Antenatal perineal massage for trauma prevention: a pilot randomized clinical trial

Monguilhott, Juliana Jacques da Costa; Brüggemann, Odaléa Maria; Velho, Manuela Beatriz; Knobel, Roxana; Costa, Roberta

doi:10.37689/acta-ape/2022AO03813459

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Original Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AO03813459 copy

Antenatal perineal massage for trauma prevention: a pilot randomized clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the adherence of pregnant women and companions to the performance of digital perineal massage during pregnancy and its effect on the prevention of perineal trauma during childbirth and on the reduction of associated morbidity at 45 and 90 days postpartum.

Methods

A pilot study of a randomized clinical trial with 153 normal risk pregnant women; 78 women in the intervention group underwent digital perineal massage and 75 women in the control group received usual care. For the analysis of the main outcome (perineal trauma) and secondary outcomes, 44 women who had vaginal delivery remained in each group. The intervention was performed daily by the pregnant woman or the companion of her choice from 34 weeks of gestation during 5-10 minutes.

Results

Perineal massage was a protective factor for edema in the first 10 days postpartum (RR 0.64 95%CI 0.41-0.99) and involuntary gas loss at 45 days postpartum (RR0.57 95%CI 0.38-0.86). The residual adjustment ≥ 2 observed in the analysis of perineal conditions postpartum showed a trend of women in the intervention group having an intact perineum. The women and companions who performed perineal massage accepted the practice well, recommended it and would do it again in a future pregnancy.

Conclusion

The digital perineal massage performed daily from 34 weeks of gestation was a practice well accepted by women of this study and their companions. Although not protecting women from perineal trauma, this practice reduced the risk of edema at 10 days postpartum and gas incontinence at 45 days postpartum. Brazilian Clinical Trial Registry: RBR-4MSYDX

Pregnant women; Perineum; Prenatal Care; Delivery; Lacerations

Characteristics	Intervention group (n = 44) n (%)	Control group (n = 44) n (%)	p-value
Sociodemographic
Age - Mean (sd)	29.5(5.5)	31.1(6.1)	0.202
Years of study - Mean (sd)	15.8(5.2)	16.50(4.3)	0.504
Marital status
Single	7(15.9)	5(11.4)	0.803
Married	19(43.2)	19(43.2)
Domestic partnership	18(40.9)	20(45.4)
Skin color
White	27(61.4)	32(72.7)	0.257
Non-white	17(38.6)	12(27.3)
Obstetrical
Gestational age US week. at randomization - Mean (sd)	33.47(1.3)	33.50(1.5)	0.679^¥
Previous births
No	35(79.5)	35(79.5)	1.000
Yes (only one)	9(20.5)	9(20.5)
Previous episiotomy (n= 9)
No	6(66.7)	2(22.2)	0.153
Yes	3(33.3)	7(77.8)
Laceration with prior suture (n= 9)
No	4(44.4)	7(77.8)	0.335
Yes	5(55.6)	2(22.2)
Antenatal care
Public service	29(65.9)	29(65.9)	1.000
Private service	15(34.1)	15(34.1)
Childbirth care
Place
Maternity A	30(68.2)	32(72.7)	0.432
Maternity B	3(6.8)	6(13.6)
Maternity C	5(11.4)	2(4.5)
Another institution	6(13.6)	4(9.2)
Labor induction*
No	33(75.0)	32(72.7)	0.808
Yes	11(25.0)	12(27.3)
Use of oxytocin*
No	31(72.1)	28(65.1)	0.486
Yes	12(27.9)	15(34.9)
Kristeller maneuver
No	42(95.5)	41(95.3)	1.000
Yes	2(4.5)	2(4.7)
Position of birth*
Horizontal	6(13.6)	5(11.4)	0.352
Vertical	38(86.4)	39(88.6)
Valsalva maneuver
No	17(38.6)	18(40.9)	0.828
Yes	27(61.4)	26(59.1)
Newborn Weight* – Mean(sd)	3310.2(520.1)	3179.4(445.7)	0.499

Variables	Intervention group (n = 44) n(%)	Control group (n = 44) n(%)	p-value
Perineal conditions
Intact perineum	15(34.9)^¥	7(15.9)	0.292
1^st degree laceration without suture	6(14.0)	6(13.6)
1^st degree laceration with suture	9(20.9)	10(22.7)
2^nd degree laceration	12(27.9)	20(45.5)^*
Episiotomy	1(2.3)	1(2.3)

	Mean (Standard deviation)	Mean (Standard deviation)

Perineal pain score right after delivery	3.0(2.9)	4.1(2.9)	0.085^¥
Return to sexual activity (days)	34.9(8.3)	36.1(15.3)	0.767
Pain score 45 days postpartum	1.4(2.1)	1.7(2.5)	0.642
Dyspareunia score 45 days postpartum	2.3(2.2)	3.1(2.8)	0.432
Pain score 90 days postpartum	0.3(1.0)	0.3(0.9)	0.789
Dyspareunia score 90 days postpartum	1.3(1.8)	2.0(2.5)	0.242

Variables	Intervention group (n = 43) n(%)	Control group (n = 42) n(%)	RR (95% CI)	p-value
Perineal conditions
No trauma*	21(48.8)	13(29.5)	0.73 (0.51-1.03)	0.065
With trauma	22(51.2)	31(70.5)	0.73 (0.51-1.03)	0.065
Pain in the first 10 days
No	19(48.7)	20(51.3)	1.07 (0.72-1.58)	0.751
Yes	24(52.2)	22(47.8)	1.07 (0.72-1.58)
Redness in the first 10 days
No	39(90.7)	35(83.3)	0.56 (0.18-1.77)	0.351
Yes	4(9.3)	7(16.7)	0.56 (0.18-1.77)	0.351
Hematoma in the first 10 days
No	42(97.7)	40(95.2)	0.49 (0.05-5.19)	0.616
Yes	1(2.3)	2(4.8)	0.49 (0.05-5.19)	0.616
Edema in the first 10 days
No	26(60.5)^¥	16(38.1)	0.64 (0.41-0.99)	0.032
Yes	17(39.5)	26(61.9)^¥	0.64 (0.41-0.99)	0.032
Urinary incontinence 45 days
No	30(69.8)	25(59.5)	0.75 (0.41-1.34)	0.323
Yes	13(30.2)	17(40.5)	0.75 (0.41-1.34)	0.323
Bowel incontinence 45 days
No	39(90.7)	39(92.9)	1.30 (0.31-5.47)	1.000
Yes	4(9.3)	3(7.1)	1.30 (0.31-5.47)	1.000
Involuntary gas loss 45 days
No	34(79.1)	22(52.4)	0.57 (0.38-0.86)	0.009
Yes	9(20.9)	20(47.6)	0.57 (0.38-0.86)	0.009
Urinary incontinence 90 days (n=42)
No	32(76.2)	34(81.0)	1.25 (0.55-2.85)	0.595
Yes	10(23.8)	8(19.0)	1.25 (0.55-2.85)	0.595
Bowel incontinence 90 days (n=42)
No	42(100.0)	40(95.2)	- (-)	-
Yes	-(-)	2(4.8)	- (-)	-
Involuntary gas loss 90 days (n=42)
No	33(78.6)	27(64.3)	0.60 (0.30-1.22)	0.147
Yes	9(21.4)	15(35.7)	0.60 (0.30-1.22)	0.147

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[1] Corresponding author: Juliana Jacques da Costa Monguilhott E-mail: juliana.monguilhott@ifsc.edu.br