Petrocnik Petra, Marshall Jayne E
University of Ljubljana, Faculty of Health Sciences, Slovenia.
St Georges, University of London/Kingston University, UK.
Midwifery. 2015 Feb;31(2):274-9. doi: 10.1016/j.midw.2014.10.004. Epub 2014 Nov 5.
vaginal birth is often accompanied with perineal trauma that affects postpartum morbidity. There are many techniques for protecting the perineum from injury during childbirth. The Hands-On or Hands Poised (HOOP) study (McCandlish et al., 1998) was the first trial that compared different techniques of perineal protection during the second stage of labour with very little research subsequently being undertaken.
to systematically review all available literature that compares the hands-on and hands-poised techniques of perineal management during the second stage of labour.
using the principles of a modified systematic literature review, quantitative, comparative and primary research studies were selected. These were assessed for quality using the Critical Appraisal Skills Programme (CASP) framework including a data extraction form. The results were reported narratively.
five studies were included and outlined the importance of both techniques. The hands-poised technique appeared to cause less perineal trauma and reduced rates of episiotomy. The hands-on technique resulted in increased perineal pain after birth and higher rates of postpartum haemorrhage.
as the five studies selected for this review have widely differing variables, comparisons that have been drawn must be viewed with caution. Evidence would suggest that the hands-poised technique is a safe and recommended technique for perineal management and discussions of such a technique should be included in all midwifery education and training programmes. The challenge for midwives is how to support women in making informed choices about perineal management during childbirth. Until there is conclusive evidence, the choice of the hands-on or hands-poised technique will ultimately be determined by the clinical judgment of the individual midwife at the time of birth. Further research is recommended. Thorough conclusions could significantly impact on reducing postpartum morbidity and improving women's sexual health and well-being in the long term, throughout the world.
阴道分娩常伴有会阴创伤，这会影响产后发病率。分娩期间有多种保护会阴免受损伤的技术。“动手操作或双手准备（HOOP）”研究（麦坎德利斯等人，1998年）是第一项比较第二产程中不同会阴保护技术的试验，随后进行的相关研究很少。
系统回顾所有比较第二产程中会阴管理的动手操作技术和双手准备技术的现有文献。
采用改良的系统文献综述原则，选择定量、比较和原发性研究。使用包括数据提取表在内的批判性评估技能计划（CASP）框架对这些研究进行质量评估。结果采用叙述性报告。
纳入了五项研究，概述了两种技术的重要性。双手准备技术似乎导致较少的会阴创伤和较低的会阴切开率。动手操作技术导致产后会阴疼痛增加和产后出血率升高。
由于本次综述所选的五项研究变量差异很大，因此对所做的比较必须谨慎看待。有证据表明，双手准备技术是一种安全且推荐的会阴管理技术，所有助产士教育和培训计划都应纳入对此类技术的讨论。助产士面临的挑战是如何支持女性在分娩期间就会阴管理做出明智的选择。在有确凿证据之前，动手操作技术或双手准备技术的选择最终将由助产士在分娩时的临床判断决定。建议进一步研究。全面的结论可能会对全球长期降低产后发病率以及改善女性性健康和福祉产生重大影响。
