The impact of reduced perineal lacerations during delivery: A systematic review

Abstract

Various interventions to reduce perineal lacerations during childbirth have been reported, but no systematic assessment of each intervention's impact has been conducted. This study conducted an umbrella review to describe and categorize various interventions for preventing perineal lacerations and evaluate their outcomes.

The review included studies on perineal laceration interventions during childbirth from existing quantitative systematic reviews, with or without meta-analysis. A comprehensive search conducted up to September 2023 spanned eight bibliometric databases and gray literature sources. Two reviewers independently assessed five systematic reviews using the Joanna Briggs Institute checklist and extracted data with a standardized tool. Findings were summarized in a tabular format with supporting text.

Of the 57 articles initially shortlisted, six were selected for in-depth analysis. These reviews included 77 randomized controlled trials involving 27,782 patients. Perineal massages and antenatal pelvic floor exercises were identified as the most effective interventions, both of which shortened the second stage of labor and reduced laceration rates. The efficacy of other interventions remains uncertain due to limited research. Future studies should explore the impact of varying intensities and frequencies of perineal massages throughout pregnancy. Integrating these practices into antenatal education and routine midwifery care could further improve clinical outcomes and prevent perineal lacerations during labor.