Cochrane · systematic review · CD006672
Perineal techniques during the second stage of labour for reducing perineal trauma
Aasheim, V, Nilsen, ABV, Reinar, LM, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
22
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 2 · 8.3%Very low 11 · 45.8%Low 7 · 29.2%Moderate 4 · 16.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Hands off (or poised) compared to hands on for reducing perineal trauma
Population: pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intact perineum Hands off (or poised) vs hands on | RR 1.03 [0.95, 1.12] | 2 studies · 6547 participants | Moderate Downgraded: imprecision, inconsistency |
Perineal trauma requiring suturing Hands off (or poised) vs hands on | no estimate extracted | 0 studies · 0 participants | Ungraded |
1st degree tear Hands off (or poised) vs hands on | RR 1.32 [0.99, 1.77] | 2 studies · 700 participants | Low Downgraded: imprecision |
2nd degree tear Hands off (or poised) vs hands on | RR 0.77 [0.47, 1.28] | 2 studies · 700 participants | Low Downgraded: imprecision |
3rd or 4th degree tears Hands off (or poised) vs hands on | RR 0.68 [0.21, 2.26] | 5 studies · 7317 participants | Very low Downgraded: imprecision, inconsistency |
Episiotomy Hands off (or poised) vs hands on | RR 0.58 [0.43, 0.79] | 4 studies · 7247 participants | Low Downgraded: imprecision, inconsistency |
Warm compresses compared to control (hands off or no warm compress) for reducing perineal trauma
Population: pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intact perineum Warm compresses vs control (hands off or no warm compress) | RR 1.02 [0.85, 1.21] | 4 studies · 1799 participants | Moderate Downgraded: imprecision |
Perineal trauma requiring suturing Warm compresses vs control (hands off or no warm compress) | RR 1.14 [0.79, 1.66] | 1 study · 76 participants | Very low Downgraded: imprecision |
1st degree tear Warm compresses vs control (hands off or no warm compress) | RR 1.19 [0.38, 3.79] | 2 studies · 274 participants | Very low Downgraded: imprecision, inconsistency |
2nd degree tear Warm compresses vs control (hands off or no warm compress) | RR 0.95 [0.58, 1.56] | 2 studies · 274 participants | Very low Downgraded: imprecision |
3rd or 4th degree tears Warm compresses vs control (hands off or no warm compress) | RR 0.46 [0.27, 0.79] | 4 studies · 1799 participants | Moderate Downgraded: imprecision |
Episiotomy Warm compresses vs control (hands off or no warm compress) | RR 0.86 [0.6, 1.23] | 4 studies · 1799 participants | Low Downgraded: imprecision |
Massage compared to control (hands off or care as usual) for reducing perineal trauma
Population: pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intact perineum Massage vs control (hands off or care | RR 1.74 [1.11, 2.73] | 6 studies · 2618 participants | Low Downgraded: inconsistency |
Perineal trauma requiring suturing Massage vs control (hands off or care | RR 1.1 [0.75, 1.61] | 1 study · 76 participants | Very low Downgraded: imprecision |
1st degree perineal tear Massage vs control (hands off or care | RR 1.55 [0.79, 3.05] | 5 studies · 537 participants | Very low Downgraded: imprecision, inconsistency |
2nd degree perineal tear Massage vs control (hands off or care | RR 1.08 [0.55, 2.12] | 5 studies · 537 participants | Very low Downgraded: imprecision, inconsistency |
3rd or 4th degree tears Massage vs control (hands off or care | RR 0.49 [0.25, 0.94] | 5 studies · 2477 participants | Moderate Downgraded: imprecision |
Episiotomy Massage vs control (hands off or care | RR 0.55 [0.29, 1.03] | 7 studies · 2684 participants | Very low Downgraded: imprecision, inconsistency |
Ritgen's manoeuvre compared to standard care for reducing perineal trauma
Population: pregnant women expecting a vaginal birth, singleton vertex presentation at term, with no medical complications
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intact perineum Ritgen's manoeuvre vs standard care | RR 0.17 [0.02, 1.31] | 1 study · 66 participants | Very low Downgraded: imprecision |
Perineal trauma requiring suturing Ritgen's manoeuvre vs standard care | no estimate extracted | 0 studies · 0 participants | Ungraded |
1st degree tear Ritgen's manoeuvre vs standard care | RR 0.32 [0.14, 0.69] | 1 study · 66 participants | Very low Downgraded: imprecision |
2nd degree tear Ritgen's manoeuvre vs standard care | RR 3.25 [1.73, 6.09] | 1 study · 66 participants | Very low Downgraded: imprecision |
3rd or 4th degree tears Ritgen's manoeuvre vs standard care | RR 1.24 [0.78, 1.96] | 1 study · 1423 participants | Low Downgraded: imprecision |
Episiotomy Ritgen's manoeuvre vs standard care | RR 0.81 [0.63, 1.03] | 2 studies · 1489 participants | Low Downgraded: imprecision |