Does the Epi-No® Birth Trainer reduce levator trauma? A randomised controlled trial

Shek, Ka Lai; Chantarasorn, Varisara; Langer, Susanne; Phipps, Hala; Dietz, Hans Peter

doi:10.1007/s00192-011-1517-x

Cited by 63 publications

(65 citation statements)

References 25 publications

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“…In the second of these investigations on the Epi-no trainer, Shek et al 23 conducted a randomized controlled trial to assess if the pelvic trainer could reduce levator trauma. The authors selected 200 nulliparous women with singleton pregnancies, and these patients were divided into intervention and control groups.…”

Section: Discussionmentioning

confidence: 99%

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

et al. 2015

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CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

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Section: Discussionmentioning

confidence: 99%

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

et al. 2015

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“…This position is to ensure the lengthening of the desirable structures and that it does not touch the uterine cervix during use. 2,4 Then, the device will be inflated by manual pumping until the tolerable woman's limit. The pregnant woman will be encouraged to daily inflate a greater volume of compressed air into the balloon so that the amount of air is greater than the quantity in the previous day, achieving, day after day, a greater stretching of perivaginal structures, always respecting the individual tolerance limit.…”

Section: Vaginal Dilator Group (Vdg)mentioning

confidence: 99%

“…The pregnant woman will be encouraged to daily inflate a greater volume of compressed air into the balloon so that the amount of air is greater than the quantity in the previous day, achieving, day after day, a greater stretching of perivaginal structures, always respecting the individual tolerance limit. 2 The amount of manual pumping imposed to inflate the balloon should be written in an Intervention Diary so that the next use, the pregnant woman will be sure that pumped the device more times than in the previous session. At the end of use, the balloon should be washed with water and mild soap and dried with a paper or cotton towel.…”

Section: Vaginal Dilator Group (Vdg)mentioning

confidence: 99%

“…[1][2][3] Thus, perineal integrity has been a challenge in the practice of pregnant women assistance and parturient, in order to avoid sequelae especially to the neuromuscular structures of the pelvic floor. These structures, when damaged, can lead to disorders, such as urinary and anorectal disorders, pelvic pain, disabilities of pelvic support and sexual dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Effects of antenatal pelvic floor preparation techniques on the perineal integrity: a randomized controlled trial protocol

et al. 2016

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Background: The objective of the present study was to compare the effects of perineal massage, vaginal dilator and pelvic floor muscles training on the perineal integrity of primiparae women. Methods: Primigravidae women over 18 years old will be selected, from the 32th gestational week and wishing to have a vaginal delivery.Pregnant women will be randomly allocated from a sequence generated by a computer program into three groups: perineal massage, vaginal dilator and pelvic floor muscles training. The technique should be practiced from the 34th week of pregnancy until the beginning of labor. Randomization will be done by a researcher who was not involved with the recruitment, assessment and treatment of the participants. All participants will undergo a clinical and functional assessment of the pelvic floor before the beginning of the technique practice, as well as a reassessment of these items and an assessment of perineal integrity between 45 and 60 days after delivery for a blind physiotherapist regarding the interventional procedures. The evaluative procedures will be done by a ‘blinded’ physiotherapist in relation to the intervention procedures. The outcome will be determined by the perineal integrity by the presence or absence of perineal laceration as well as their characteristics observed immediately after delivery. Conclusions: The knowledge of the effects of antenatal pelvic floor preparation techniques on the perineal integrity and pelvic floor muscles function after delivery, will allow a better choice about which approach is the best to pregnant women to prevent perineal trauma.

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“…However, as if they were completely unaware of the literature on the issue, the authors of this supposed review omit to reference any of the dozens of papers published on this topic since 2004. It is plainly astounding: the authors mention the Epi-No device in one of their algorithms and in the text, but not the randomised controlled trial (RCT) that was very recently published in this journal [3] and presented at a meeting in 2010 that the senior author attended.…”

mentioning

confidence: 99%

Can pelvic floor injury secondary to delivery be prevented? Comment

Dietz

2012

Int Urogynecol J

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Does the Epi-No® Birth Trainer reduce levator trauma? A randomised controlled trial

Abstract: This pilot randomised controlled trial showed a nonsignificantly lower incidence of pelvic floor muscle injury in women who used the Epi-No device from 37 weeks onwards.

Cited by 63 publications

References 25 publications

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

Effects of antenatal pelvic floor preparation techniques on the perineal integrity: a randomized controlled trial protocol

Can pelvic floor injury secondary to delivery be prevented? Comment

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