New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy

Moya-Jiménez, L.C.; Sánchez-Ferrer, María Luisa; Adoamnei, Evdochia; Mendiola, Jaime

doi:10.1007/s00192-018-3745-9

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…All investigations identified a lower incidence of episiotomies if perineal massage was applied. It should be emphasized that the decision to perform episiotomy is made by the healthcare team attending the delivery, based on professional judgment guided by experience, training, and decision‐making capacity in relation to possible complications 30 . Such an intervention is usually performed to prevent perineal tears or, if they do occur, to reduce their severity 31,32 .…”

Section: Discussionmentioning

confidence: 99%

“…It should be emphasized that the decision to perform episiotomy is made by the healthcare team attending the delivery, based on professional judgment guided by experience, training, and decision-making capacity in relation to possible complications. 30 Such an intervention is usually performed to prevent perineal tears or, if they do occur, to reduce their severity. 31,32 Evidence to date has shown that routine episiotomies do not reduce perineal trauma and that a protocol to reduce episiotomies is safer for mother and baby.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta‐analysis

Marcos‐Rodríguez

Leirós‐Rodríguez

Hernández‐Lucas

2023

Intl J Gynecology & Obste

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BackgroundNumerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage.ObjectiveTo determine the efficacy of perineal massage during the second stage of labor to prevent perineal damage.Search StrategySystematic 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 CriteriaThe 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 AnalysisTables 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 ResultsOf 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.ConclusionsMassage 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta‐analysis

Marcos‐Rodríguez

Leirós‐Rodríguez

Hernández‐Lucas

2023

Intl J Gynecology & Obste

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“…Favoring the discussion about the importance of these outcomes, a cohort [34] that analyzed 57.267 deliveries concluded that a maternal pushing more than 30 minutes long during the second stage of labor, and an expulsive stage more than one hour long are the potential factors for maternal and neonatal morbidities, especially postpartum hemorrhage, as well as uterine atony and cervical and perineal lacerations. This study recommends caution regarding obstetric interventions and better analyzing expectant management during the second stage of labor.…”

Section: Discussionmentioning

confidence: 99%

“…When analyzing research on pain, anxiety, and maternal fatigue in the second period of labor there is no consistent evidence about a direct association with the type of pushing. It is understood, however, that those outcomes might influence labor progression, as the stress generated by these sensations result in a greater release of catecholamines, fatty acids, and lactate, which can reduce the effectiveness of uterine contractions, possibly leading to prolonged labor, and consequently to dystocia, instrumentalization, higher post-partum hemorrhage risk, fetal distress and negative labor experience for the woman [32,34,35].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of spontaneous pushing with pursed lips breathing compared with directed pushing in maternal and neonatal outcomes: a clinical trial

Araújo¹,

Delgado²,

Maia³

et al. 2020

Preprint

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Objective: to evaluate the efficacy of spontaneous pushing with pursed lips breathing compared to directed pushing during the second period of labor in the occurrence of episiotomy. Methods: this is a quasi-randomized clinical trial, with 62 low-risk pregnant women in the second stage of labor. They were randomly allocated in control (CG) (n = 31) and intervention (IG) (n = 31) groups. The IG performed spontaneous pushing with pursed lips breathing while the CG was oriented to perform directed pushing associated with Valsalva Maneuver (MV). Results: There was no difference between the groups regarding the occurrence of episiotomy (RR 1,1; 95%IC 1,0 to 1,2). However, there was a decrease in the duration of the maternal pushing by 3.2 minutes (MD 3,2; 95%CI 1,4 to 5,1) and a difference in maternal anxiety (Md (IQR) IG 46 (35-52), CG 51 (44-56) p:0,049), both favoring the IG. There was no difference in others maternal and neonatal outcomes Conclusions: spontaneous pushing with pursed lips breathing was effective in reducing the duration of the pushing and showed a difference in maternal anxiety, but did not decrease the occurrence of episiotomy, nor did it alter the other studied maternal and neonatal outcomes.

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“…Perineal sizes were perineum body (PB): the distance between the posterior margin of the genital hiatus and the middle part of the anus at the time of exertion; genital hiatus (GH): the distance between meatus urethra to the posterior middle line during exertion [ 8 , 10 ]; anogenital size (AGD): the distance between the external genitalia from the anterior part of the clitoris to the anus and PB+GH [ 11 ]. Data collected through questionnaires were analyzed using SPSS-21.…”

Section: Methodsmentioning

confidence: 99%

The relationship between perineal size and episiotomy during delivery

et al. 2022

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Women have anatomically different perineal sizes. Different perineal sizes in primiparous women may be related to episiotomy and its consequences. The aim of this study was to investigate the relationship between perineal size and episiotomy during delivery. 376 primiparous women referred to Fatemieh Hospital in Hamadan with single pregnancies, in the first stage of labor, and with a gestational age of 37 weeks and more, out of which 372 participated in this study. Before entering the first stage of labor, they underwent perineal measurements, such as perineal body (PB), genital hiatus (GH), and anogenital area (AGD), in a forced position. Then, they were followed up for episiotomy and vaginal wall rupture until the end of the second stage of labor. Our outcome in this study was an episiotomy during delivery. The mean gestational age was 39.10±1.21 weeks, and the neonatal weight was 3107.37±42.39 g. 86.3% of women had an episiotomy, and 5.4% experienced perineal tear (laceration). Mean perineal size was 3.99±0.77, genital hiatus was 3.040±0.74, GH+PB was 7.39±1.05, and AGD was 8.49±1.22 cm. There was a statistically significant relationship between perineal body size episiotomy (P=0.011), GH+PB (P=0.003), AGD (P=0.017), neonatal birth weight (P=0.021), as well as grade 1 and 2 rupture (P<0.001). The size of GH+PB at the cut-off point of 6.25 cm and AGD at the cut-off point of 9.25 cm significantly increased the chance of performing an episiotomy. In primiparous women with a gestational age of 37 to 42 weeks, vaginal delivery, shorter perineum, vaginal hiatus, and anogenital distance significantly increased the likelihood of an episiotomy. On the other hand, performing an episiotomy significantly reduced grade 1 and 2 perineal tear rates.

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New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy

Abstract: This study introduces measures of AGD as risk factors for episiotomy. We propose that "gh + pb" length <77 mm and AGDac <93 mm may predict the likelihood of requiring episiotomy and may be useful for diminishing subjectivity in the decision to perform an episiotomy.

Cited by 8 publications

References 25 publications

Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta‐analysis

Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta‐analysis

Efficacy of spontaneous pushing with pursed lips breathing compared with directed pushing in maternal and neonatal outcomes: a clinical trial

The relationship between perineal size and episiotomy during delivery

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