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A MODERN VIEW ON THE PREVENTION OF PERINEAL TRAUMA DURING
CHILDBIRTH
Zakirova Nodira Islamovna
Professor of the Department of Obstetrics and Gynecology №1, Samarkand State
Medical University, Samarkand, Uzbekistan
Saidova Zuhra Shuhrat kizi
1st stage master's student of the Department of Obstetrics and Gynecology №1,
Samarkand State Medical University, Samarkand, Uzbekistan
https://doi.org/10.5281/zenodo.14636289
Abstract.
Perineal trauma during childbirth, including spontaneous tears and episiotomy,
is a common outcome of vaginal delivery, affecting 70–85% of women. These injuries can have
long-term physical and psychological consequences, such as chronic pain, pelvic floor
dysfunction, and sexual health issues. This article reviews the risk factors for perineal trauma
and evidence-based strategies for its prevention, including antenatal preparation, intrapartum
techniques, and postnatal recovery support. Emphasis is placed on individualized care, patient
education, and the role of skilled healthcare providers in minimizing perineal injury.
Keywords:
perineal trauma, vaginal delivery, prevention, episiotomy, antenatal
preparation, pelvic floor, childbirth techniques.
Introduction.
Perineal trauma refers to injuries to the perineal region (skin, muscles, and
tissues between the vaginal opening and anus) sustained during childbirth. While minor tears
may heal without intervention, severe trauma, such as third- and fourth-degree perineal tears,
can lead to complications, including anal incontinence and sexual dysfunction. The prevention
of perineal trauma is crucial to improving maternal outcomes and enhancing the birthing
experience.
This article explores the causes and risk factors associated with perineal trauma, as well
as evidence-based preventive measures and recommendations for clinical practice.
Causes and Risk Factors
1.
Maternal Factors:
• First vaginal delivery (primiparity).
• Maternal age (≥35 years).
• Reduced perineal elasticity due to lifestyle, genetics, or comorbidities.
2.
Fetal Factors:
• Macrosomia (birth weight >4 kg).
• Occiput posterior or abnormal fetal position.
3.
Delivery Factors:
• Prolonged or rapid second stage of labor.
• Instrumental delivery (forceps or vacuum extraction).
• Routine episiotomy, which increases the risk of severe tears in subsequent births.
4.
Cultural and Institutional Practices:
• Lack of access to skilled birth attendants.
• Inadequate use of evidence-based intrapartum techniques.
Prevention Strategies
1. Antenatal Preparation
• Perineal Massage:
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Regular perineal massage from the 34th week of pregnancy improves tissue flexibility,
reducing the likelihood of tearing. Studies suggest a 15–30% reduction in trauma risk,
especially for first-time mothers.
• Pelvic Floor Exercises:
Strengthening the pelvic floor improves tissue resilience and reduces the risk of prolapse
postpartum.
• Optimal Nutrition:
Adequate intake of vitamin C, collagen, and hydration supports tissue elasticity and
healing capacity.
2. Intrapartum Techniques
• Controlled Delivery:
Slow, guided delivery of the fetal head during crowning reduces pressure on the perineum
and prevents tearing.
• Warm Compresses:
Applying warm compresses to the perineum during the second stage of labor enhances
blood flow, softens tissues, and reduces tearing risk by 25%.
• Hands-On or Hands-Poised Techniques:
Hands-on techniques, where the midwife supports the perineum and fetal head, have
shown efficacy in minimizing severe tears. However, some studies advocate for a hands-poised
approach to allow natural stretching.
• Selective Episiotomy:
Routine episiotomy is discouraged. A selective approach, based on medical necessity (e.g.,
fetal distress), reduces trauma risk while minimizing unnecessary cuts.
• Labor Positions:
Upright or side-lying positions during labor reduce perineal strain compared to the
lithotomy position.
3. Skilled Healthcare Providers
• Training Programs:
Regular training in perineal protection techniques ensures healthcare providers can
recognize risk factors and apply preventive measures effectively.
• Use of Evidence-Based Guidelines:
Following standardized guidelines from organizations like WHO and RCOG helps
minimize variability in care practices and outcomes.
Outcomes of Preventive Strategies
1.
Reduction in Perineal Tears:
Studies have shown a significant decrease in third- and fourth-degree tears with the
implementation of warm compresses and perineal massage.
2.
Improved Maternal Satisfaction:
Women receiving education and preventive care report greater satisfaction with their
childbirth experience.
3.
Long-Term Benefits:
Prevention of severe perineal trauma reduces the incidence of pelvic floor dysfunction,
incontinence, and sexual health problems later in life.
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Preventing perineal trauma requires a multifaceted approach that combines antenatal
preparation, skilled intrapartum care, and postpartum recovery support. While many strategies
are supported by evidence, cultural and institutional barriers can limit their implementation.
Future research should focus on personalized preventive strategies based on maternal
risk factors, as well as innovative approaches, such as perineal support devices or regenerative
therapies.
Conclusion.
Perineal trauma prevention is integral to improving maternal health
outcomes and enhancing the quality of life for postpartum women. Evidence-based strategies,
including perineal massage, warm compresses, and selective episiotomy, have demonstrated
significant efficacy in reducing the incidence and severity of injuries. A collaborative approach
involving patients, healthcare providers, and institutions ensures these practices are widely
adopted and standardized.
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