Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications

Rationale

Postpartum haemorrhage (PPH) is responsible for around 27% of global maternal deaths. Perineal tears are common in vaginal births and a significant contributor to excessive blood loss. A diversity of perineal techniques are utilised to prevent perineal trauma and reduce the incidence of PPH; however, they lack evidence‐based comparisons to understand their effects.

Objectives

To assess the effect of perineal techniques during the second stage of labour on the incidence of and morbidity associated with perineal trauma to prevent postpartum complications.

Search methods

We searched four databases and two trial registers up to 16 April 2024. We checked references, searched citations and contacted study authors to identify additional studies.

Eligibility criteria

We included randomised controlled trials (RCTs) of women in the second stage of labour who intended to give birth vaginally, comparing any perineal techniques with control or another perineal technique. We excluded studies that performed perineal techniques outside the second stage of labour.

Outcomes

Our critical outcomes were second‐, third‐ and fourth‐degree tears measured immediately after birth, and PPH ≥ 500 mL measured within 24 hours after birth.