Perineal techniques during the second stage of labour for reducing perineal trauma

Cochrane Database Syst Rev. 2011 Dec 7;(12):CD006672. doi: 10.1002/14651858.CD006672.pub2.


Background: Most vaginal births are associated with some form of trauma to the genital tract. The morbidity associated with perineal trauma is significant, especially when it comes to third- and fourth-degree tears. Different perineal techniques and interventions are being used to prevent perineal trauma. These interventions include perineal massage, warm compresses and perineal management techniques.

Objectives: The objective of this review was to assess the effect of perineal techniques during the second stage of labour on the incidence of perineal trauma.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2011), the Cochrane Central Register of ControlledTrials (The Cochrane Library 2011, Issue 2 of 4), MEDLINE (January 1966 to 20 May 2011) and CINAHL (January 1983 to 20 May 2011).

Selection criteria: Published and unpublished randomised and quasi-randomised controlled trials evaluating any described perineal techniques during the second stage.

Data collection and analysis: Three review authors independently assessed trails for inclusion, extracted data and evaluated methodological quality. Data were checked for accuracy.

Main results: We included eight trials involving 11,651 randomised women. There was a significant effect of warm compresses on reduction of third- and fourth-degree tears (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.28 to 0.84 (two studies, 1525 women)). There was also a significant effect towards favouring massage versus hands off to reduce third- and fourth-degree tears (RR 0.52, 95% CI 0.29 to 0.94 (two studies, 2147 women)). Hands off (or poised) versus hand on showed no effect on third- and fourth-degree tears, but we observed a significant effect of hands off on reduced rate of episiotomy (RR 0.69, 95% CI 0.50 to 0.96 (two studies, 6547 women)).

Authors' conclusions: The use of warm compresses on the perineum is associated with a decreased occurrence of perineal trauma. The procedure has shown to be acceptable to women and midwives. This procedure may therefore be offered to women.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anal Canal / injuries*
  • Delivery, Obstetric / methods*
  • Episiotomy / adverse effects
  • Episiotomy / statistics & numerical data
  • Female
  • Hot Temperature / therapeutic use
  • Humans
  • Labor Stage, Second*
  • Lacerations / prevention & control*
  • Massage
  • Obstetric Labor Complications / prevention & control*
  • Perineum / injuries*
  • Pregnancy