Hands-on or hands-off the perineum at childbirth: A re-appraisal of the available evidence
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Department of Midwifery, Midwifery School, ‘Alexander’ Technological Educational Institute of Thessaloniki, Greece
Angeliki Antonakou   

Department of Midwifery, Midwifery School, ‘Alexander’ Technological Educational Institute of Thessaloniki, PC 57400, Greece
Submission date: 2017-09-24
Acceptance date: 2017-10-13
Publication date: 2017-10-19
Eur J Midwifery 2017;1(October):5
Hals Elisabeth, Øian Pål, Pirhonen Tiina, Gissler Mika, Hjelle Sissel, Nilsen Elisabeth Berge, Severinsen Anne Mette, Solsletten Cathrine, Hartgill Tom, Pirhonen Jouko. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstet Gynecol. 2016 ;116:901–908. doi: 10.1097/aog.0b013e3181eda77a
Hirsch Emmet, Haney Elaine I., Gordon Trent E.J., Silver Richard K. Reducing high-order perineal laceration during operative vaginal delivery. Am J Obstet Gynecol. 2008;198:668. doi: 10.1016/j.ajog.2008.02.002
Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J. Anal incontinence after vaginal delivery: a five year prospective cohort study. Obstet Gynecol. 2004;104:1397–1402. doi: 10.1097/01.aog.0000147597.45349
Evers Emily C., Blomquist Joan L., McDermott Kelly C., Handa Victoria L. Obstetrical anal sphincter laceration and anal incontinence 5–10 years after childbirth. Am J Obstet Gynecol. 2012; 207:425.e1-6. doi: 10.1016/j.ajog.2012.06.055
Radestad I, Olsson A, Nissen E, Rubertsson C. Tears in the vagina, perineum, sphincter ani, and rectum and first sexual intercourse after childbirth: a nationwide follow-up. Birth. 2008; 35:98–106. doi: 10.1111/j.1523-536x.2008.00222.x
Roos AM, Thakar R, Sultan AH. Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol. 2010; 36:368–374. doi: 10.1002/uog.7512
NICE Guideline (CG49) (2007) Faecal incontinence in adults: management.
Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, Templeton A, van der Meulen JH. Third- and fourth degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG.2013; 120:1516–1525. doi: 10.1111/1471-0528.12363
NICE Guideline (CG190) (2014) Intrapartum care for healthy women and babies.
NICE Guideline (CG55) (2007) Intrapartum care: Care of healthy women and their babies during childbirth.
Royal College of Midwives (2012). Evidence Based Guidelines for Midwifery- Led Care in Labour: Care of the Perineum.
McCandlish Rona, Bowler Ursula, Asten Hedwig, Berridge Georgina, Winter Cathy, Sames Lesley, Garcia Jo, Renfrew Mary, Elbourne Diana. A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol. 1998;105:1262–1272. doi: 10.1111/j.1471-0528.1998.tb10004.x
Mayerhofer K, Bodner-Adler B, Bodner K et al Traditional care of the perineum during birth: a prospective, randomised, multicenter study of 1076 women. J Reprod Med. 2002; 47:477–482.
Trochez Ruben, Waterfield Malcolm, Freeman Robert M.. Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS). Int Urogynecol J. 2011; 22:1279-85. doi: 10.1007/s00192-011-1454-8
Jansova Magdalena, Kalis Vladimir, Rusavy Zdenek, Zemcik Robert, Lobovsky Libor, Laine Katariina. Modeling manual perineal protection during vaginal delivery. Int Urogynecol J. 2014; 25:65-71. doi: 10.1007/s00192-013-2164-1
Laine Katariina, Skjeldestad Finn Egil, Sandvik Leiv, Staff Anne Cathrine. Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open. 2012; 2(5), e001649. doi: 10.1136/bmjopen-2012-001649
Baghestan Elham, Irgens Lorentz M., Børdahl Per E., Rasmussen Svein. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol. 2010; 116:25-34. doi: 10.1097/aog.0b013e3181e2f50b
Pirhonen JP, Grenman SE, Haadem K, Gudmundsson S, Lindqvist P, Siihola S, Erkkola RU, Marsal K. Frequency of anal sphincter rupture at delivery in Sweden and Finland--result of difference in manual help to the baby's head. Acta Obstet Gynecol Scand. 1998; 77:974-7. doi: 10.1034/j.1600-0412.1998.771005.x
Räisänen S, Cartwright R, Gissler M, Kramer MR, Laine K, Jouhki MR, Heinonen S. Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004-2011. BMJ Open. 2013; 3:e003216. doi: 10.1136/bmjopen-2013-003216
Laine Katariina, Pirhonen Tiina, Rolland Rune, Pirhonen Jouko. Decreasing the incidence of anal sphincter tears during delivery. Obstet Gynecol. 2008; 111:1053-7. doi: 10.1097/aog.0b013e31816c4402
Naidu Madhu, Sultan Abdul H., Thakar Ranee. Reducing obstetric anal sphincter injuries using perineal support: our preliminary experience. Int Urogynecol J. 2016; 28:381-389. doi: 10.1007/s00192-016-3176-4
Bulchandani S, Watts E, Sucharitha A, Yates D, Ismail KM. Manual perineal support at the time of childbirth: a systematic review and meta-analysis. BJOG. 2015; 122:1157-65. doi: 10.1111/1471-0528.13431
The OASI care Bundle Project. Available at: https://www.rcog.org.uk/OASICa... (accessed September 2017).