Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial

Investigating discrepancies in findings between rigorous randomized trials and meta-analyses evaluating pregnancy interventions to limit gestational weight gain

INTRODUCTION

Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta-analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions.

METHODS

We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5 kg/m2. We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre-eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta-analyses was performed based on intervention group and level of potential bias in the effect estimate.

RESULTS

We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10 kg (95% CI -1.62 to -0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes.

CONCLUSIONS

Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit.

The Effect of Perineum Massage Applied With and Without an Instrument in the Active Phase of Labor Birth Outcomes: A Randomized Clinical Trial

INTRODUCTION AND HYPOTHESIS

Perineal massage during labor reduces the need for episiotomy and shortens the length of the episiotomy. Pregnant women should be offered instrumented (EPI-NO) or manual perineal massage in labor. This study was conducted to determine the effect of perineal massage applied with (EPI-NO) and without an instrument during the active phase of labor on episiotomy rate and episiotomy length in women who gave birth vaginally.

METHODS

The study included 101 pregnant women aged 18-35 years, with gestational ages between 38 and 42 weeks and indications for vaginal delivery. Participants were randomly assigned to one of three groups: EPI-NO massage, manual massage, and control. The perineal massage was administered during the active labor phase (4- to 8-cm dilation) for 20 min in the intervention groups. Postpartum episiotomy rates and lengths were recorded using standardized forms. The research data were collected using the Introductory Information Form and Birth Assessment Form.

RESULTS

The episiotomy rate was found to be 33.3% in group I, 75.0% in group II, and 74.4% in the Control group, and a statistically significant difference was found between the groups (p = 0.001; p < 0.01). The mean episiotomy length of the women was 1.5 cm (mean ± SD: 1.50 ± 1.20) for group I, 3 cm (mean ± SD 2.70 ± 1.50) for group II, and 3.5 cm (mean ± SD 3.10 ± 2.00) for the control group (p < 0.000).

CONCLUSION

Perineal massage with EPI-NO was the most effective method at decreasing the episiotomy rate and shortening the episiotomy length compared with other groups.

Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials

INTRODUCTION

The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens' health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear.

MATERIAL AND METHODS

A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted.

RESULTS

Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%).

CONCLUSIONS

PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.

Current Understanding and Future Challenges in Physical Activity during Pregnancy

Obesity and overweight attributed to poor nutrition and a lack of physical activity increasingly become a serious problem among women of reproductive age [...].

Exercise throughout Pregnancy Prevents Excessive Maternal Weight Gain during the COVID-19 Pandemic: A Randomized Clinical Trial

The purpose of this study was to examine the effects of a virtual exercise program throughout pregnancy during the COVID-19 pandemic on maternal weight gain. A randomized clinical trial (NCT NCT04563065) was performed. In total, 300 pregnant individuals were assessed for eligibility, and a total of 157 were randomized, of which 79 were in the control group (CG), and 78 were in the intervention group (IG). Those in the intervention group participated in a virtual supervised exercise program throughout pregnancy, 3 days per week. Fewer pregnant participants exceeded the weight gain recommendations in the IG group than in the CG (n = 4/5.9% vs. n = 31/43.1%, p = 0.001). Weight gain during pregnancy was lower in the IG than in the CG (9.96 ± 3.27 kg vs. 12.48 ± 4.87 kg, p = 0.001). Analysis of subgroups based on pre-pregnancy body mass index, showed significant differences in excessive maternal weight gain between study groups in normal-weight (IG, n = 0/0% vs. CG, n = 10/25%, p = 0.001) and those with overweight (IG, n = 2/18% vs. CG, n = 12/60%, p = 0.025). A virtual supervised exercise program throughout pregnancy could be a clinical tool to manage maternal weight gain during the COVID-19 pandemic by controlling excessive gain.