title: Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review.
abstract: OBJECTIVE
  In this systematic review we aimed to assess if the Epi-No birth trainer used during antepartum could prevent perineal trauma in nulliparous women.
  
  
  METHODS
  We searched CENTRAL, MEDLINE, EMBASE, Scielo, and Conference abstracts, looking for randomized controlled studies (RCT). High heterogeneity (i(2) > 50 %) was corrected with random models. All studies were analyzed according to their quality and risk of bias. Nulliparous women or women whose previous pregnancy ended before 21 weeks' gestation were included and the main outcome measures were: episiotomy rates, perineal tears, severe (3rd/4th) perineal tears, and intact perineum.
  
  
  RESULTS
  Five studies were included (1,369 participants) for systematic review and two of them (932 participants) were eligible for meta-analysis. Epi-No did not reduce episiotomy rates (RR 0.92 [95%CI 0.75-1.13], n = 710, p =0.44; two studies; fixed model) and second stage of labor (MD -12.50 [95%CI -29.62, -4.62], n = 162, p = 0.54; one study; fixed model), and did not increase intact perineum (RR 1.15 [95 % CI 0.81-1.64], n = 705, p = 0.43; two studies; random model). No influence of Epi-No on reducing all perineal tears (RR 0.99 [95%CI 0.84-1.17], n = 705, p = 0.93, two studies; fixed model) or severe (3rd/4th) perineal tears (RR 1.31 [95%CI 0.72-2.37], n = 705, p = 0.38, two studies; fixed model). Mean birthweight of the Epi-No group was higher than that of the control group in both studies, with no statistical significance.
  
  
  CONCLUSIONS
  Epi-No birth trainer is a device that did not reduce episiotomy rates and had no influence on reducing perineal tears.
authors: Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of Sao Paulo, Avenida Bandeirantes, 3900 - 8th floor - Monte Alegre, Ribeirão Preto, 14049-900, SP, Brazil. lgobrito@gmail.com.
authors: Luiz Gustavo Oliveira
authors: LG
authors: Brito
authors: Physical Therapy Course, Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.
authors: Cristine Homsi Jorge
authors: CH
authors: Ferreira
authors: Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of Sao Paulo, Avenida Bandeirantes, 3900 - 8th floor - Monte Alegre, Ribeirão Preto, 14049-900, SP, Brazil.
authors: Geraldo
authors: G
authors: Duarte
authors: Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of Sao Paulo, Avenida Bandeirantes, 3900 - 8th floor - Monte Alegre, Ribeirão Preto, 14049-900, SP, Brazil.
authors: Antonio Alberto
authors: AA
authors: Nogueira
authors: Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of Sao Paulo, Avenida Bandeirantes, 3900 - 8th floor - Monte Alegre, Ribeirão Preto, 14049-900, SP, Brazil.
authors: Alessandra Cristina
authors: AC
authors: Marcolin
mesh_terms: D004106:Dilatation / Q000295:instrumentation*; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D014621:Vagina
keywords: Epi-No; Episiotomy; Perineal trauma; Systematic review