Beckmann M M, Garrett A J
QE2 Jubilee Hospital, Kessels Road, Coopers Plains, Queensland, Australia, 4108.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD005123. doi: 10.1002/14651858.CD005123.pub2.
Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma.
To assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), PubMed (1966 to January 2005), EMBASE (1980 to January 2005) and reference lists of relevant articles.
Randomised and quasi-randomised controlled trials evaluating any described method of antenatal perineal massage undertaken for at least the last four weeks of pregnancy.
Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information.
Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)). Again this reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.85 (95% CI 0.74 to 0.97), NNT 20 (11 to 110)). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.68 (95% CI 0.50 to 0.91) NNT 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage.
AUTHORS' CONCLUSIONS: Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.
阴道分娩后的会阴创伤可能会导致严重的短期和长期发病率。产前会阴按摩被提议作为一种降低会阴创伤发生率的方法。
评估产前会阴按摩对出生时会阴创伤发生率及后续发病率的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2005年1月30日）、Cochrane对照试验中心注册库（Cochrane图书馆，2005年第1期）、PubMed（1966年至2005年1月）、EMBASE（1980年至2005年1月）以及相关文章的参考文献列表。
评估在妊娠最后至少四周进行的任何所述产前会阴按摩方法的随机和半随机对照试验。
两位综述作者独立应用选择标准，从纳入研究中提取数据并评估研究质量。我们联系研究作者获取更多信息。
纳入了三项比较指压会阴按摩与对照组的试验（2434名女性）。所有试验质量良好。产前会阴按摩与需要缝合的创伤发生率总体降低相关（三项试验，2417名女性，相对危险度（RR）0.91（95%置信区间（CI）0.86至0.96），需治疗人数（NNT）16（10至39））。仅对于既往无阴道分娩史的女性，这种降低具有统计学意义（三项试验，1925名女性，RR 0.90（95%CI 0.84至0.96），NNT 14（9至35））。进行会阴按摩的女性行会阴切开术的可能性较小（三项试验，2417名女性，RR 0.85（95%CI 0.75至0.97），NNT 23（13至111））。同样，仅对于既往无阴道分娩史的女性，这种降低具有统计学意义（三项试验，1925名女性，RR 0.85（95%CI 0.74至0.97），NNT 20（11至110））。在一度或二度会阴撕裂或三度/四度会阴创伤的发生率方面未发现差异。仅既往有阴道分娩史的女性报告产后三个月疼痛发生率有统计学意义的降低（一项试验，376名女性，RR 0.68（95%CI 0.50至0.91），NNT 13（7至60））。与未进行会阴按摩的女性相比，进行会阴按摩的女性在器械助产率、性满意度或尿失禁、粪失禁或排气失禁发生率方面未观察到显著差异。
产前会阴按摩可降低会阴创伤（主要是会阴切开术）的可能性以及持续性会阴疼痛的报告率，并且通常为女性所接受。因此，应让女性了解会阴按摩可能带来的益处，并为其提供如何进行按摩的信息。
