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How can second-stage management prevent perineal trauma? Critical review
P Flynn1, J Franiek, P Janssen
1University of British Columbia's (UBC) Department of Family Practice.
Canadian Family Physician Medecin De Famille Canadien
|January 1, 1997
Summary
Limiting episiotomy is strongly recommended to maintain perineal integrity. Women can choose birth positions and perineal massage, while caretakers should monitor pushing techniques to avoid placental issues.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Pelvic Floor Health
Background:
- Perineal integrity is crucial for maternal postpartum health.
- Factors influencing perineal trauma and pelvic floor dysfunction require identification.
- Modifiable factors for intervention by healthcare providers and pregnant women are of interest.
Purpose of the Study:
- To identify modifiable factors affecting perineal integrity during childbirth.
- To evaluate the evidence for interventions aimed at preserving perineal outcomes.
Main Methods:
- A systematic review of medical, nursing, and midwifery literature was conducted.
- Focus was placed on randomized controlled trials examining perineal trauma, sexual function, urinary incontinence, and pelvic floor function.
- 16 relevant papers were selected from an initial search of 80.
Main Results:
- Five factors were identified: episiotomy, third-trimester perineal massage, maternal position, pushing technique, and epidural analgesia.
- Routine episiotomy did not improve outcomes.
- Evidence for perineal massage, birth positions, pushing methods, and epidural analgesia was limited or inadequate for firm recommendations.
Conclusions:
- Strong recommendation for limiting episiotomy.
- Encourage women to choose birth positions and consider perineal massage.
- Advise awareness of potential placental interference from prolonged breath-holding during pushing.