The effectiveness of interventions in the prevention of perineal trauma in parturients: A systematic review with meta-analysis

Silva, Marianne Lucena da; Santos, Thaísy Andressa Bastos Primo de Sousa; Leite, Lindely Wane Carvalho; Silva, Carlos Emanoel Chaves da; Nascimento, Alef Oliveira do; Alves, Aylton J.; Driusso, Patrícia; Cunha, Katiane da Costa

doi:10.1016/j.ejogrb.2023.02.008

Cited by 6 publications

(12 citation statements)

References 55 publications

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“…Our results are in line with the systematic review of da Silva et al. including 50 RCTs ( N = 17 221) of different interventions both during pregnancy and during labor 21 . They concluded with evidence for interventions during pregnancy, but not during labor, to lower the risk of perineal laceration when compared to no intervention (RR = 0.81, 95% CI [0.71, 0.93]: p = 0.05, I 2 = 47%).…”

Section: Discussionsupporting

confidence: 92%

“…including 50 RCTs ( N = 17 221) of different interventions both during pregnancy and during labor. 21 They concluded with evidence for interventions during pregnancy, but not during labor, to lower the risk of perineal laceration when compared to no intervention (RR = 0.81, 95% CI [0.71, 0.93]: p = 0.05, I 2 = 47%). Among the different techniques included in their review perineal massage had RR = 0.69, 95% CI [0.54, 0.87]: p < 0.01) to prevent laceration when compared to no intervention.…”

Section: Discussionmentioning

confidence: 96%

“…19,20 A recent systematic review and meta-analysis, comprising exclusively randomized controlled trials (RCTs), investigated the effectiveness of various interventions aimed at preventing perineal trauma in parturient individuals, but limited the inclusion of studies on PFMT to RCTs that compared training with untreated controls. 21 Therefore, the aim of this systematic review was to examine the effect of PFMT, implemented as a specific section within a PA program or as a single intervention during pregnancy, on UI, episiotomy and third-or fourth-degree perineal tear.…”

Section: Introductionmentioning

confidence: 99%

“…The Cochrane review of PFMT during pregnancy included studies up to June 2019 only, 15 and to date there is scant knowledge whether PFMT during pregnancy can prevent episiotomy and third and fourth degree perineal tear 19,20 . A recent systematic review and meta‐analysis, comprising exclusively randomized controlled trials (RCTs), investigated the effectiveness of various interventions aimed at preventing perineal trauma in parturient individuals, but limited the inclusion of studies on PFMT to RCTs that compared training with untreated controls 21 …”

Section: Introductionmentioning

confidence: 99%

“… 19 , 20 A recent systematic review and meta‐analysis, comprising exclusively randomized controlled trials (RCTs), investigated the effectiveness of various interventions aimed at preventing perineal trauma in parturient individuals, but limited the inclusion of studies on PFMT to RCTs that compared training with untreated controls. 21 …”

Section: Introductionmentioning

confidence: 99%

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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

Zhang,

Bo,

Montejo

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionThe 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 methodsA 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.ResultsThirty 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%).ConclusionsPFMT 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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Zhang,

Bo,

Montejo

et al. 2023

Acta Obstet Gynecol Scand

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Prophylaxe von Beckenbodenschäden

Kimmich

2023

Gynäkologie

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Zusammenfassung Hintergrund Der Wunsch schwangerer Frauen nach Erhalt ihrer Beckenbodenfunktion im Rahmen vaginaler Geburten ist groß, zumal Beckenbodentraumata mit einer hohen Rate physischer und psychosozialer Belastungen bis hin zur posttraumatischen Belastungsstörung einhergehen. Ziel der Arbeit Darstellung der Risikofaktoren für eine Beeinträchtigung der Beckenbodenfunktion und Herausarbeitung möglicher evidenzbasierter protektiver Maßnahmen im Rahmen vaginaler Geburten. Material und Methoden Literaturrecherche in der Online-Datenbank Pubmed. Ergebnisse Schwangerschaft und Geburt sind Hauptrisikofaktoren für Beckenbodenschäden. Im Rahmen einer vaginalen Geburt können die Geburtsmechanik und der Geburtsverlauf jedoch bis zu einem gewissen Grad durch verschiedene evidenzbasierte Maßnahmen im Sinne einer Primärprävention positiv beeinflusst werden. Schlussfolgerungen Aufgrund z. T. eingeschränkter therapeutischer Möglichkeiten, v. a. hinsichtlich Levatoravulsionen oder -überdehnungen, kommt der Prophylaxe von Beckenbodenschäden peripartal eine besondere Rolle zu. Es empfiehlt sich eine gezielte und effektive Selektion solcher Frauen, deren Grundvoraussetzungen für eine beckenbodenschonende Geburt eher suboptimal erscheinen. Mit diesen Frauen kann großzügig die Möglichkeit einer primären Sectio caesarea besprochen werden. Bei allen anderen Frauen empfiehlt sich die Anwendung der beschriebenen evidenzbasierten Maßnahmen zur Primärprophylaxe von Beckenbodenschäden.

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Perineal massage and warm compresses – Randomised controlled trial for reduce perineal trauma during labor

et al. 2023

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The effectiveness of interventions in the prevention of perineal trauma in parturients: A systematic review with meta-analysis

Cited by 6 publications

References 55 publications

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

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

Prophylaxe von Beckenbodenschäden

Perineal massage and warm compresses – Randomised controlled trial for reduce perineal trauma during labor

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