Use of Hyaluronidase to Prevent Perineal Trauma During Spontaneous Delivery: A Pilot Study

Abstract

Our objective was to compare the frequency, degree, and location of perineal trauma during spontaneous delivery with or without perineal injections of hyaluronidase (HAase). This was a randomized, controlled pilot study, conducted in a midwife-led hospital birth center in São Paulo, Brazil. Primiparous women (N = 139) were randomly assigned to an intervention group (HAase injection, n = 71) or to a control group (no injection, n = 68). Significant differences were noted between the two groups in frequency of perineal trauma (intervention, 39.4%; control, 76.5%), degree of spontaneous laceration (intervention, 0.0%; control, 82.4%), and laceration located in the posterior region of the perineum (intervention, 54.2%; control, 84.3%). When episiotomy and second-degree lacerations were considered together and women with intact perineum were excluded from the analysis, the difference between the groups was no longer significant. With the use of the HAase enzyme, the relative risk was 0.5 for perineal trauma and 0.0 for second-degree lacerations. The present findings suggest that perineal injection of HAase prevented perineal trauma. These findings provide strong rationale for a larger follow-up study.

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

“…In two other studies, the authors afirmed that there were less cases of second degree laceration and more parturitions with intact perineum in black women (11)(12)(13)(14) . Age was the next variable, and studies confirmed the absence of scientific evidence to associate perineal trauma to the maternal age, and emphasized the lack of significance in association between these variables (11,(14)(15)(16) , confirming the findings of this study.…”

“…In a transversal study about factors related to perineal trauma in normal parturition in nulliparas (10,12) , there was a prevalence of white women experiencing perineal trauma, but not at a statistically relevant level. In two other studies, the authors afirmed that there were less cases of second degree laceration and more parturitions with intact perineum in black women (11)(12)(13)(14) .…”

A mixed methods study to explore women and clinician׳s response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE]

“…This is a common event that affects women across a variety of international settings (Barreto-Scarabotto and Gonzalez-Riesco, 2008;Kettel et al, 2010;Ismail et al, 2013;Smith et al, 2013). Despite the frequency of the event there is a dearth of research which relates to women's experience of perineal suturing or the clinician's decision to suture.…”

Promoting normality in the management of the perineum during the second stage of labour

“…A small Brazilian study (Scarabotto and Riesco 2008) considered the use of hyaluronidase injections into the perineum during second stage and found that the incidence and severity of perineal trauma was significantly reduced in the intervention group. This method would need to be researched on a sample, both larger in number and suitable to apply results to the UK before practice could be adapted.…”