Luiz Gustavo Oliveira Brito1, Cristine Homsi Jorge Ferreira2, Geraldo Duarte3, Antonio Alberto Nogueira3, Alessandra Cristina Marcolin3. 1. Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of Sao Paulo, Avenida Bandeirantes, 3900 - 8th floor - Monte Alegre, Ribeirão Preto, 14049-900, SP, Brazil. lgobrito@gmail.com. 2. Physical Therapy Course, Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil. 3. Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of Sao Paulo, Avenida Bandeirantes, 3900 - 8th floor - Monte Alegre, Ribeirão Preto, 14049-900, SP, Brazil.
Abstract
INTRODUCTION AND HYPOTHESIS: In this systematic review we aimed to assess if the Epi-No birth trainer used during antepartum could prevent perineal trauma in nulliparous women. METHODS: We searched CENTRAL, MEDLINE, EMBASE, Scielo, and Conference abstracts, looking for randomized controlled studies (RCT). High heterogeneity (i(2) > 50 %) was corrected with random models. All studies were analyzed according to their quality and risk of bias. Nulliparous women or women whose previous pregnancy ended before 21 weeks' gestation were included and the main outcome measures were: episiotomy rates, perineal tears, severe (3rd/4th) perineal tears, and intact perineum. RESULTS: Five studies were included (1,369 participants) for systematic review and two of them (932 participants) were eligible for meta-analysis. Epi-No did not reduce episiotomy rates (RR 0.92 [95%CI 0.75-1.13], n = 710, p =0.44; two studies; fixed model) and second stage of labor (MD -12.50 [95%CI -29.62, -4.62], n = 162, p = 0.54; one study; fixed model), and did not increase intact perineum (RR 1.15 [95 % CI 0.81-1.64], n = 705, p = 0.43; two studies; random model). No influence of Epi-No on reducing all perineal tears (RR 0.99 [95%CI 0.84-1.17], n = 705, p = 0.93, two studies; fixed model) or severe (3rd/4th) perineal tears (RR 1.31 [95%CI 0.72-2.37], n = 705, p = 0.38, two studies; fixed model). Mean birthweight of the Epi-No group was higher than that of the control group in both studies, with no statistical significance. CONCLUSION: Epi-No birth trainer is a device that did not reduce episiotomy rates and had no influence on reducing perineal tears.
INTRODUCTION AND HYPOTHESIS: In this systematic review we aimed to assess if the Epi-No birth trainer used during antepartum could prevent perineal trauma in nulliparous women. METHODS: We searched CENTRAL, MEDLINE, EMBASE, Scielo, and Conference abstracts, looking for randomized controlled studies (RCT). High heterogeneity (i(2) > 50 %) was corrected with random models. All studies were analyzed according to their quality and risk of bias. Nulliparous women or women whose previous pregnancy ended before 21 weeks' gestation were included and the main outcome measures were: episiotomy rates, perineal tears, severe (3rd/4th) perineal tears, and intact perineum. RESULTS: Five studies were included (1,369 participants) for systematic review and two of them (932 participants) were eligible for meta-analysis. Epi-No did not reduce episiotomy rates (RR 0.92 [95%CI 0.75-1.13], n = 710, p =0.44; two studies; fixed model) and second stage of labor (MD -12.50 [95%CI -29.62, -4.62], n = 162, p = 0.54; one study; fixed model), and did not increase intact perineum (RR 1.15 [95 % CI 0.81-1.64], n = 705, p = 0.43; two studies; random model). No influence of Epi-No on reducing all perineal tears (RR 0.99 [95%CI 0.84-1.17], n = 705, p = 0.93, two studies; fixed model) or severe (3rd/4th) perineal tears (RR 1.31 [95%CI 0.72-2.37], n = 705, p = 0.38, two studies; fixed model). Mean birthweight of the Epi-No group was higher than that of the control group in both studies, with no statistical significance. CONCLUSION:Epi-No birth trainer is a device that did not reduce episiotomy rates and had no influence on reducing perineal tears.
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