Birmingham Women's NHS Foundation Trust, Birmingham, UK.
Medical School, University of Birmingham, Birmingham, UK.
BJOG. 2015 Aug;122(9):1157-65. doi: 10.1111/1471-0528.13431. Epub 2015 May 15.
Genital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS). Debate continues regarding the effectiveness of perineal support during childbirth in reducing the risk of trauma.
This review aimed to assess the effect of routine 'hands on'/manual perineal support (MPS) during childbirth, versus ad hoc/no perineal support ('hands off/poised'), on the risk and degree of perineal trauma.
This review is registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007058). We searched the CENTRAL, Embase, Medline, CINAHL, and OVIDs midwifery and infant care databases (from inception to December 2014).
Published randomised controlled trials (RCTs) and non-randomised studies (NRSs) evaluating any 'hands on' perineal support technique during childbirth.
Two reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer.
We included five RCTs and seven NRSs in the review. Meta-analysis of RCTs did not demonstrate a statistically significant protective effect of MPS on the risk of OASIS (three studies, 6647 women; relative risk, RR 1.03; 95% confidence interval, 95% CI 0.32-3.36; statistical test for heterogeneity I(2) = 71%). Meta-analysis of NRSs showed a significant reduction in the risk of OASIS with MPS (three studies, 74,744 women; RR 0.45; 95% CI 0.40-0.50; I(2) = 32%).
Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS policies, ensuring controlled childbirth, is urgently needed.
生殖道创伤在阴道分娩中很常见，与显著的发病率有关，尤其是产科肛门括约肌损伤（OASIS）。关于分娩时会阴支持的有效性以降低创伤风险的争论仍在继续。
本综述旨在评估分娩时常规“手动手动”会阴支持（MPS）与临时/无会阴支持（“手放手势”）相比，对会阴创伤的风险和程度的影响。
本综述在 PROSPERO（http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007058）上注册。我们检索了 CENTRAL、Embase、Medline、CINAHL 和 OVID 助产和婴儿护理数据库（从建立到 2014 年 12 月）。
评估分娩时任何“手动手动”会阴支持技术的已发表随机对照试验（RCT）和非随机研究（NRS）。
两名审查员独立评估试验的纳入、数据提取和方法学质量。通过与第三名审查员的讨论解决了分歧。
我们纳入了五项 RCT 和七项 NRS。RCT 的荟萃分析未显示 MPS 对 OASIS 风险有统计学意义的保护作用（三项研究，6647 名女性；相对风险，RR 1.03；95%置信区间，95%CI 0.32-3.36；异质性检验 I(2) = 71%）。NRS 的荟萃分析显示，MPS 显著降低 OASIS 的风险（三项研究，74744 名女性；RR 0.45；95%置信区间，0.40-0.50；I(2) = 32%）。
目前的证据不足以推动实践的改变。迫切需要一项设计合理、有足够效力的随机试验，以评估 MPS 政策所采用的复杂干预措施，确保受控分娩。
