title: Perineal techniques during the second stage of labour for reducing perineal trauma.
abstract: BACKGROUND
  Most vaginal births are associated with some form of trauma to the genital tract. The morbidity associated with perineal trauma is significant, especially when it comes to third- and fourth-degree tears. Different perineal techniques and interventions are being used to prevent perineal trauma. These interventions include perineal massage, warm compresses and perineal management techniques.
  
  
  OBJECTIVE
  The objective of this review was to assess the effect of perineal techniques during the second stage of labour on the incidence of perineal trauma.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2011), the Cochrane Central Register of ControlledTrials (The Cochrane Library 2011, Issue 2 of 4), MEDLINE (January 1966 to 20 May 2011) and CINAHL (January 1983 to 20 May 2011).
  
  
  METHODS
  Published and unpublished randomised and quasi-randomised controlled trials evaluating any described perineal techniques during the second stage.
  
  
  METHODS
  Three review authors independently assessed trails for inclusion, extracted data and evaluated methodological quality. Data were checked for accuracy.
  
  
  RESULTS
  We included eight trials involving 11,651 randomised women. There was a significant effect of warm compresses on reduction of third- and fourth-degree tears (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.28 to 0.84 (two studies, 1525 women)). There was also a significant effect towards favouring massage versus hands off to reduce third- and fourth-degree tears (RR 0.52, 95% CI 0.29 to 0.94 (two studies, 2147 women)). Hands off (or poised) versus hand on showed no effect on third- and fourth-degree tears, but we observed a significant effect of hands off on reduced rate of episiotomy (RR 0.69, 95% CI 0.50 to 0.96 (two studies, 6547 women)).
  
  
  CONCLUSIONS
  The use of warm compresses on the perineum is associated with a decreased occurrence of perineal trauma. The procedure has shown to be acceptable to women and midwives. This procedure may therefore be offered to women.
authors.affiliation: Department of Postgraduate Studies, Bergen University College, Møllendalsveien 6, PO Box7030, Bergen, Norway, 5020.
authors.forename: Vigdis
authors.initials: V
authors.lastname: Aasheim
authors.forename: Anne Britt Vika
authors.initials: AB
authors.lastname: Nilsen
authors.forename: Mirjam
authors.initials: M
authors.lastname: Lukasse
authors.forename: Liv Merete
authors.initials: LM
authors.lastname: Reinar
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000379:methods*; D004841:Episiotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D007748:Labor Stage, Second; D022125:Lacerations / Q000517:prevention & control*; D008405:Massage; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy