Does the Epi-No® Birth Trainer reduce levator trauma? A randomised controlled trial
- 1k Downloads
Introduction and hypothesis
The purpose of this study is to evaluate whether antepartum use of a birth trainer may reduce levator trauma.
Two hundred nulliparous women were examined with four-dimensional translabial ultrasonography at 35–37 weeks of gestation and 3 months postpartum in a randomised controlled pilot study. Women in the intervention group were instructed to use the birth trainer from 37 weeks onwards.
One hundred forty-six women returned for follow-up 5.6 months (range 2.3–22.1) after childbirth. Seventy-eight of them had had normal vaginal deliveries (53%), 32 vacuum/forceps (22%) and 36 a caesarean section (25%). The risk of avulsion was halved in the intervention group (6% vs 13%, P = 0.19) on modified intention to treat analysis. A treatment received analysis revealed a nonsignificant 42% and 30% reduction in levator avulsion and microtrauma, respectively (P ≥ 0.22).
This pilot randomised controlled trial showed a nonsignificantly lower incidence of pelvic floor muscle injury in women who used the Epi-No® device from 37 weeks onwards.
KeywordsChildbirth Epi-No birth trainer Levator avulsion Levator microtrauma Pelvic organ prolapse Ultrasound
The Epi-No® Birth Trainer was donated by the Starnberg Medical, Tecsana GMBH, Muenchen, Germany.
Conflict of interest statement
KL Shek, V Chantarasorn, S Langer and H Phipps have no conflict of interest to declare. HP Dietz has acted as a consultant for AMS (American Medical Systems) and CCS (Continence Control Systems); has accepted Speaker’s fees from GE (General Electric), AMS and Astellas and has benefited from equipment loans provided by GE, Bruel and Kjaer and Toshiba.
- 7.Broos SV, Zerba E, Faulkner JA (1995) Injury to muscle fibres after single stretches of passive and maximally stimulated muscles in mice. J Physiol 488(2):459–469Google Scholar
- 10.Dietz HP, Simpson JM (2007) Does delayed child-bearing increase the risk of levator injury in labour? Aust NZ J OG 47(6):491–495Google Scholar
- 14.Kovacs G, Heath P, Heather C (2004) First Australian trial of the birth-training device Epi-No: a highly significantly increased chance of an intact perineum. Aust NZ J OG 44:347–348Google Scholar
- 25.Shek K, Dietz H (2010) Can levator avulsion be predicted antenatally? Am J Obstet Gynecol. doi: 10.1016/j.ajog.2009.11.038
- 26.Valsky D, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D et al (2009) Fetal head circumference and length of second stage of labour are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 201(91):e1–e7PubMedGoogle Scholar
- 27.Brooks S, Zebra E, Faulkner J (1995) Injury to the muscle fibres after single stretches of passive and maximally stimulated muscle in mice. J Physio 488(2):459–469Google Scholar