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

Vigdis Aasheim; Anne Britt Vika Nilsen; Mirjam Lukasse; Liv Merete Reinar

doi:10.1002/14651858.CD006672.pub2

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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Hands off (or poised) versus hands on, Outcome 1 3^rd or 4^th degree tears.

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Analysis 1.2

Comparison 1 Hands off (or poised) versus hands on, Outcome 2 Episiotomy.

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Analysis 1.3

Comparison 1 Hands off (or poised) versus hands on, Outcome 3 Intact perineum.

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Analysis 2.1

Comparison 2 Warm compresses versus control (hands off or no warm compress), Outcome 1 3^rd or 4^th degree tears.

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Analysis 2.2

Comparison 2 Warm compresses versus control (hands off or no warm compress), Outcome 2 Episotomy.

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Analysis 2.3

Comparison 2 Warm compresses versus control (hands off or no warm compress), Outcome 3 Intact perineum.

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Analysis 3.1

Comparison 3 Massage versus control (hands off or care as usual), Outcome 1 3^rd or 4^th degree tears.

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Analysis 3.2

Comparison 3 Massage versus control (hands off or care as usual), Outcome 2 Episiotomy.

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Analysis 3.3

Comparison 3 Massage versus control (hands off or care as usual), Outcome 3 Intact perineum.

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Analysis 4.1

Comparison 4 Ritgen's manoeuvre versus standard care, Outcome 1 3^rd degree tears.

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Analysis 4.2

Comparison 4 Ritgen's manoeuvre versus standard care, Outcome 2 4^th degree tears.

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Analysis 4.3

Comparison 4 Ritgen's manoeuvre versus standard care, Outcome 3 3^rd or 4^th degree tears.

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Analysis 4.4

Comparison 4 Ritgen's manoeuvre versus standard care, Outcome 4 Episiotomy.

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Comparison 1. Hands off (or poised) versus hands on

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 3^rd or 4^th degree tears Show forest plot	3	6617	Risk Ratio (M‐H, Random, 95% CI)	0.73 [0.21, 2.56]

2 Episiotomy Show forest plot	2	6547	Risk Ratio (M‐H, Random, 95% CI)	0.69 [0.50, 0.96]

3 Intact perineum Show forest plot	2	6547	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.95, 1.12]

Comparison 1. Hands off (or poised) versus hands on

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Comparison 2. Warm compresses versus control (hands off or no warm compress)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 3^rd or 4^th degree tears Show forest plot	2	1525	Risk Ratio (M‐H, Random, 95% CI)	0.48 [0.28, 0.84]

2 Episotomy Show forest plot	2	1525	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.62, 1.39]

3 Intact perineum Show forest plot	2	1525	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.86, 1.26]

Comparison 2. Warm compresses versus control (hands off or no warm compress)

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Comparison 3. Massage versus control (hands off or care as usual)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 3^rd or 4^th degree tears Show forest plot	2	2147	Risk Ratio (M‐H, Random, 95% CI)	0.52 [0.29, 0.94]

2 Episiotomy Show forest plot	2	2147	Risk Ratio (M‐H, Random, 95% CI)	1.42 [0.42, 4.87]

3 Intact perineum Show forest plot	2	2147	Risk Ratio (M‐H, Random, 95% CI)	1.04 [0.90, 1.20]

Comparison 3. Massage versus control (hands off or care as usual)

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Comparison 4. Ritgen's manoeuvre versus standard care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 3^rd degree tears Show forest plot	1	1423	Risk Ratio (M‐H, Random, 95% CI)	1.42 [0.86, 2.36]

2 4^th degree tears Show forest plot	1	1423	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.18, 2.03]

3 3^rd or 4^th degree tears Show forest plot	1	1423	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.78, 1.96]

4 Episiotomy Show forest plot	1	1423	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.63, 1.03]

Comparison 4. Ritgen's manoeuvre versus standard care

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