Schantz C
Commission scientifique du Collège National des sages-femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 45, rue des Saints-Pères, 75006 Paris, France.
Gynecol Obstet Fertil Senol. 2018 Dec;46(12):922-927. doi: 10.1016/j.gofs.2018.10.027. Epub 2018 Nov 2.
Several interventions during pregnancy have been described that might prevent the risk of postnatal perineal injury or dysfunction; these include prenatal perineal massage, use of the Epi-No device, and pelvic floor muscle training exercises. Our objective was to evaluate the effectiveness of these different interventions during pregnancy.
A systematic review of the literature was conducted on PubMed, including articles in French and English published before May 2018, to evaluate the effectiveness of these different interventions on perineal protection in the post-partum period.
Perineal massage during pregnancy diminishes the episiotomy rate (LE1) as well as post-partum perineal pain and flatus (LE2). It does not reduce the rate of either OASIS (LE1) or post-partum urinary incontinence (LE2). The Epi-No device does not provide benefits for perineal protection (LE1). Prenatal pelvic floor muscle training exercises do not reduce the risk of perineal lacerations (LE2); they reduce the prevalence of post-partum urinary incontinence at 3 to 6 months but not at 12 months post-partum (LE2).
Perineal massage during pregnancy must be encouraged among women who want it (Grade B). The use of the Epi-No device during pregnancy is not recommended for the prevention of OASIS (grade B). Pelvic floor muscle training during pregnancy is not recommended for the prevention of OASIS (grade B); moreover, its absence of effect in the medium term does not allow us to recommend it for urinary incontinence (professional consensus).
已描述了孕期的几种干预措施，这些措施可能预防产后会阴损伤或功能障碍；其中包括产前会阴按摩、使用Epi-No装置以及盆底肌肉训练练习。我们的目的是评估孕期这些不同干预措施的有效性。
在PubMed上对文献进行了系统综述，纳入了2018年5月之前发表的法语和英语文章，以评估这些不同干预措施对产后会阴保护的有效性。
孕期会阴按摩可降低会阴切开率（低质量证据1）以及产后会阴疼痛和肠胃胀气（低质量证据2）。它不会降低重度会阴裂伤（低质量证据1）或产后尿失禁的发生率（低质量证据2）。Epi-No装置对会阴保护没有益处（低质量证据1）。产前盆底肌肉训练练习不会降低会阴撕裂的风险（低质量证据2）；它们可降低产后3至6个月而非产后12个月时尿失禁的发生率（低质量证据2）。
对于有需求的女性，应鼓励孕期进行会阴按摩（B级）。不建议孕期使用Epi-No装置来预防重度会阴裂伤（B级）。不建议孕期进行盆底肌肉训练来预防重度会阴裂伤（B级）；此外，由于其在中期没有效果，因此不建议将其用于预防尿失禁（专业共识）。
