FPIN's Help Desk Answers
Antepartum Perineal Massage for Intrapartum Lacerations
Am Fam Physician. 2021 Jan 15;103(2):115-116.
Does antepartum perineal massage reduce intrapartum lacerations?
Digital antepartum and intrapartum perineal massage did not decrease perineal lacerations compared with a control group. (Strength of Recommendation: A, based on a meta-analysis.) Digital antepartum perineal massage reduced the incidence of trauma requiring suturing by 9% and the likelihood of episiotomy by 16% in patients without a previous vaginal birth. Digital intrapartum perineal massage resulted in higher rates of intact perineum and a lower incidence of episiotomy in nulliparous patients.
A 2013 Cochrane review analyzed four randomized controlled trials (RCTs) and quasi-RCTs (N = 2,497) in which patients planning on vaginal delivery received self- or partner-administered digital antepartum perineal massage.1 This was defined as three to 10 minutes of intravaginal perineal massage with almond oil, three to seven days a week, starting at 34 weeks' gestation until delivery. Three of the studies included patients without previous vaginal births; the last trial included patients with previous vaginal birth. The primary inclusion criterion was any digital perineal massage during the last four weeks of pregnancy. Patients at high risk of cesarean delivery were excluded. Participants were instructed not to inform their birth attendants of their allocation. In patients without a previous vaginal birth who had digital antepartum perineal massage, there was a 9% decrease in perineal trauma that required suturing (relative risk [RR] = 0.91; 95% CI, 0.86 to 0.96; number needed to treat [NNT] = 15) and a 16% decrease in episiotomy (RR = 0.84; 95% CI, 0.74 to 0.95; NNT = 21).
There was no difference between patients receiving perineal massage and the control group for having a first- (RR = 0.96; 95% CI, 0.78 to 1.19), second- (RR = 0.99; 95% CI, 0.85 to 1.15), or third- or fourth-degree laceration (RR = 0.81; 95% CI, 0.56 to 1.18). Three of the four studies included attestation
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1. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;(4):CD005123.
2. Aquino CI, Guida M, Saccone G, et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2020;33(6):1051–1063.
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