Modified Ritgen's maneuver for anal sphincter injury at delivery: a randomized controlled trial

Area of Science:

• Obstetrics and Gynecology
• Perinatal Care
• Surgical Techniques in Obstetrics

Background:

• Perineal tears, particularly third- to fourth-degree tears, are a significant concern during vaginal delivery, potentially leading to maternal morbidity.
• Ritgen's maneuver is an obstetrical technique described to control the delivery of the fetal head and protect the perineum.
• The efficacy of Ritgen's maneuver in preventing severe perineal lacerations requires rigorous investigation.

Purpose of the Study:

• To evaluate whether the application of Ritgen's maneuver during childbirth reduces the incidence of third- to fourth-degree perineal tears.
• To compare the outcomes of Ritgen's maneuver against standard perineal support techniques in nulliparous women.

Main Methods:

• A randomized controlled trial involving 1,423 nulliparous women with singleton, term, cephalic presentations was conducted.
• Participants were assigned to either Ritgen's maneuver (performed during contractions) or standard perineal support.
• Intention-to-treat analysis was used to compare the rates of severe perineal tears between the two groups.

Main Results:

• The rate of third- to fourth-degree perineal tears was 5.5% in the Ritgen's maneuver group and 4.4% in the standard care group.
• The relative risk of severe tears with Ritgen's maneuver was 1.24 (95% CI 0.78-1.96), indicating no statistically significant reduction.
• Ritgen's maneuver was successfully performed in 79.6% of assigned participants, while standard care was used in 4.3% of the control group.

Conclusions:

• Ritgen's maneuver, when performed during uterine contractions, does not appear to decrease the risk of anal sphincter injuries during vaginal delivery.
• The findings suggest that current modifications or applications of Ritgen's maneuver may not offer protective benefits against severe perineal trauma.