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. 1997 Jan;43:73–84.

How can second-stage management prevent perineal trauma? Critical review.

P Flynn 1, J Franiek 1, P Janssen 1, W J Hannah 1, M C Klein 1
PMCID: PMC2255173  PMID: 9626426

Abstract

OBJECTIVE: To learn which factors influencing perineal integrity were modifiable by physicians and pregnant women. DATA SOURCES: Medical, nursing, and midwifery literature was searched mainly for randomized controlled trials. STUDY SELECTION: We chose articles on perineal trauma pattern, sexual dysfunction or satisfaction, urinary incontinence, and pelvic floor function. We identified 80 papers and studied 16 in detail. SYNTHESIS: Five factors affected perineal integrity: episiotomy, third-trimester perineal massage, mother's position in second-stage labour, method of pushing, and administration of epidural analgesia. Episiotomy does not improve perineal outcomes when used routinely. Third-trimester perineal massage was discussed only in inadequate studies. Studies comparing position in birth chairs and recumbent versus upright positions were inadequate for making firm recommendations. Studies of methods of pushing and use of epidural analgesia were limited and uncontrolled; no recommendations were possible. CONCLUSION: Only limiting episiotomy can be strongly recommended. In the absence of strong data to the contrary, women should be encouraged to engage in perineal massage if they wish and to adopt the birth positions of their choice. Caretakers should be aware of the possibility of interfering with placental function when women hold their breath for a long time when pushing.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alam MS, Katayama N, Kim IJ, Sun CR, Tanikella V, V, Bortoletto D, Chen A, Goldberg M, Holmes R, Horwitz N. Branching ratios of B mesons to K+,K-, and K0/K-bar0. Phys Rev Lett. 1987 May 4;58(18):1814–1817. doi: 10.1103/PhysRevLett.58.1814. [DOI] [PubMed] [Google Scholar]
  2. Avery M. D., Burket B. A. Effect of perineal massage on the incidence of episiotomy and perineal laceration in a nurse-midwifery service. J Nurse Midwifery. 1986 May-Jun;31(3):128–134. doi: 10.1016/0091-2182(86)90148-5. [DOI] [PubMed] [Google Scholar]
  3. BEYNON C. L. The normal second stage of labour; a plea for reform in its conduct. J Obstet Gynaecol Br Emp. 1957 Dec;64(6):815–820. doi: 10.1111/j.1471-0528.1957.tb08483.x. [DOI] [PubMed] [Google Scholar]
  4. Coats P. M., Chan K. K., Wilkins M., Beard R. J. A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol. 1980 May;87(5):408–412. doi: 10.1111/j.1471-0528.1980.tb04569.x. [DOI] [PubMed] [Google Scholar]
  5. Crowley P., Elbourne D., Ashurst H., Garcia J., Murphy D., Duignan N. Delivery in an obstetric birth chair: a randomized controlled trial. Br J Obstet Gynaecol. 1991 Jul;98(7):667–674. doi: 10.1111/j.1471-0528.1991.tb13453.x. [DOI] [PubMed] [Google Scholar]
  6. Gardosi J., Sylvester S., B-Lynch C. Alternative positions in the second stage of labour: a randomized controlled trial. Br J Obstet Gynaecol. 1989 Nov;96(11):1290–1296. doi: 10.1111/j.1471-0528.1989.tb03226.x. [DOI] [PubMed] [Google Scholar]
  7. Harrison R. F., Brennan M., North P. M., Reed J. V., Wickham E. A. Is routine episiotomy necessary? Br Med J (Clin Res Ed) 1984 Jun 30;288(6435):1971–1975. doi: 10.1136/bmj.288.6435.1971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Klein M. C., Gauthier R. J., Robbins J. M., Kaczorowski J., Jorgensen S. H., Franco E. D., Johnson B., Waghorn K., Gelfand M. M., Guralnick M. S. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol. 1994 Sep;171(3):591–598. doi: 10.1016/0002-9378(94)90070-1. [DOI] [PubMed] [Google Scholar]
  9. Liddell H. S., Fisher P. R. The birthing chair in the second stage of labour. Aust N Z J Obstet Gynaecol. 1985 Feb;25(1):65–68. doi: 10.1111/j.1479-828x.1985.tb00607.x. [DOI] [PubMed] [Google Scholar]
  10. Sleep J., Grant A., Garcia J., Elbourne D., Spencer J., Chalmers I. West Berkshire perineal management trial. Br Med J (Clin Res Ed) 1984 Sep 8;289(6445):587–590. doi: 10.1136/bmj.289.6445.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Sleep J., Grant A. West Berkshire perineal management trial: three year follow up. Br Med J (Clin Res Ed) 1987 Sep 26;295(6601):749–751. doi: 10.1136/bmj.295.6601.749. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Stewart P., Hillan E., Calder A. A. A randomised trial to evaluate the use of a birth chair for delivery. Lancet. 1983 Jun 11;1(8337):1296–1298. doi: 10.1016/s0140-6736(83)92412-1. [DOI] [PubMed] [Google Scholar]
  13. Stewart P., Spiby H. A randomized study of the sitting position for delivery using a newly designed obstetric chair. Br J Obstet Gynaecol. 1989 Mar;96(3):327–333. doi: 10.1111/j.1471-0528.1989.tb02393.x. [DOI] [PubMed] [Google Scholar]
  14. Waldenström U., Gottvall K. A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor. Birth. 1991 Mar;18(1):5–10. doi: 10.1111/j.1523-536x.1991.tb00045.x. [DOI] [PubMed] [Google Scholar]
  15. Yeates D. A., Roberts J. E. A comparison of two bearing-down techniques during the second stage of labor. J Nurse Midwifery. 1984 Jan-Feb;29(1):3–11. doi: 10.1016/0091-2182(84)90324-0. [DOI] [PubMed] [Google Scholar]

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