The role of thumb and index finger placement in manual perineal protection

Jansová, Magdalena; Kališ, Vladimír; Lobovský, Libor; Hynčík, Luděk; Karbanová, Jaroslava; Rušavý, Zdeněk

doi:10.1007/s00192-014-2425-7

Cited by 29 publications

(44 citation statements)

References 21 publications

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“…Indeed, computational analysis revealed that the degree of reduction in perineal strain at the fourchette is a determinant of where the thumb and index finger are placed on the perineum as well as the distance and direction of their medial movements. Based on measures of maximum perineal strain, minor alterations in these parameters were associated with a gradual reduction in the maneuver’s efficacy . Interestingly, all the respondents who provided correct and complete information about the MPP technique had <5 years’ work experience in maternity care.…”

Section: Discussionmentioning

confidence: 99%

“…This is mainly achieved by a reduction in the transverse perineal tension using the accoucheur’s thumb and index finger alongside the vaginal opening . Subsequent computational biomechanical studies showed that such maneuver can produce up to a 30% reduction in relative tension in the perineal region, dependent on the precision of its execution . Indeed, the maneuver is most effective when the thumb and index finger were applied 12 cm apart, 2 cm anterior to the posterior fourchette and approximated medially by 1 cm on either side.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19] Subsequent computational biomechanical studies showed that such maneuver can produce up to a 30% reduction in relative tension in the perineal region, dependent on the precision of its execution. 18,20,21 Indeed, the maneuver is most effective when the thumb and index finger were applied 12 cm apart, 2 cm anterior to the posterior fourchette and approximated medially study took place in three maternity units that support manual perineal protection policy in three European countries (Czech Republic, Slovenia and the UK). Our study demonstrated that the majority of participants are aware of the concept of manual perineal protection.…”

Section: Introductionmentioning

confidence: 99%

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Manual perineal protection: The know‐how and the know‐why

Kleprlikova

Kališ

Lučovnik

et al. 2019

Acta Obstet Gynecol Scand

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Manual perineal protection is an obstetric intervention to mitigate the risk of perineal trauma. There are two effective techniques (Finnish and Viennese) with minor but distinctive differences in between them. The main aim of this study was to explore clinicians’ knowledge about the manual perineal protection technique they use. The study took place in three maternity units that support manual perineal protection policy in three European countries (Czech Republic, Slovenia and the UK). Our study demonstrated that the majority of participants are aware of the concept of manual perineal protection. However, there were significant differences between staff responses regarding their views and experience with manual perineal protection in general. Less than 6% of respondents were able to provide an accurate account of the actual maneuvers they perform when manually protecting the perineum. Although this is not necessarily synonymous with suboptimal performance, it highlights the potential need to give more attention to the theory that underpins the technical skill in manual perineal protection training programs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Manual perineal protection: The know‐how and the know‐why

Kleprlikova

Kališ

Lučovnik

et al. 2019

Acta Obstet Gynecol Scand

Self Cite

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“…One would expect such confounding factors to be balanced in a suitably powered RCT. Moreover, there are several techniques of MPS that might have different degrees of effectiveness in supporting the pelvic floor …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there are several techniques of MPS that might have different degrees of effectiveness in supporting the pelvic floor. 60…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

Manual perineal support at the time of childbirth: a systematic review and meta‐analysis

Bulchandani

Watts

Sucharitha

et al. 2015

BJOG

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Background Genital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS). Debate continues regarding the effectiveness of perineal support during childbirth in reducing the risk of trauma.Objectives This review aimed to assess the effect of routine 'hands on'/manual perineal support (MPS) during childbirth, versus ad hoc/no perineal support ('hands off/poised'), on the risk and degree of perineal trauma.Search strategy This review is registered on PROSPERO (http:// www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42014007058). We searched the CENTRAL, Embase, Medline, CINAHL, and OVIDs midwifery and infant care databases (from inception to December 2014).Selection criteria Published randomised controlled trials (RCTs) and non-randomised studies (NRSs) evaluating any 'hands on' perineal support technique during childbirth.Data collection and analysis Two reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer.Main results We included five RCTs and seven NRSs in the review. Meta-analysis of RCTs did not demonstrate a statistically significant protective effect of MPS on the risk of OASIS (three studies, 6647 women; relative risk, RR 1.03; 95% confidence interval, 95% CI 0.32-3.36; statistical test for heterogeneity I 2 = 71%). Meta-analysis of NRSs showed a significant reduction in the risk of OASIS with MPS (three studies, 74 744 women; RR 0.45; 95% CI 0.40-0.50; I 2 = 32%).Conclusion Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS policies, ensuring controlled childbirth, is urgently needed.Keywords Obstetric anal sphincter injuries, parturition, perineal support, perineal trauma. IntroductionIt is reported that 85% of women having a vaginal birth sustain some degree of perineal trauma. 1 Perineal tears are defined as first degree when the perineal skin is involved, second degree when the tear involves perineal muscles and skin, third degree when the anal sphincter complex is involved, and fourth degree when the tear involves all of the above structures and the anal epithelium or rectal mucosa. 2,3 Third-and fourth-degree tears are collectively called obstetric anal sphincter injuries (OASIS). The overall rate of OASIS varies in reports (0.6-10.2%), 4-8 and is sometimes attributed to differences in definitions and clinical practices. 9 Perineal trauma is associated with considerable shortand long-term morbidity. The risk and severity of complications is proportional to the extent of the trauma. 10,11 Despite identification and repair, postpartum complications such as perineal pain and faecal incontinence have a higher prevalence following OASIS, [12][13][14][15][16] and are associated with www.bjog.org Systematic review major psychological, physical, and social problems....

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