Effectiveness of prenatal perineal massage in reducing the risk of perineal trauma during vaginal delivery in nulliparous women: A meta-analysis and evidence based review

Background: Perineal injury occurs in 85% of all women who experience a vaginal, delivery. Perineal injury involves an episiotomy and/or a laceration. Urinary incontinence (UI) is the most frequently reported morbidity following a perineal injury.

Objectives: To synthesize the existing literature to determine if perineal massage should be performed in pregnant women as preparation for their vaginal delivery to reduce the likelihood and severity of perineal trauma.

Study Design: PubMed, PEDro, International Journal of Gynecology & Obstetrics, were searched. Incidence of episiotomy and degree of perineal laceration were measured following vaginal delivery.

Methods: This meta-analysis included controlled clinical trials studying 2,877 primipara women with an average age of 28 years old. All women had medically uncomplicated pregnancies and full-term vaginal deliveries. Articles were appraised for quality using the PEDro Scale.

Results: Seven controlled trials met the inclusion criteria and were included for analysis. The most important finding of this meta-analysis is that perineal massage reduced the severity of perineal injury during vaginal delivery. Women who practiced perineal massage in their third trimester were 21% less likely to have third and fourth degree perineal lacerations. In addition, dynamic perineal massage reduces the risk of third and fourth degree tears by 16% and episiotomy by 13%. In terms of frequency of perineal massage i.e. daily versus 3-4 times a week, the results suggest that daily perineal massage have a statistically significant effect in reducing the risk of first degree tear by 416%.

Conclusions: Perineal massage reduces the severity of perineal injury. This will allow women to return to their prior level of function at an increased rate and reduce the likelihood of secondary morbidities.