The Effect of Perineum Massage Applied With and Without an Instrument in the Active Phase of Labor Birth Outcomes: A Randomized Clinical Trial

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2024 Sep 6

PMID 39240370

Authors

Meryem Metinoglu

Nezihe Kizilkaya Beji

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: Perineal massage during labor reduces the need for episiotomy and shortens the length of the episiotomy. Pregnant women should be offered instrumented (EPI-NO) or manual perineal massage in labor. This study was conducted to determine the effect of perineal massage applied with (EPI-NO) and without an instrument during the active phase of labor on episiotomy rate and episiotomy length in women who gave birth vaginally.

Methods: The study included 101 pregnant women aged 18-35 years, with gestational ages between 38 and 42 weeks and indications for vaginal delivery. Participants were randomly assigned to one of three groups: EPI-NO massage, manual massage, and control. The perineal massage was administered during the active labor phase (4- to 8-cm dilation) for 20 min in the intervention groups. Postpartum episiotomy rates and lengths were recorded using standardized forms. The research data were collected using the Introductory Information Form and Birth Assessment Form.

Results: The episiotomy rate was found to be 33.3% in group I, 75.0% in group II, and 74.4% in the Control group, and a statistically significant difference was found between the groups (p = 0.001; p < 0.01). The mean episiotomy length of the women was 1.5 cm (mean ± SD: 1.50 ± 1.20) for group I, 3 cm (mean ± SD 2.70 ± 1.50) for group II, and 3.5 cm (mean ± SD 3.10 ± 2.00) for the control group (p < 0.000).

Conclusion: Perineal massage with EPI-NO was the most effective method at decreasing the episiotomy rate and shortening the episiotomy length compared with other groups.

References

Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E . Perineal trauma: incidence and its risk factors. J Obstet Gynaecol. 2018; 39(2):206-211. DOI: 10.1080/01443615.2018.1476473. View

Silva-Jose C, Sanchez-Polan M, Diaz-Blanco A, Perez-Medina T, Carrero Martinez V, Alzola I . Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial. J Clin Med. 2021; 10(22). PMC: 8621123. DOI: 10.3390/jcm10225250. View

Frass K, Al-Harazi A . Episiotomy is still performed routinely in Yemeni women. Saudi Med J. 2010; 31(7):764-7. View

Taleb S, Saeedi M . The effect of the Verbascum Thapsus on episiotomy wound healing in nulliparous women: a randomized controlled trial. BMC Complement Med Ther. 2021; 21(1):166. PMC: 8186151. DOI: 10.1186/s12906-021-03339-6. View

Ye J, Chen Y, Yang H, Chen Q, Huang Y, Zhao J . A nationwide cross-sectional survey of episiotomy practice in China. Lancet Reg Health West Pac. 2022; 19:100345. PMC: 8671730. DOI: 10.1016/j.lanwpc.2021.100345. View

Kavvadias T, Hoesli I . The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor-Implications for Future Research. Obstet Gynecol Int. 2016; 2016:3818240. PMC: 4769774. DOI: 10.1155/2016/3818240. View

Paschoal A, Uchiyama Nakamara M, Araujo Junior E, Petricelli C, Alexandre S, Diniz Zanetti M . Device to predict pelvic floor integrity during vaginal delivery: an intra- and interrater reliability study of the Epi-no distensibility measurement. J Matern Fetal Neonatal Med. 2019; 34(21):3481-3487. DOI: 10.1080/14767058.2019.1685970. View

Ruckhaberle E, Jundt K, Bauerle M, Brisch K, Ulm K, Dannecker C . Prospective randomised multicentre trial with the birth trainer EPI-NO for the prevention of perineal trauma. Aust N Z J Obstet Gynaecol. 2009; 49(5):478-83. DOI: 10.1111/j.1479-828X.2009.01044.x. View

Brito L, Ferreira C, Duarte G, Nogueira A, Marcolin A . Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review. Int Urogynecol J. 2015; 26(10):1429-36. DOI: 10.1007/s00192-015-2687-8. View

10.

de Freitas S, Cabral A, Pinto R, Magalhaes Resende A, Baldon V . Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study. Int Urogynecol J. 2018; 30(6):951-957. DOI: 10.1007/s00192-018-3793-1. View

11.

McHugh M, Cosgrave C . To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports. 2009; 20(2):169-81. DOI: 10.1111/j.1600-0838.2009.01058.x. View

12.

Kok J, Tan K, Koh S, Cheng P, Lim W, Yew M . Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore. Singapore Med J. 2004; 45(7):318-23. View

13.

Kovacs G, Heath P, Heather C . First Australian trial of the birth-training device Epi-No: a highly significantly increased chance of an intact perineum. Aust N Z J Obstet Gynaecol. 2004; 44(4):347-8. DOI: 10.1111/j.1479-828X.2004.00265.x. View

14.

Abdelhakim A, Eldesouky E, Elmagd I, Mohammed A, Farag E, Mohammed A . Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J. 2020; 31(9):1735-1745. DOI: 10.1007/s00192-020-04302-8. View

15.

Azon E, Mir E, Hernandez J, Aguilon J, Torres A, Satustegui P . [Update on the effectiveness and evidence of ante-natal perineal massage]. An Sist Sanit Navar. 2021; 44(3):437-444. DOI: 10.23938/ASSN.0976. View

16.

Beckmann M, Stock O . Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013; (4):CD005123. PMC: 11297413. DOI: 10.1002/14651858.CD005123.pub3. View