Effects of different techniques during the second stage of labour on reducing perineal laceration: An overview of systematic reviews

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-tohigh quality systematic reviews. The overview was reported according to the PRISMA statement.Results: Eighteen reviews were included, of which four reviews had moderate-tohigh 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 fourthdegree 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.

Predicting obstetric anal sphincter injuries among laboring women: 2 prediction models and 1 risk calculator

“…In our study, we established 2 prediction models that can be used to dynamically evaluate the risk of OASIS in different stages of labor, thus promoting the implementation of precision medicine. Model I, based on known antenatal factors, can be applied to estimate the risk of OASIS before childbirth to guide midwives to take preventive measures for women at high risk of OASIS during the first and second stages of labor, such as perineal massage and warm compresses 33 . However, the risk of OASIS may change at different stages of labor.…”

Practice Programme for Upright Positions in the Second Stage of Labour: The development of a complex intervention based on the Medical Research Council framework

“…We carried out a series of systematic reviews to summarize the best available evidence on each item in the content framework from relevant clinical guidelines, systematic reviews and original studies. The iterative process of evidence retrieval and synthesis included (1) a systematic review of normal birth guidelines to summarize evidence on indications and contraindications, implementation methods, observations and potential risks of upright positions in the second stage of labour (Zang, 2021); (2) a systematic review of original studies to summarize specific implementation methods of different kinds of upright positions (Zang, 2021); (3) an overview of systematic reviews to clarify potential risks of upright positions in the second stage of labour (Zang, Lu, Zhang, Huang, et al, 2021); and (4) an overview of systematic reviews to summarize evidence on precautions against potential risks of upright positions (Zang et al, 2022). All reviews have published elsewhere with detailed methodological and conclusive presentations, see Table 1.…”

“…(4) an overview of systematic reviews to summarize evidence on precautions against potential risks of upright positions (Zang et al, 2022). All reviews have published elsewhere with detailed methodological and conclusive presentations, see Table 1.…”

“…First, by systematically reviewing the published clinical practice guidelines containing preventive measures for postpartum haemorrhage, we finally found three definite precautions to prevent the risk(Zang, 2021): (1) assessment of risk factors; (2) oxytocin use (10 IU, IM/IV) in the third stage of labour; and (3) assist women to adapt to semi-recumbent or all-fours positions from upright birth positions before the expulsion of the foetus. As for second-degree perineal laceration, due to the evidence from the guidelines being too dated, we further conducted an overview of systematic reviews to conclude the available best evidence(Zang et al, 2022): (1) with maternal consent and if conditions permit, perineal laceration can be prevented by perineal massage, warm compresses and a "hand on" guarding of the perineum; (2) similarly, before the foetus is delivered, assisting women with upright birth positions changing to a semi-recumbent or all-fours position.T A B L E 2 Practice Programme for Upright Positions in the Second Stage of Labour (UPSSL Programme)…”