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Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Introduction and hypothesis

Most vaginal births are associated with trauma to the perineum. The morbidity associated with perineal trauma can be significant, especially when it leads to third- and fourth-degree perineal tears. We hypothesized that antenatal perineal massage could decrease the incidence of perineal trauma, particularly severe perineal tears and other postpartum complications.

Methods

We searched four different databases from inception until August 2019 for the available trials. We included randomized controlled trials (RCTs) which assessed the effect of antenatal perineal massage (intervention group) versus control group (no antenatal perineal massage) in perineal trauma patients. Data were extracted from eligible studies and meta-analyzed using RevMan software. Primary outcomes were the risk of episiotomies and perineal tears. Secondary outcomes were perineal pain, second stage of labor duration, wound healing, anal incontinence, and Apgar scores at 1 and 5 min.

Results

Eleven RCTs with 3467 patients were analyzed. Women who received antenatal perineal massage had significantly lower incidence of episiotomies (RR = 0.79, 95% CI [0.72, 0.87], p < 0.001) and perineal tears (RR = 0.79, 95% CI [0.67, 0.94], p = 0.007), particularly the risk of third- and fourth-degree perineal tears (p = 0.03). Better wound healing and less perineal pain were evident in the antenatal perineal massage group. Antenatal perineal massage reduced the second stage of labor duration (p = 0.005) and anal incontinence (p = 0.003) with significant improvement in Apgar scores at 1 and 5 min (p = 0.01 and p = 0.02).

Conclusions

Antenatal perineal massage is associated with a lower risk of severe perineal trauma and postpartum complications.

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Author information

Authors and Affiliations

  1. Kasr Al-Ainy, Faculty of Medicine, Cairo University, 395 Portsaid Street, Bab el-kalq, Cairo, 11638, Egypt

    Ahmed Mohamed Abdelhakim

  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Elsayed Eldesouky, Ibrahim Abo Elmagd, Attia Mohammed, Elsayed Aly Farag & Nawal Hamdy Ahmed Keshta

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt

    Abd Elhalim Mohammed

  4. Faculty of Medicine and Surgery, October 6 University, Giza, Egypt

    Khaled M. Hamam

  5. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Ahmed Salah Hussein & Ahmed Said Ali

  6. Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed Hamza, Ahmed Samy & Ali Abdelhafeez Abdel-Latif

Authors
  1. Ahmed Mohamed Abdelhakim
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Contributions

Ahmed Mohamed Abdelhakim: Project development, Data Collection, and Manuscript writing.

Elsayed Eldesouky: Manuscript editing.

Ibrahim Abo Elmagd: Manuscript editing.

Attia Mohammed: Manuscript editing.

Elsayed Aly Farag: Manuscript editing.

Abd Elhalim Mohammed: Manuscript revision.

Khaled M. Hamam: Project development and Data collection.

Ahmed Salah hussien: Data analysis.

Ahmed Said Ali: Data analysis.

Nawal Hamdy Ahmed Keshta: Manuscript revision.

Mohamed Hamza: Manuscript revision.

Ahmed Samy: Manuscript writing.

Ali Abdelhafeez Abdel-Latif: Manuscript writing.

Corresponding author

Correspondence to Ahmed Mohamed Abdelhakim.

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Abdelhakim, A.M., Eldesouky, E., Elmagd, I.A. et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 31, 1735–1745 (2020). https://doi.org/10.1007/s00192-020-04302-8

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