Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

152 questions · 154 findings · 36 reviews

No studies found 17 · 11%GRADE not reported 23 · 14.9%Very low 60 · 39%Low 35 · 22.7%Moderate 17 · 11%High 2 · 1.3%

Antibiotic prophylaxis vs no treatment

Infection rate at 2 weeks postpartum ‐ perineal wound infection in third‐ or fourth‐degree tear · Women with third‐ and fourth‐degree perineal tear during vaginal birth

Antibiotic prophylaxis probably leads to lower infection rate at 2 weeks postpartum ‐ perineal wound infection in… compared with no treatment (moderate certainty).

1 finding from 1 review

Antibiotic prophylaxis vs no treatment

Infection rate at 6 weeks postpartum ‐ perineal wound infection in third‐ or fourth‐degree tear · Women with third‐ and fourth‐degree perineal tear during vaginal birth

Antibiotic prophylaxis showed no clear difference in infection rate at 6 weeks postpartum ‐ perineal wound infection in… compared with no treatment (low certainty).

1 finding from 1 review

Massage vs control (hands off or care

Perineal trauma requiring suturing · pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications

It is very uncertain whether massage changes perineal trauma requiring suturing compared with control (hands off or care (very low certainty).

1 finding from 1 review

Massage vs control (hands off or care

1st degree perineal tear · pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications

It is very uncertain whether massage changes 1st degree perineal tear compared with control (hands off or care (very low certainty).

1 finding from 1 review

Warm compresses vs control (hands off or no warm compress)

Perineal trauma requiring suturing · pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications

It is very uncertain whether warm compresses changes perineal trauma requiring suturing compared with control (hands off or no warm compress) (very low certainty).

1 finding from 1 review

Lateral postures vs other postures

Severe perineal tears (3rd degree or higher, as defined by trialists) · fetal malposition in labour

It is very uncertain whether lateral postures changes severe perineal tears (3rd degree or higher, as defined by trialists) compared with other postures (very low certainty).

1 finding from 1 review

Hands and knees posture vs other postures

Severe perineal tears (3rd degree or higher, as defined by trialists) · fetal malposition in labour

It is very uncertain whether hands and knees posture changes severe perineal tears (3rd degree or higher, as defined by trialists) compared with other postures (very low certainty).

1 finding from 1 review

Low‐cavity forceps vs any vacuum cup

Third‐ or fourth‐degree perineal tear (with or without episiotomy) · Women in the second stage of labour, requiring an assisted vaginal birth

It is very uncertain whether low‐cavity forceps changes third‐ or fourth‐degree perineal tear (with or without episiotomy) compared with any vacuum cup (very low certainty).

1 finding from 1 review

Soft cup vs rigid cup

Third‐ or fourth‐degree perineal tear (with or without episiotomy) · Women in the second stage of labour, requiring an assisted vaginal birth

Soft cup showed no clear difference in third‐ or fourth‐degree perineal tear (with or without episiotomy) compared with rigid cup (low certainty).

1 finding from 1 review

Handheld vacuum vs any vacuum cup

Third‐ or fourth‐degree perineal tear (with or without episiotomy) · Women in the second stage of labour, requiring an assisted vaginal birth

Handheld vacuum showed no clear difference in third‐ or fourth‐degree perineal tear (with or without episiotomy) compared with any vacuum cup (moderate certainty).

1 finding from 1 review

Any type of forceps vs any vacuum cup

Third‐ or fourth‐degree perineal tear (with or without episiotomy) · Women in the second stage of labour, requiring an assisted vaginal birth

Any type of forceps may leads to higher third‐ or fourth‐degree perineal tear (with or without episiotomy) compared with any type of vacuum cup (low certainty).

1 finding from 1 review

Antibiotics vs placebo or no treatment

Infected episiotomy/laceration (superficial perineal wound infection) № of participants: 3420 (1 RCT) · Women undergoing operative vaginal delivery

Any antibiotics leads to lower infected episiotomy/laceration (superficial perineal wound… compared with placebo or no treatment (high certainty).

1 finding from 1 review