Studies with 3467 patients on the potential benefits of perineal massage
Title: Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials.
A majority of vaginal births are accompanied by perineal injuries. Perineal trauma can cause severe morbidity, especially resulting from third- and fourth- degree perineal tears. The researchers assumed that antenatal perineal massage helps reduce the occurrence of perineal trauma especially severe perineal tears and other postpartum complications.
The researchers used four different databases for the available trials from the beginning of the research to August 2019 that evaluate the incidence of perineal tears in perineal trauma patients, that is, pregnant women practicing antenatal perineal massage versus pregnant women who do not practice perineal massage.
In total, eleven studies with 3467 patients were evaluated and results showed that women who receive antenatal perineal massage had considerably much lower incidence of episiotomies and perineal tears; better wound healing and less perineal pain. Moreover, antenatal perineal massage was shown to reduce the duration of the second stage of labor and anal incontinence. In addition, newborn babies from patients who practiced antenatal perineal massage had better Apgar scores at 1 and 5 min after birth.
The study found that practicing antenatal perineal massage is linked to lower risk of perineal trauma and postpartum complications.
Citation: Int Urogynecol J. 2020 May 12. doi: 10.1007/s00192-020-04302-8
A review of 26 studies on reducing third- and fourth-degree tears
Title: Third- and fourth-degree tears: A review of the current evidence for prevention and management.
Australian women have been found to have higher rates of third- and fourth- degree tears as compared to women from countries with the same economic status as Australia.
This research aims to thoroughly study and review previous literature and published articles to find the best ways to prevent and manage third- and fourth- degree perineal tears in Australian maternity clinics.
The researchers reviewed twenty-six studies in total. The most common risk factors found for third- and fourth- degree tears in these studies were the mother giving birth for the first time or has only given birth once before; mother’s ethnicity; large babies and interventions done during labor and at birth such as deliveries done with the aid of instruments.
Preventive practices with varying degrees of effectiveness included: antenatal perineal massage, maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for births with the aid of instruments.
The authors of the study conclude that third- and fourth- degree tears are linked with direct and long-term consequences for women and health care systems. They recommend evidence-based approaches to prevent women from sustaining severe perineal tears and ease the implications of those who do.
Citation: Aust N Z J Obstet Gynaecol. 2020 Apr;60(2):175-182. doi: 10.1111/ajo.13127. Epub 2020 Feb 17.
Reducing perineal trauma in pregnant woman aged 35+ with perineal massage
Title: Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial.
The researchers of this study wanted to determine the effectiveness of educational prevention programs on perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) in pregnant women above 35 years old to prevent perineal tear and episiotomy.
To do this, 400 pregnant women at the obstetrics outpatient clinic who were 4 weeks prior to their due date were divided/slit into two groups randomly. The first group which had 200 participants were asked to do perineal massage, pelvic floor muscle training and received an educational PFD prevention program. The second group, also composed of 200 participants receive only the PFD prevention program. The incidence of perineal tears were reported at the time of delivery as the primary outcome.
Women from the first group reported fewer perineal tears, episiotomies and postnatal pain. In addition, the grades of perineal tear in the first group were mostly first and second degree as compared with the second group. Moreover, there was a lesser need for analgesia during the hospital stay in the first group.
The authors concluded that practicing antenatal perineal massage and PFMT in addition to health education is beneficial to decrease perineal complications.
Citation: Int Urogynecol J 2020 Mar;31(3):613-619.