The role of thumb and index finger placement in manual perineal protection.
OBJECTIVE
Comparison of the modifications of the Viennese method of manual perineal protection (VMPP) and hands-off delivery techniques by applying basic principles of mechanics with assessments of tensions within perineal structures using a novel biomechanical model of the perineum. Evaluation of the role of the precise placements of the accoucheur's posterior (dominant) thumb and index finger in perineal tissue tension when performing a modified Viennese method of MPP.


METHODS
We carried out an experimental study on a biomechanical model of the perineum at NTIS (New Technologies for Information Society, Pilsen, Czech Republic). Hands-off and 38 variations of VMPP were simulated during vaginal delivery with the finite element model imitating a clinical lithotomy position.


RESULTS
The main outcome measures were quantity and extent of strain/tension throughout the perineal body during vaginal delivery. Stress distribution between modifications of VMPP showed a wide variation in peak perineal tension from 72 to 102 % compared with 100 % for the "hands-off" technique. Extent of reduction depended on the extent of finger movement across a horizontal, transverse x-axis, and on final finger position on a vertical, antero-posterior y-axis. The most effective modification of VMPP was initial position of fingers 12 cm apart (x = ±6) on the x-axis, 2 cm anteriorly from the posterior fourchette (y = +2) on the y-axis with 1cm movement of both finger and thumb toward the midline on the x-axis (Δx = 1) with no movement on the y-axis (Δy = 0).


CONCLUSIONS
In a biomechanical assessment with simulation of vaginal delivery, exact placement of fingertips on the perineal skin, together with their co-ordinated movement, plays an important role in the extent of reduction of perineal tension.
New Technologies-Research Centre, University of West Bohemia, Pilsen, Czech Republic.
Magdalena
M
Jansova
Vladimir
V
Kalis
Libor
L
Lobovsky
Ludek
L
Hyncik
Jaroslava
J
Karbanova
Zdenek
Z
Rusavy
D001696:Biomechanical Phenomena; D003198:Computer Simulation; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005385:Fingers; D006801:Humans; D008954:Models, Biological; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D014947:Wounds and Injuries / Q000517:prevention & control*