Prevention of perineal trauma

Abstract

Perineal trauma is a highly prevalent condition. The short- and long-term morbidity associated with perineal repair can lead to major physical, psychological, and social problems. Although it would be impossible to completely prevent perineal trauma, it could be minimized. Proven strategies include the practice of perineal massage in the antenatal period, delayed pushing in the second stage of labor with an epidural in situ, restrictive use of episiotomy, preference of a mediolateral over a midline episiotomy, and the use of a vacuum extractor instead of forceps for instrumental delivery. Other strategies have been suggested but remain unproven in randomized controlled trials. Further research in this area is required. © 2010 Springer-Verlag Milan.