PRACTICES THAT MINIMIZE TRAUMA TO THE GENITAL-TRACT IN CHILDBIRTH - ASYSTEMATIC REVIEW OF THE LITERATURE

Background: Trauma to the genital tract commonly occurs at birth, and can cause short- and long-term morbidity. Clinical measures to reduce its occurrence have not been fully identified. Methods: A systematic r eview of the English language literature was conducted to describe the current state of knowledge on reduction of genital tract trauma befor e planning a large randomized controlled trial of ways to prevent such trauma. Randomized trials and other published reports were identified from relevant databases and hand searches. Studies were reviewed and assessed using a structured format. Results: A total of 77 papers and chapters were identified and placed into 5 categories after critical r eview: 25 randomized trials, 4 meta-analyses, 4 prospective studies, 3 6 retrospective studies, and 8 descriptions of practice from textbooks . The available evidence is conclusive in favor of restricted use of e pisiotomy. The contribution of maternal characteristics and attitudes to intact perineum has not been investigated. Several other topics war rant further study, including maternal position, style of pushing, and antenatal perineal massage. Strong opinions and sparse data exist reg arding the role of hand maneuvers by the birth attendant for perineal management and birth of the baby. This became the topic of the planned randomized controlled trial, which was completed; results will be pub lished soon. Conclusions: The case for restricting the use of episioto my is conclusive. Several other clinical factors warrant investigation , including the role of hand maneuvers by the birth attendant in preve nting birth trauma. A large randomized controlled trial will report on this topic.