Ritgen's maneuver in childbirth care: A case-control study in a Central Italian setting

Vaginal delivery can cause genital tract trauma and lacerations of different severity. This study aims to establish if routinary use of Ritgen's maneuver decreases the prevalence and severity of perineal lacerations compared to the traditional manual perineal protection (MPP).

This prospective case-control study was conducted in the labor ward of Fondazione Policlinico A. Gemelli, Rome, Italy. One hundred sixteen women who met inclusion criteria were included. The study group (n=58) consisted of women who were assisted using the Ritgen maneuver, whereas the women who gave birth immediately afterward were selected as the control group (n=58). All information was retrieved through electronic medical records.

In all, 22% women of the study group reported no perineal lacerations compared with 5% of the control group (p=0.007). Regarding the degree of lacerations, the study group exhibited more first-degree lacerations and fewer second-degree lacerations, while the control group exhibited the opposite trend. Among women who received epidural analgesia, 24% of the study group did not experience perineal lacerations, compared to 4.5% of the control (OR=0.15; 95% CI: 0.03-0.72; p=0.008). Similarly, 23.4% of cases in the study group with oxytocin-enhanced labor, experienced no perineal trauma while none in the control group had no perineal trauma in cases of oxytocin augmentation (p=0.005).

Our results suggest that using Ritgen's maneuver in childbirth care may reduce the incidence and severity of perineal lacerations, even in the presence of known risk factors for perineal lacerations such as oxytocin augmentation and epidural analgesia.