International Urogynecology Journal

, Volume 26, Issue 10, pp 1429–1436 | Cite as

Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review

  • Luiz Gustavo Oliveira BritoEmail author
  • Cristine Homsi Jorge Ferreira
  • Geraldo Duarte
  • Antonio Alberto Nogueira
  • Alessandra Cristina Marcolin
Review Article


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.


We searched CENTRAL, MEDLINE, EMBASE, Scielo, and Conference abstracts, looking for randomized controlled studies (RCT). High heterogeneity (i2 > 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.


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.


Epi-No birth trainer is a device that did not reduce episiotomy rates and had no influence on reducing perineal tears.


Perineal trauma Systematic review Epi-No Episiotomy 



We would like to thank Nieck Pouwels for helping us with the German translation of the Hillebrenner data.

Conflicts of interest


Authors’ participation

L.G. Brito: project development, data collection/analysis, manuscript writing/editing; A.C. Marcolin: project development, data collection, manuscript editing; C.H. Ferreira: manuscript writing/editing; G. Duarte, and A.A. Nogueira: project development, manuscript editing


The authors declare that no funding was provided to perform this systematic review.


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Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Luiz Gustavo Oliveira Brito
    • 1
    Email author
  • Cristine Homsi Jorge Ferreira
    • 2
  • Geraldo Duarte
    • 1
  • Antonio Alberto Nogueira
    • 1
  • Alessandra Cristina Marcolin
    • 1
  1. 1.Department of Gynecology and Obstetrics, Ribeirão Preto School of MedicineUniversity of Sao PauloRibeirão PretoBrazil
  2. 2.Physical Therapy Course, Ribeirão Preto School of MedicineUniversity of Sao PauloRibeirao PretoBrazil

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