Scientific evidence on perineal trauma during labor: Integrative review

Eur J Obstet Gynecol Reprod Biol. 2018 Apr:223:18-25. doi: 10.1016/j.ejogrb.2018.01.036. Epub 2018 Feb 11.


Objective: To assess the scientific evidence for management and preservation of perineal integrity during the expulsive stage of labor.

Study design: Integrative review that employed the Population, Intervention, Comparison, Outcome strategy to formulate the research question: Which perineal measure(s) is(are) effective in maintaining perineal integrity during labor? The search was performed in the databases MEDLINE, LILACS, BDENF and SciELO. The ten selected studies were analyzed based on their level of evidence and grade of recommendation.

Results: Four categories of measures were located: antenatal perineal care, perineal massage during the expulsive phase of labor, manual perineal support during the expulsive phase of labor and perineal hyaluronidase injection.

Conclusion: Based on its level of evidence, perineal massage with lubricants performed by the women or their partners at the end of pregnancy may be recommended as a measure favorable for perineal protection.

Keywords: Labor; Obstetric; Perineal trauma; Perineum.

Publication types

  • Review

MeSH terms

  • Episiotomy
  • Female
  • Humans
  • Labor, Obstetric / physiology*
  • Lacerations / prevention & control
  • Lubricants
  • Massage
  • Obstetric Labor Complications / prevention & control*
  • Perineum / injuries*
  • Pregnancy
  • Prenatal Care
  • Randomized Controlled Trials as Topic


  • Lubricants