantly less likely to suffer perineal trauma in spontaneous deliveries compared to the women in the control group. After evaluating these results, it is concluded that health center managers should promote the training of midwives in the prevention and treatment of pelvic floor injuries during pregnancy and should consider strategies to enhance adhesion and participation with respect to pelvic floor exercise programs throughout pregnancy by means of Apps and other digital media specifically aimed at this phase.
Collapse
|
16
|
Rusavy Z, Kalis V, Aglyamov S, Egorov V. Feasibility and safety of antepartum tactile imaging. Int Urogynecol J 2020; 32:1785-1791. [PMID: 33068133 PMCID: PMC8295083 DOI: 10.1007/s00192-020-04552-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/27/2020] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis Quantitative characterization of the birth canal and critical structures before delivery may provide risk assessment for maternal birth injury. The objective of this study was to explore imaging capability of an antepartum tactile imaging (ATI) probe. Methods Twenty randomly selected women older than 21 years with completed 35th week of pregnancy and a premise of vaginal delivery were enrolled in the feasibility study. The biomechanical data were acquired using the ATI probe with a double-curved surface, shaped according to the fetal skull and equipped with 168 tactile sensors and an electromagnetic motion tracking sensor. Software package COMSOL Multiphysics was used for finite element modeling. Subjects were asked for assessment of pain and comfort levels experienced during the ATI examination. Results All 20 nulliparous women were successfully examined with the ATI. Mean age was 27.8 ± 4.1 years, BMI 30.7 ± 5.8, and week of pregnancy 38.8 ± 1.4. Biomechanical mapping with the ATI allowed real-time observation of the probe location, applied load to the vaginal walls, and a 3D tactile image composition. The nonlinear finite element model describing the stress–strain relationship of the pelvic tissue was developed and used for calculation of Young’s modulus (E). Average perineal elastic modulus was 11.1 ± 4.3 kPa, levator ani 4.8 ± 2.4 kPa, and symphysis–perineum distance was 30.1 ± 6.9 mm. The pain assessment level for the ATI examination was 2.1 ± 0.8 (scale 1–4); the comfort level was 2.05 ± 0.69 (scale 1–3). Conclusions The antepartum examination with the ATI probe allowed measurement of the tissue elasticity and anatomical distances. The pain level was low and the comfort level was comparable with manual palpation.
Collapse
Affiliation(s)
- Zdenek Rusavy
- Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic. .,Biomedical Center, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic. .,Department of Gynecology and Obstetrics, University Hospital in Pilsen, Pilsen, Czech Republic.
| | - Vladimir Kalis
- Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic
| | | | | |
Collapse
|
17
|
Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women-Systematic Review of Methods. J Clin Med 2020; 9:jcm9103255. [PMID: 33053702 PMCID: PMC7600070 DOI: 10.3390/jcm9103255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) affects approximately 0.25-6% of the population, both men and women. The most common causes of FI are damage to/weakness of the anal sphincter muscle and/or pelvic floor muscles, as well as neurological changes in the central or peripheral nervous system. The purpose of this study is to report the results of a systematic review of the possibilities and effectiveness of physiotherapy techniques for the prevention and treatment of FI in women. For this purpose, the PubMed, Embase, and Web of Science databases were searched for 2000-2020. A total of 22 publications qualified for detailed analysis. The studies showed that biofeedback (BF), anal sphincter muscle exercises, pelvic floor muscle training (PFMT), and electrostimulation (ES) are effective in relieving FI symptoms, as reflected in the International Continence Society recommendations (BF: level A; PFMT and ES: level B). Research has confirmed that physiotherapy, by improving muscle strength, endurance, and anal sensation, is beneficial in the prevention of FI, both as an independent method of conservative treatment or in pre/post-surgery treatment. Moreover, it can significantly improve the quality of life of patients. In conclusion, physiotherapy (in particular, BF, PFMT, or ES, as effective methods) should be one of the key elements in the comprehensive therapy of patients with FI.
Collapse
|
18
|
Cueva‐Reguera M, Rodríguez‐Sanz D, Calvo‐Lobo C, Fernández‐Martínez S, Martínez‐Pascual B, Robledo‐Do‐Nascimento Y, Blanco‐Morales M, Romero‐Morales C. Effectiveness of manual lymphatic drainage vs. perineal massage in secundigravida women with gestational oedema: A randomised clinical trial. Int Wound J 2020; 17:1453-1461. [DOI: 10.1111/iwj.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mónica Cueva‐Reguera
- Faculty of Sport Sciences Universidad Europea de Madrid Madrid 28670 Spain
- Facultad de Enfermería, Físioterapia y Podologia Universidad Complutense de Madrid Madrid 28040 Spain
| | - David Rodríguez‐Sanz
- Facultad de Enfermería, Físioterapia y Podologia Universidad Complutense de Madrid Madrid 28040 Spain
| | - César Calvo‐Lobo
- Facultad de Enfermería, Físioterapia y Podologia Universidad Complutense de Madrid Madrid 28040 Spain
| | | | | | | | | | | |
Collapse
|
19
|
Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 2020; 31:1735-1745. [DOI: 10.1007/s00192-020-04302-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
|
20
|
Romina S, Ramezani F, Falah N, Mafi M, Ranjkesh F. Effect of Perineal Massage with Ostrich Oil on the Episiotomy and Lacerations in Nulliparous Women: A Randomized Controlled Clinical Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:134-138. [PMID: 32195159 PMCID: PMC7055184 DOI: 10.4103/ijnmr.ijnmr_76_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 11/10/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Samira Romina
- Students of Midwifery, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Faeze Ramezani
- Students of Midwifery, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Neda Falah
- Students of Midwifery, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Mafi
- Department of Biostatistics, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Ranjkesh
- Instructor of Midwifery, Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|