Perineal techniques during the second stage of labour for reducing perineal trauma (Review)

Abstract

Background Most vaginal births are associated with trauma to the genital tract. The morbidity associated with perineal trauma can be significant, especially when it comes to third- and fourth-degree tears. Different interventions including perineal massage, warm or cold compresses, and perineal management techniques have been used to prevent trauma. This is an update of a Cochrane review that was first published in 2011. Objectives To assess the effect of perineal techniques during the second stage of labour on the incidence and morbidity associated with perineal trauma. Search methods We searched Cochrane Pregnancy and Childbirth’s Trials Regist er (26 September 2016) and reference lists of retrieved studies. Selection criteria Published and unpublished randomised and quasi-randomised controlled trials evaluating perineal techniques during the second stage of labour. Cross-over trials were not eligible for inclusion. Data collection and analysis Three review authors independently assessed trials for inclusion, extracted data and evaluated methodological quality. We checked data for accuracy. Main results Twenty-two trials were eligible for inclusion (with 20 trials involving 15,181 women providing data). Overall, trials were at moderate to high risk of bias; none had adequate blinding, and most were unclear for both allocation concealment and incomplete outcome data. Interventions compared included the use of perineal massage, warm and cold compresses, and other perineal management techniques. Most studies did not report data on our secondary outcomes. We downgraded evidence for risk of bias, inconsistency, and imprecision for all comparisons