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Second Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Perineal massage has been evaluated for a decrease in perineal lacerations. Perineal massage has not been associated with complications. For perineal massage during pregnancy and before labor, see Chap. 2. Perineal massage and stretching of the perineum with a water-soluble lubricant in the second stage of labor are associated with a 40% increased rate of intact perineum, a 51% decreased rate of severe perineal trauma, and a 44% decreased rate of episiotomy compared with controls [27]. A Cochrane review also favored perineal massage versus hands off for a 51% reduction in third- or fourth-degree tears [28]. In summary, perineal massage is recommended in the second stage of labor to decrease perineal trauma.
Perineal, anal sphincter and bladder injury
Published in Sheila Broderick, Ruth Cochrane, Trauma and Birth, 2020
Sheila Broderick, Ruth Cochrane
Antenatal perineal massage can reduce the incidence of perineal trauma in women having their first baby (Labrecque et al 1999), but perineal stretching during the second stage of labour has not been shown to help. Other useful measures to try to prevent perineal trauma are the application of a warm compress to the perineum during the second stage of labour, and allowing the baby’s head to deliver in a controlled fashion (Kapoor et al 2015).
Operative delivery
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
Some women perform perineal massage in the antenatal period and this may reduce the risk or extent of tearing. Perineal tears occur more commonly with prolonged labour, especially the active second stage, with big babies and in association with instrumental delivery. Third-degree tears are reported in approximately 3% of primigravidae and 0.5% of multiparae. In general terms, external anal sphincter incompetence causes faecal urgency, whereas internal anal sphincter incompetence causes faecal incontinence. Third- and fourth-degree tears are grouped together and termed obstetric anal sphincter injuries (OASI).
Effect of lubricant gel on the length of the first stage of labour and perineal trauma in primiparous women
Published in Journal of Obstetrics and Gynaecology, 2022
Fatemeh Azarkish, Roksana Janghorban, Shirin Bozorgzadeh, Fariba Merbalouchzai, Massoumeh Razavi, Maleknaz Badiee
Eepisiotomy has been used for nearly 200 years to shorten the second stage of labour and, to reduce the severity of perineal trauma (Cunningham et al. 2018). The frequency of episiotomy has significantly decreased over the past 25 years, but episiotomy has continued to increase in Asian women due to the short and strong tissue of perineum (Schantz et al. 2015). This increase in episiotomy has been associated with an increased risk of perineal trauma. Studies showed that episiotomy in nulliparous women is eight times more common than in multiparous women (Kütük et al. 2016; Singh et al. 2016). Trends in changes in the rate of episiotomy around the world were very different (Goueslard et al. 2018; Clesse et al. 2019). There is clear evidence which suggests that performing episiotomy as a form of care is not effective (Jiang et al. 2017). In addition, new research does not support the claim that episiotomy reduces brain haemorrhage in preterm infants and the duration of the second stage of labour (Kopas 2014; Aasheim et al. 2011). The Use of episiotomy in all deliveries does shorten the second stage of labour and prevent low neonatal Apgar scores or reduce trauma to the perineum (Paris et al. 2011). The use of perineal massage with gel at the end of the second stage of labour has already been examined and shown to reduce the length of the second stage of labour, but does not have a significant effect on the strength and health of perineum (Aasheim et al. 2011; Kopas 2014). Ideal management of labour should increase the probability of vaginal birth and reduce the risk of maternal and foetal complications (London et al. 2015; Rasouli et al. 2016).
Factors related to episiotomy practice: an evidence-based medicine systematic review
Published in Journal of Obstetrics and Gynaecology, 2019
Christophe Clesse, Joëlle Lighezzolo-Alnot, Sylvie De Lavergne, Sandrine Hamlin, Michèle Scheffler
Scientific research has highlighted a wide variety of technical factors related to episiotomy practice (Table 3). A first category corresponds to the massage performing techniques which are considered as protective especially according to Beckmann and Stock’s (2013) Cochrane review about prenatal digital massage. Similarly, despite the precautions put forward by the authors, perineal massage is also considered as a protective factor by the Aasheim et al. Cochrane review (2017). It would be relevant to question whether the origin of this protective factor is related to a physiological and/or psychological effect induced by the massage, or if this factor induces a practitioner particular attention on the preservation of the perineum. Other findings from the study by Aasheim et al. (2017) show, however, that hands-on techniques are rather considered as risk factors. Moreover, the use of hot compresses or Ritgen’s manoeuvre has no impact on the episiotomy rate (Aasheim et al. 2017). In contrast, fundal pressure is perceived as a risk-factor (Cromi et al. 2014). Among parturition positions, the lithotomy (Meyvis et al. 2012; Ballesteros-Meseguer et al. 2016) and the semi-upright position (Silva da et al. 2012) are both considered as risk factors, whereas alternative positions are perceived as protective factors (Räisänen et al. 2010a). Specifically, sitting-position (Warmink-Perdijk et al. 2016) and lateral position (Meyvis et al. 2012) serve as protective factors. In addition, a Cochrane meta-analysis demonstrated the impact of the upright position as a protective factor (Gupta et al. 2012). The presence of these factors may be a source of reflection concerning the adjustment of the birthing conditions of parturients in the future.