The prevention of perineal trauma during vaginal birth

Okeahialam, Nicola Adanna; Sultan, Abdul H.; Thakar, Ranee

doi:10.1016/j.ajog.2022.06.021

Cited by 8 publications

(9 citation statements)

References 73 publications

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“…Furthermore, regarding the angle of incision, studies have demonstrated that midline episiotomies carry a higher risk of anal sphincter injury compared to mediolateral episiotomy (Pergialiotis et al., 2014 , 2020 ; Verghese et al., 2016 ). Consequently, the use of midline episiotomy is discouraged (Okeahialam et al., 2023 ). Our study found that no midwives reported using midline episiotomy, aligning with the current recommendations.…”

Section: Discussionmentioning

confidence: 99%

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Laderas Díaz,

Rodríguez‐Almagro,

Picón Rodríguez

et al. 2024

Nursing Open

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AimDifferent clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy.DesignObservational cross‐sectional study.MethodsThree hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated.ResultsIntrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first‐degree tears and 273 (89.5%) always sutured second‐degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69–15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39–9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46–8.79) were significantly more likely to adopt a restrictive use of episiotomy.ConclusionsThere is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training.Patient or Public ContributionNo patient or public contribution.

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Section: Discussionmentioning

confidence: 99%

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Laderas Díaz,

Rodríguez‐Almagro,

Picón Rodríguez

et al. 2024

Nursing Open

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“…The episiotomy, particularly the mediolateral approach, has long been a topic of considerable debate in the field of obstetrics. This surgical intervention, despite its initial design to minimize severe perineal trauma during childbirth, has been scrutinised for its potential drawbacks, including pain and healing complications 18,19 . Mediolateral episiotomy is conventionally performed at varying angles, and the question of which angle optimises healing and minimises pain is pivotal for enhancing maternal care.…”

Section: Discussionmentioning

confidence: 99%

“…This surgical intervention, despite its initial design to minimize severe perineal trauma during childbirth, has been scrutinised for its potential drawbacks, including pain and healing complications. 18 , 19 Mediolateral episiotomy is conventionally performed at varying angles, and the question of which angle optimises healing and minimises pain is pivotal for enhancing maternal care. Our meta‐analysis suggests that a lower angle, deviating from the traditional 40° to 60° range, is significantly associated with reduced postoperative pain and improved wound healing.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of perineal wound healing and pain outcomes after low‐angle mediolateral episiotomy in women undergoing vaginal childbirth: A systematic review and meta‐analysis

Luo,

Lu,

2024

International Wound Journal

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The efficacy of episiotomy, particularly the angle of incision in mediolateral episiotomies, remains a significant area of inquiry in obstetrics. This meta‐analysis aimed to evaluate the impact of low‐angle mediolateral episiotomy on perineal wound healing and pain outcomes in women undergoing vaginal childbirth. Adhering to PRISMA guidelines, a systematic review was conducted using the PICO framework. Studies were selected based on predefined inclusion and exclusion criteria, focusing on randomised controlled trials (RCTs) involving low‐angle mediolateral episiotomies. Comprehensive literature searches were performed across major electronic databases including PubMed, Embase, Web of Science and Cochrane Library. Data extraction and quality assessments were meticulously carried out by independent reviewers, employing the Cochrane Collaboration's risk of bias tool. A total of 1246 articles were initially identified, with 8 articles meeting the strict inclusion criteria for the final analysis. The meta‐analysis revealed significant heterogeneity among studies regarding postoperative pain (p < 0.0001, I2 = 77.5%), and employed a random‐effects model. Results showed that low‐angle episiotomies significantly reduced postoperative pain (OR = 0.27, 95% CI: 0.17–0.42, p < 0.001), and increased first‐degree healing rates (OR = 2.95, 95% CI: 2.20–3.96, p < 0.001) compared to traditional angles. Sensitivity analyses confirmed the stability of these findings, and no significant publication bias was detected. The analysis suggests that low‐angle episiotomies can potentially reduce postoperative perineal pain and enhance wound healing. However, the limited number and varying quality of the included studies warrant cautious interpretation of these results. Further well‐designed studies are needed to corroborate these findings and guide clinical practice.

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“…One of the most typical postpartum consequences of vaginal delivery is perineal trauma. According to statistics [1,2], perineal injuries of varying degrees occur in 53-89% of women experiencing vaginal delivery, with the highest incidence in primiparous women [3], including spontaneous and human intervention-induced perineal injuries [4]. However, both short-term and long-term complications are linked to perineal trauma during childbirth [5,6].…”

Section: Introductionmentioning

confidence: 99%

Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis

Yin,

Chen,

Huang

et al. 2024

BMC Pregnancy Childbirth

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Background Perineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the early postpartum period. However, there is still debate concerning the best period to apply perineal massage, which is either antenatal or in the second stage of labor, as well as its safety and effectiveness. Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women. Methods We searched nine different electronic databases from inception to April 16, 2024. The randomized controlled trials (RCTs) we included assessed the effects of antenatal and second-stage labor perineal massage in primiparous women. All data were analyzed with Revman 5.3, Stata Statistical Software, and Risk of Bias 2 was used to assess the risk of bias. Subgroup analyses were performed based on the different periods of perineal massage. The primary outcomes were the incidence of perineal integrity and perineal injury. Secondary outcomes were perineal pain, duration of the second stage of labor, postpartum hemorrhage, urinary incontinence, fecal incontinence, and flatus incontinence. Results This review comprised a total of 10 studies that covered 1057 primigravid women. The results of the analysis showed that perineal massage during the second stage of labor reduced the perineal pain of primigravid women in the immediate postpartum period compared to the antenatal period, with a statistical value of (MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001). Additionally, only the antenatal stage reported that perineal massage reduced fecal incontinence (P = 0.04) and flatus incontinence (P = 0.01) in primiparous women at three months postpartum, but had no significant effect on urinary incontinence in primiparous women at three months postpartum (P = 0.80). Conclusions Reducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage. Trial registration CRD42023415996 (PROSPERO).

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The prevention of perineal trauma during vaginal birth

Cited by 8 publications

References 73 publications

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Evaluation of perineal wound healing and pain outcomes after low‐angle mediolateral episiotomy in women undergoing vaginal childbirth: A systematic review and meta‐analysis

Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis

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