Aquino Carmen Imma, Guida Maurizio, Saccone Gabriele, Cruz Yuri, Vitagliano Amerigo, Zullo Fulvio, Berghella Vincenzo
Department of Obstetrics and Gynecology, School of Medicine, University of Salerno, Salerno, Italy.
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy.
J Matern Fetal Neonatal Med. 2020 Mar;33(6):1051-1063. doi: 10.1080/14767058.2018.1512574. Epub 2018 Sep 19.
Different techniques have been analyzed to reduce the risk of perineal trauma during labor. To evaluate whether perineal massage techniques during vaginal delivery decreases the risk of perineal trauma. Electronic databases (Medline, Prospero, Scopus, ClinicalTrials.gov, Embase, ScienceDirect, the Cochrane Library, SciELO) were searched from their inception until February 2018. No restrictions for language or geographic location were applied. We included all randomized controlled trials (RCTs) comparing the use of perineal massage during labor (i.e. intervention group) with a control group (i.e. no perineal massage) in women with singleton gestation and cephalic presentation at ≥36 weeks. Perineal massage was defined as massage of the posterior perineum by the clinician's fingers (with or without lubricant). Trials on perineal massage during antenatal care, before the onset of labor, or only in the early part of the first stage, were not included. All analyses were done using an intention-to-treat approach. The primary outcome was severe perineal trauma, defined as third and fourth degree perineal lacerations. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk (RR) with 95% confidence interval (CI). Nine trials including 3374 women were analyzed. All studies included women with singleton pregnancy in cephalic presentation at ≥36 weeks undergoing spontaneous vaginal delivery. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant. Women randomized to receive perineal massage during labor had a significantly lower incidence of severe perineal trauma, compared to those who did not (RR 0.49, 95% CI 0.25-0.94). All the secondary outcomes were not significant, except for the incidence of intact perineum, which was significantly higher in the perineal massage group (RR 1.40, 95% 1.01-1.93), and for the incidence of episiotomy, which was significantly lower in the perineal massage group (RR 0.56, 95% CI 0.38-0.82). Perineal massage during labor is associated with significant lower risk of severe perineal trauma, such as third and fourth degree lacerations. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant.
人们分析了不同的技术以降低分娩期间会阴创伤的风险。为评估阴道分娩时会阴按摩技术是否能降低会阴创伤的风险。检索了电子数据库（Medline、Prospero、Scopus、ClinicalTrials.gov、Embase、ScienceDirect、Cochrane图书馆、SciELO），从其创建至2018年2月。未对语言或地理位置设限。我们纳入了所有比较分娩期间使用会阴按摩（即干预组）与对照组（即不进行会阴按摩）的随机对照试验（RCT），这些试验的对象为单胎妊娠且孕36周及以上头先露的女性。会阴按摩定义为临床医生用手指（使用或不使用润滑剂）按摩会阴后部。产前护理期间、分娩开始前或仅在第一产程早期进行的会阴按摩试验未纳入。所有分析均采用意向性分析方法。主要结局是严重会阴创伤，定义为会阴Ⅲ度和Ⅳ度裂伤。采用DerSimonian和Laird随机效应模型进行荟萃分析，以产生相对风险（RR）及95%置信区间（CI）形式的汇总治疗效果。分析了9项试验，共3374名女性。所有研究均纳入了孕36周及以上单胎妊娠头先露且进行自然阴道分娩的女性。会阴按摩通常由助产士在第二产程、用力期间或用力间歇期，用食指和中指并使用水溶性润滑剂进行。与未接受会阴按摩的女性相比，随机分配在分娩期间接受会阴按摩的女性严重会阴创伤发生率显著更低（RR 0.49，95% CI 0.25 - 0.94）。除完整会阴发生率外，所有次要结局均无显著差异，会阴按摩组完整会阴发生率显著更高（RR 1.40，95% 1.01 - 1.93），会阴切开术发生率在会阴按摩组显著更低（RR 0.56，95% CI 0.38 - 0.82）。分娩期间进行会阴按摩与显著降低严重会阴创伤（如Ⅲ度和Ⅳ度裂伤）的风险相关。会阴按摩通常由助产士在第二产程、用力期间或用力间歇期，用食指和中指并使用水溶性润滑剂进行。
