West Berkshire perineal management trial: three year follow up

A randomized study of two methods of teaching perineal massage: effects on practice rates, episiotomy rates, and lacerations

This study examined the effects of two methods of teaching perineal massage on the rates of practice of perineal massage, of episiotomy, and of lacerations in primiparas at birth. Couples in 20 randomly selected sections of four prenatal class series received routine printed and verbal instruction and a 12-minute video demonstration of perineal massage, or only the routine printed and verbal instruction. Women reported their practice rates in daily diary records, which were mailed to the researcher weekly. Hospital records provided delivery data. Of the 83 women, 23 (28%) practiced perineal massage: 16 (35.6%) in the experimental group, 7 (18.4%) controls. Even though the rate of practice almost doubled among experimental group women, the videotape instruction method was statistically nonsignificant. Episiotomy and laceration rates were not affected by teaching method. More severe lacerations occurred among the experimental group; however, the control group had almost four times as many severe (21%) as minor (5.3%) lacerations. The experimental group had twice as many severe (28.9%) as minor (13.3%) lacerations. These results were also nonsignificant.

Urinary incontinence after perineal trauma at childbirth

Stress urinary incontinence is the most common form of female incontinence. The purpose with this study was to describe consequences of episiotomy and spontaneous tears on urinary incontinence after the delivery. A postal questionnaire was sent to 205 women who had participated in an earlier study concerning episiotomy and spontaneous tears during delivery. They were contacted four years post-partum. One hundred and eighty-five women (90%) responded and there was no difference in the response rate between the group with episiotomy and in the group with spontaneous tears. Urinary incontinence symptoms were found in 65 women (36%). This frequency was similar in both groups. The study does not confirm the protective value of episiotomy on urinary incontinence.

Episiotomy: can its routine use be defended?

Episiotomy is routinely used before delivery in the United States. The rationale for routine episiotomy is based on two foundation arguments: that episiotomy reduces perineal trauma and that it prevents subsequent pelvic relaxation. A careful review finds little evidence to support these arguments. Episiotomy may predispose the gravid woman to third- and fourth-degree lacerations. Efforts should be directed to determine whether episiotomy is beneficial.

Ultrasound and pulsed electromagnetic energy treatment for perineal trauma. A randomized placebo-controlled trial

Ultrasound and pulsed electromagnetic energy therapies are increasingly used for perineal trauma sustained during childbirth. The study included 414 women with moderate or severe perineal trauma randomly allocated to receive active ultrasound, or active pulsed electromagnetic energy, or corresponding placebo therapies; the allocation was double-blind for each machine. Overall, more than 90% thought that treatment made their problem better. There were no clear differences between the groups in outcome either immediately after treatment, or 10 days or 3 months postpartum, other than more pain associated with pulsed electromagnetic energy treatment at 10 days. Bruising looked more extensive after ultrasound therapy but then seemed to resolve more quickly. Neither therapy had an effect on perineal oedema or haemorrhoids. The place of these new therapies in postnatal care should be clarified by further controlled trials before they become part of routine care.