In a biomechanical assessment with simulation of vaginal delivery, exact placement of fingertips on the perineal skin, together with their co-ordinated movement, plays an important role in the extent of reduction of perineal tension.

Objective The aim of this study was to evaluate whether a previously identified modification of Vien-nese method of perineal protection remains most effective for reduction of perineal tension in cases with substantially smaller or larger fetal heads. Methods A previously designed finite element model was used to compare perineal tension of different modifications of the Viennese method of perineal protection to "hands-off" technique for three different sizes of the fetal head. Quantity and extent of tension throughout the perineal body during vaginal delivery at the time when the suboccipito-bregmatic circumference passes between the fourchette and the lower margin of the pubis was determined. Results The order of effectiveness of different modifications of manual perineal protection was similar for all three sizes of fetal head. The reduction of perineal tension was most significant in delivery simulations with larger heads. The final position of fingers 2cm anteriorly from the fourchette (y = +2) consistently remains most effective in reducing the tension. The extent of finger movement along the anterior-posterior (y-axis) contributes to the effectiveness of manual perineal protection.

Although the Wexner score neglects fecal urgency, it is the most commonly used scoring system. The study contributes to the standardization of terminology and reproducibility of results in research and clinical management of anal incontinence.

Incidence and extent of pain in the first 10 days after LE correspond to those after adequately performed MLE.

ObjectiveThe aim of this study was to evaluate whether a previously identified modification of Viennese method of perineal protection remains most effective for reduction of perineal tension in cases with substantially smaller or larger fetal heads.MethodsA previously designed finite element model was used to compare perineal tension of different modifications of the Viennese method of perineal protection to "hands-off" technique for three different sizes of the fetal head. Quantity and extent of tension throughout the perineal body during vaginal delivery at the time when the suboccipito-bregmatic circumference passes between the fourchette and the lower margin of the pubis was determined.ResultsThe order of effectiveness of different modifications of manual perineal protection was similar for all three sizes of fetal head. The reduction of perineal tension was most significant in delivery simulations with larger heads. The final position of fingers 2cm anteriorly from the fourchette (y = +2) consistently remains most effective in reducing the tension. The extent of finger movement along the anterior-posterior (y-axis) contributes to the effectiveness of manual perineal protection.ConclusionAppropriately performed Viennese manual perineal protection seems to reduce the perineal tension regardless of the fetal head size, and thus the method seems to be applicable to reduce risk of perineal trauma for all parturients.