International Urogynecology Journal

, Volume 25, Issue 1, pp 65–71 | Cite as

Modeling manual perineal protection during vaginal delivery

  • Magdalena Jansova
  • Vladimir KalisEmail author
  • Zdenek Rusavy
  • Robert Zemcik
  • Libor Lobovsky
  • Katariina Laine
Original Article


Introduction and hypothesis

We compared hands-on manual perineal protection (MPP) and hands-off delivery techniques using the basic principles of mechanics and assessed the tension of perineal structures using a novel biomechanical model of the perineum. We also measured the effect of the thumb and index finger of the accoucheur’s dominant-posterior hand on perineal tissue tension when a modified Viennese method of MPP is performed.


Hands-off and two variations of hands-on manual perineal protection during vaginal delivery were simulated using a biomechanical model, with the main outcome measure being strain/tension throughout the perineal body during vaginal delivery.


Stress distribution with the hands-on model shows that when using MPP, the value of highest stress was decreased by 39 % (model B) and by 30 % (model C) compared with the hands-off model A. On the cross section there is a significant decrease in areas of equal tension throughout the perineal body in both hands-on models. Simulation of the modified Viennese MPP significantly reduces the maximum tension on the inner surface of the perineum measured at intervals of 2 mm from the posterior fourchette.


In a biomechanical assessment with a finite element model of vaginal delivery, appropriate application of the thumb and index finger of the accoucheur’s dominant-posterior hand to the surface of the perineum during the second stage of delivery significantly reduces tissue tension throughout the entire thickness of the perineum; thus, this intervention might help reduce obstetric perineal trauma.


Manual perineal protection Hands-on Hands-off Modeling Perineal tension Perineal strain 



The study was supported by the internal grant project SGS-2013-026 of the University of West Bohemia, by the European Regional Development Fund (ERDF), project “NTIS - New Technologies for the Information Society”, European Centre of Excellence, CZ.1.05/1.1.00/02.0090 and by the Charles University Research Fund (project number P36).

Ethical approval and funding

No formal ethical approval was required for this study; no external funding was obtained.

Conflicts of interest



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Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Magdalena Jansova
    • 1
  • Vladimir Kalis
    • 2
    Email author
  • Zdenek Rusavy
    • 2
  • Robert Zemcik
    • 3
  • Libor Lobovsky
    • 4
  • Katariina Laine
    • 5
  1. 1.New Technologies—Research CentreUniversity of West BohemiaPilsenCzech Republic
  2. 2.Department of Obstetrics and GynecologyUniversity Hospital, Faculty of Medicine, Charles UniversityPilsenCzech Republic
  3. 3.Department of Mechanics, Faculty of Applied SciencesUniversity of West BohemiaPilsenCzech Republic
  4. 4.NTIS—New Technologies for Information Society, Faculty of Applied SciencesUniversity of West BohemiaPilsenCzech Republic
  5. 5.Department of ObstetricsOslo University HospitalOsloNorway

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