COMPARATIVE ANALYSIS OF DIFFERENT PERINEAL PROTECTION TECHNIQUES DURING VAGINAL DELIVERY: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Abstract

Perineal trauma remains one of the most frequent complications of vaginal delivery and a significant contributor to maternal morbidity worldwide. Despite the widespread use of various perineal protection techniques, including manual perineal support, warm compress application, and controlled fetal head delivery, there is currently no unified clinical standard guiding their implementation. This variability contributes to inconsistent obstetric outcomes and limits the effectiveness of preventive strategies.

The aim of this randomized controlled trial was to compare the effectiveness of four different perineal protection techniques in reducing soft tissue birth canal trauma. A total of 240 parturient women with term singleton pregnancies were randomly assigned into four equal groups: hands-off technique, hands-on technique, warm compress application, and a combined method integrating all interventions. Primary outcomes included the incidence and severity of perineal tears and the rate of episiotomy. Secondary outcomes included the duration of the second stage of labor and neonatal condition assessed by Apgar scores.

The results demonstrated that the combined method was associated with the lowest rates of perineal trauma and episiotomy, as well as improved labor efficiency. The incidence of perineal tears decreased from 30% in the hands-off group to 10% in the combined group, while episiotomy rates decreased from 40% to 15%, respectively. Neonatal outcomes remained favorable across all groups.

These findings indicate that the integration of multiple perineal protection strategies produces a synergistic effect, significantly improving maternal outcomes. The combined approach should be considered as a potential standard of care for the management of the second stage of labor.