Episiotomy Extended by Laceration
Conditions
Keywords
Perineal massage, Vaginal delivery, Episiotomy, Perineal laceration, Perineal tear, Obstetric perineal injury
Brief summary
A randomized controlled trial was conducted at the Department of Obstetrics and Gynaecology, Sheikh Zayed Hospital, Rahim Yar Khan, over 6 months following Institutional Review Board and College of Physicians and Surgeons Pakistan approval, to assess whether intrapartum perineal massage reduces mediolateral episiotomy and lowers the frequency and severity of perineal tears in women undergoing term (37-42 weeks), singleton, cephalic vaginal delivery. Women aged 18-45 years in active labour who provided written informed consent were consecutively enrolled and randomized (1:1) by a computer-generated sequence with sequentially numbered, opaque, sealed envelopes to either standard intrapartum care or standard care plus perineal massage; women with conditions requiring urgent delivery/caesarean section or contraindicating vaginal delivery/perineal manipulation were excluded. In the intervention arm, a trained doctor performed standardized perineal massage using sterile water-based lubricant during the first stage and again near the second stage, with predefined stopping criteria for safety; the control arm received routine care without massage beyond usual perineal support at delivery. Primary outcomes were episiotomy (Yes/No) and perineal tear occurrence and grade (first-fourth), assessed immediately post-delivery by a consultant obstetrician not involved in providing massage.
Interventions
PROCEDUREIntrapartum perineal massage
Standardized technique with gloved hands and water-based lubricant; thumbs introduced \~2-3 cm into the vagina with steady lateral pressure to vaginal side walls during resting intervals, delivered as 10-minute sessions repeated during first stage of labour, with an additional session near second stage; discontinued if bleeding, severe pain, suspected infection, non-reassuring fetal status, or urgent obstetric indication arose.
OTHERStandard Intrapartum Care Group (Control)
Women received routine intrapartum care only, with no perineal stretching or massage manoeuvres beyond routine perineal support during delivery, as per hospital protocols.
Sponsors
Sheikh Zayed Medical College
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18-45 years * Primigravida and multigravida women in active labor. * Singleton, cephalic presentation of the fetus. * Women who provide informed consent to participate in the study. * Women at Term pregnancy (37 - 42 weeks).
Exclusion criteria
* Women with placental abruption, vaginal bleeding, macrosomia, fetal distress, vaginal infections, placenta previa and preterm births. * Non-vertex fetal presentations such as breech. * Women scheduled for a cesarean section. * Pregnancies with multiple gestations (e.g., twins, triplets). * Presence of active genital herpes or other contraindications to vaginal birth (HIV). * Active vaginal infections, including bacterial vaginosis or yeast infections.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of episiotomy | Immediately at the time of delivery (during second stage and recorded immediately after birth) | Proportion of participants in whom a mediolateral episiotomy was performed during vaginal delivery, based on predefined clinical indications and documented by the consultant obstetrician. |
| Frequency of perineal tears | Immediately after birth (post-delivery examination in the labour room) | Proportion of participants with any spontaneous perineal laceration after vaginal delivery, determined on systematic post-delivery perineal and vaginal examination by the consultant obstetrician. |
Countries
Pakistan
Contacts
PRINCIPAL_INVESTIGATORSumbal Amjad
Sheikh Zayed Medical college/Hospital, Rahimyar Khan
Outcome results
None listed