EFFECT OF ANTENATAL PERINEAL MASSAGE ON PERINEAL TRAUMA DURING CHILDBIRTH: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Perineal trauma is common during childbirth especially in the
nulliparous women. It causes significant short and long term maternal morbidity and
precarious perinatal bonding. Antenatal perineal massage when properly carried out
has the potential to reducing the prevalence of perineal trauma during child birth.
However, there is paucity of data regarding the effectiveness of the technique in our
environment.
Aims and objective: The study was aimed at evaluating the effectiveness of antenatal
perineal massage at reducing perineal trauma. The specific objectives were to evaluate
the effectiveness of antenatal perineal massage at reducing the rate of episiotomy,
spontaneous perineal tear and postpartum fecal/flatus and urinary incontinences.
Materials and methods: The study was a prospective randomized controlled trial.
The patients for the study were drawn from the pregnant women attending antenatal
care at the antenatal clinic of the University of Nigeria Teaching Hospital Ituku
Ozalla, Enugu. The eligible women at gestational ages of 34-36weeks were assigned
randomly into two sample groups; the intervention group A and control group B, to
receive antenatal perineal massage and not to receive antenatal perineal massage
respectively.
Data collection and statistical analysis: All data collected were recorded on the pro
forma prepared for the study. The data collected were keyed into the statistical
package for social sciences (SPSS) computer software version 16.0 for windows. The
outcome measures were compared between the two groups. Continuous variables
were analyzed using mean ± standard deviation (SD) and the student’s t test. Discrete
variables were compared using Chi-square and Fisher’s exact test as applicable. All
tests were two sided and statistical significance was at probability value of < 0.05.
Results: There were no statistically significant differences between the two groups
regarding their baseline characteristics including maternal age, gestational age at
recruitment, gestational age at delivery and the parity.
Women who received antenatal perineal massage were significantly more likely to
have intact perineum (27(50.9%) versus 16(29.1%); RR: 1.75, [95% C.I: 1.07 – 2.86
P=0.02]). The incidence of episiotomy in the antenatal perineal massage group was
(20(37.7%) versus 32(58.2%); RR: 0.65, [95% C.I: 0.43-0.98 P=0.03, NNT=5] ).
Women who received antenatal perineal massage were significantly less likely to
develop flatus incontinence (4(8.3%) versus 13(26.0%);RR: 0.32 [95% C.I; 0.1123
0.9114; P=0.03]). The need for use of lignocane was also less likely in intervention
group than the control group; (18(34.0%) versus 32(58.2%), P=0.01). The gestational
age at which the labour occurred, onset of labour, duration of the labour, route of
delivery and neonatal outcome were similar in the two groups.
Conclusion: Antenatal perineal massage reduces the incidence of episiotomy and
increases the incidence of women with intact perineum after vaginal delivery without
increased maternal or neonatal complications.
Women should therefore be counselled on the likely benefits of antenatal perineal
massage and the information on the procedure provided during antenatal care.
Obstetricians should consider the technique as routine prenatal care so as to reduce the
incidence of perineal trauma after vaginal birth in our environment

EFFECT OF ANTENATAL PERINEAL MASSAGE ON PERINEAL TRAUMA DURING CHILDBIRTH: A RANDOMIZED CONTROLLED TRIAL