Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis.
Study Goal
The researchers aimed to compare the effects of perineal massage during the antenatal period versus the second stage of labor on perineal injuries and postpartum pelvic floor function in primiparous women.
Results Summary
Perineal massage during the second stage of labor reduced immediate postpartum perineal pain, while antenatal massage improved fecal and flatus incontinence at three months postpartum but had no significant effect on urinary incontinence. Both periods of massage contributed to reducing perineal injuries.
Population
Primiparous women (first-time mothers).
Effective Dosage
Not specified.
Duration
Not specified.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
perineal massage during the second stage of labor | decrease | perineal pain | primigravid women in the immediate postpartum period | MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001 | reduced | #1 |
perineal massage | decrease | fecal incontinence | primiparous women at three months postpartum | P = 0.04 | reduced | #2 |
perineal massage | decrease | flatus incontinence | primiparous women at three months postpartum | P = 0.01 | reduced | #3 |
perineal massage | no change | urinary incontinence | primiparous women at three months postpartum | P = 0.80 | had no significant effect | #4 |
perineal massage both antenatally and during the second stage of labor | decrease | perineal injuries | primiparous women | - | reducing | #5 |
perineal massage during the antenatal stage | increase | pelvic floor function | primiparous women in the postnatal phase | - | improved | #6 |
BACKGROUND: Perineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the early postpartum period. However, there is still debate concerning the best period to apply perineal massage, which is either antenatal or in the second stage of labor, as well as its safety and effectiveness. Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women. METHODS: We searched nine different electronic databases from inception to April 16, 2024. The randomized controlled trials (RCTs) we included assessed the effects of antenatal and second-stage labor perineal massage in primiparous women. All data were analyzed with Revman 5.3, Stata Statistical Software, and Risk of Bias 2 was used to assess the risk of bias. Subgroup analyses were performed based on the different periods of perineal massage. The primary outcomes were the incidence of perineal integrity and perineal injury. Secondary outcomes were perineal pain, duration of the second stage of labor, postpartum hemorrhage, urinary incontinence, fecal incontinence, and flatus incontinence. RESULTS: This review comprised a total of 10 studies that covered 1057 primigravid women. The results of the analysis showed that perineal massage during the second stage of labor reduced the perineal pain of primigravid women in the immediate postpartum period compared to the antenatal period, with a statistical value of (MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001). Additionally, only the antenatal stage reported that perineal massage reduced fecal incontinence (P = 0.04) and flatus incontinence (P = 0.01) in primiparous women at three months postpartum, but had no significant effect on urinary incontinence in primiparous women at three months postpartum (P = 0.80). CONCLUSIONS: Reducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage. TRIAL REGISTRATION: CRD42023415996 (PROSPERO).