Effectiveness of Intrapartum Perineal Massage in Preventing Perineal Trauma in Nulliparous Women During the Second Stage of Labour: A Randomised Controlled Trial

Abstract

Objectives: To determine the effectiveness of perineal massage during the second stage of labour in preventing perineal trauma in nulliparous women. Methods: A randomized control trial involving 104 nulliparous women undergoing vaginal delivery. The participants were randomised into two arms (intervention-group 'A' and control-group 'B') in a 1:1 ratio. The intervention group had perineal massage and routine hands-on technique according to the hospital protocol while the control group received only hands-on technique. The primary outcome measure was the incidence of perineal tears during vaginal delivery, while the secondary outcome measures were the incidence of episiotomy during vaginal delivery, the mean duration of second stage of labour, and perineal pain score. Results: The baseline socio-demographic and maternal characteristics of the participants were similar in both arms. The incidence of perineal lacerations in the intervention group (massage group) was significantly lower than in the control group (27 (54%) vs. 40 (81.6%); p=0.003). Although the incidence of episiotomy (26% vs. 44.9%; RR = 0.66; 95% CI = 0.50-0.88; p=0.060) was not significantly different, mean perineal pain score at 4 h postpartum (4.3 ± 0.3 vs. 6.1 ± 0.50; p=0.03), mean perineal pain score at 24 h postpartum (2.2 ± 0.1 vs. 4.2 ± 0.3; p=0.02), and mean duration of second stage of labour (83.1 ± 17.5 min vs. 94.2 ± 18.9 min; p=0.002) were significantly lower in the intervention-group. There was no significant difference in the neonatal outcomes (head circumference, birth weight, and Apgar scores: p > 0.05) between the two groups. Conclusion: Intrapartum perineal massage significantly decreases the risk of overall perineal trauma, perineal pain, and duration of the second stage of labour among nulliparous parturients during the second stage of labour. Nulliparous women should be counselled on the potential benefits of intrapartum perineal massage, and obstetricians are encouraged to provide the technique to consenting women. Trial Registration: Pan African Clinical Trial Registry (PACTR): PACTR 202207835155214.

Keywords: laceration; nulliparity; perineal massage; perineal pain; second stage of labour; vaginal delivery.

Figure 1

Visual analogue scale.

Figure 2

Consort/study flowchart.