背景:会阴按摩,作为预防性干预,已被证明可以降低会阴损伤的风险,并可能在产后早期对盆底功能产生积极影响。然而,关于应用会阴按摩的最佳时期仍然存在争议,无论是产前还是在分娩的第二阶段,以及它的安全性和有效性。采用Meta分析评价产前与第二产程实施会阴按摩对初产妇产程会阴损伤的预防及产后早期盆底功能的影响。
方法:从开始到2024年4月16日,我们搜索了9个不同的电子数据库。我们纳入的随机对照试验(RCT)评估了产前和第二产程会阴按摩对初产妇的影响。所有数据均采用Revman5.3,Stata统计软件,偏差风险2用于评估偏差风险。根据会阴按摩的不同时期进行亚组分析。主要结果是会阴完整性和会阴损伤的发生率。次要结果是会阴疼痛,分娩第二阶段的持续时间,产后出血,尿失禁,大便失禁,和大便失禁.
结果:本综述共包括10项研究,涵盖1057名初产妇。分析结果显示,第二产程会阴按摩较产前减少初产妇产后即刻的会阴疼痛,统计值为(MD=-2.29,95%CI[-2.53,-2.05],P<0.001)。此外,只有产前阶段报告会阴按摩减少了产后三个月初产妇的大便失禁(P=0.04)和肛门失禁(P=0.01),但对产后3个月初产妇尿失禁无显著影响(P=0.80)。
结论:减少初产妇会阴损伤可以通过在产前和第二产程提供会阴按摩来实现。在产前阶段通过会阴按摩在产后阶段改善骨盆底功能。
背景:CRD42023415996(PROSPERO)。
BACKGROUND: Perineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the early postpartum period. However, there is still debate concerning the best period to apply perineal massage, which is either antenatal or in the second stage of labor, as well as its safety and effectiveness. Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women.
METHODS: We searched nine different electronic databases from inception to April 16, 2024. The randomized controlled trials (RCTs) we included assessed the effects of antenatal and second-stage labor perineal massage in primiparous women. All data were analyzed with Revman 5.3, Stata Statistical Software, and Risk of Bias 2 was used to assess the risk of bias. Subgroup analyses were performed based on the different periods of perineal massage. The primary outcomes were the incidence of perineal integrity and perineal injury. Secondary outcomes were perineal pain, duration of the second stage of labor, postpartum hemorrhage, urinary incontinence, fecal incontinence, and flatus incontinence.
RESULTS: This review comprised a total of 10 studies that covered 1057 primigravid women. The results of the analysis showed that perineal massage during the second stage of labor reduced the perineal pain of primigravid women in the immediate postpartum period compared to the antenatal period, with a statistical value of (MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001). Additionally, only the antenatal stage reported that perineal massage reduced fecal incontinence (P = 0.04) and flatus incontinence (P = 0.01) in primiparous women at three months postpartum, but had no significant effect on urinary incontinence in primiparous women at three months postpartum (P = 0.80).
CONCLUSIONS: Reducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage.
BACKGROUND: CRD42023415996 (PROSPERO).