International Urogynecology Journal

, Volume 26, Issue 10, pp 1415–1427 | Cite as

The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review with meta-analysis

  • Yihui Du
  • Li Xu
  • Lilu Ding
  • Yiping Wang
  • Zhiping WangEmail author
Review Article


Introduction and hypothesis

Pelvic floor muscle training (PFMT) has been widely used to prevent and treat urinary incontinence; however, the possible effect of antenatal PFMT on labor and delivery is still not clear. The purpose of the study was to investigate the possible effect of antenatal PFMT on labor and delivery.


A systematic review of the scientific literature was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Randomized or quasi-randomized controlled studies of an obstetric population who had done antenatal PFMT met the inclusion criteria. Data about labor and delivery outcomes included the first stage of labor, the second stage of labor, episiotomy, instrumental delivery, and perineal laceration. The nine English and four Chinese databases were searched from their inception through November 6, 2014. Fixed or random effects models were selected based on study heterogeneity. The weighted mean differences (WMDs) and odds ratios (ORs) with the corresponding 95 % confidence intervals (CIs) were calculated to assess the association between PFMT and the labor and delivery outcomes.


Twelve studies were identified, involving a total of 2,243 women, in which 1,108 were PFMT and 1,135 controls. They indicated that PFMT during pregnancy significantly shortened the first and second stage of labor in the primigravida (WMD = −28.33, 95 % CI: −42.43 to −14.23, I2 = 0.0 % , and WMD = −10.41, 95 % CI: −18.38 to −2.44, I2 = 64.0 % respectively). In the subgroup analysis on the second stage of labor, heterogeneity decreased for subgroups of China and European countries (I2 = 0.0 %, P = 0.768 and I2 = 0.0 %, P = 0.750 respectively), but statistically significant association only existed in the subgroup of China (WMD = −17.42, 95 % CI: −23.41 to −11.43). When evaluating the effect on the rates of episiotomy, instrumental delivery and perineal laceration, the meta-analysis showed that the results were not significant (OR = 0.75, 95 % CI: 0.54 to 1.02; OR = 0.84, 95 % CI: 0.61 to 1.17 and OR = 0.96, 95 % CI: 0.66 to 1.40 respectively).


Antenatal PFMT might be effective at shortening the first and second stage of labor in the primigravida. The moderate heterogeneity for the second stage of labor data need further study. Antenatal PFMT may not increase the risk of episiotomy, instrumental delivery, and perineal laceration in the primigravida.


Delivery Labor Meta-analysis Pelvic floor muscle Training 



We thank the library of Shandong University for assistance during the preparation of the manuscript. We also appreciate the contribution of Ping Liu, Shuting Wang, and Cuiling Zhang for help in finishing the final manuscript.



Conflicts of interest


Supplementary material

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Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Yihui Du
    • 1
  • Li Xu
    • 2
  • Lilu Ding
    • 3
  • Yiping Wang
    • 1
  • Zhiping Wang
    • 1
    Email author
  1. 1.Department of Epidemiology and Health Statistics, School of Public HealthShandong UniversityJinanPeople’s Republic of China
  2. 2.Department of Women Health CareJinan Maternal and Child Care HospitalJinanPeople’s Republic of China
  3. 3.Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of HealthShandong UniversityJinanPeople’s Republic of China

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