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The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis

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Abstract

Background

In order to reduce the complications of perineal damage and the pain caused by it for the mother, this study was conducted to determine the effect of warm perineal compress on perineal trauma (1st-, 2nd-, 3rd-, and 4th-degree perineal tears), postpartum pain, intact perineum (primary outcomes), episiotomy, length of the second stage, and APGAR score at 1 and 5 min after childbirth (secondary outcome).

Methods

PubMed, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, SID, Magiran, and ClinicalTrials.gov were searched to identify the relevant articles from inception to November 1, 2022, with language restriction (only English and Persian). A manual search was also performed. Risk of bias 2 (RoB2) and ROBIN-I were employed to evaluate the quality of the included papers. Meta-analysis was conducted using RevMan 5.3. Heterogeneity was assessed using I2. In cases with high heterogeneity, subgroup analysis was utilized based on the parity and ethnicity, and time of pain measurement after delivery also a random-effects model was used instead of a fixed-effects model. Trial sequential analysis (TSA) was performed for the primary outcomes. The certainty of evidence was assessed using the GRADE approach.

Results

A total number of 228 articles were found in databases. Of these articles, eighty-six were screened by title, 27 by abstract, and 21 by full text. Finally, 14 articles were included, of which ten were RCT and four were non-RCT. Meta-analysis results revealed that warm perineal compress significantly reduced perineal pain (RR 0.23, 95% CI 0.08–0.66; P = 0.0006), average pain (SMD − 0.73, 95% CI 1.23 to − 0.23; P = 0.004), second-degree perineal tear (RR 0.65, 95% CI 0.54–0.79; P˂0.00001), third-degree perineal tear (RR 0.32, 95% CI 0.15–0.67; P = 0.003), fourth-degree perineal tear (RR 0.11, 95% CI 0.01–0.87; P = 0.04), episiotomy (RR 0.63, 95% CI 0.46–0.86; P = 0.004), and intact perineum significantly increased (RR 3.06, 95% CI 1.79–5.22; P < 0.0001) compared to the control group. However, there was no statistically significant difference in terms of first-degree tear (RR 1.04, 95% CI 0.86–1.25; P = 0.72), length of the second stage of labor (MD − 0.60, 95% CI − 2.43 to 1.22; P = 0.52), the first minute (MD − 0.03, 95% CI − 0.07 to 0.02; P = 0.24) and the fifth minute Apgar score (MD − 0.02, 95% CI − 0.07 to 0.03; P = 0.46) between the two groups.

Conclusion

Warm perineal compress administered during the second stage of labor reduce postpartum pain, second and third-degree perineal tears, and episiotomy rate while it increases the incidence of intact perineum compared to the control group.

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Data availability

The data that support this systematic review and meta-analysis are available from the corresponding author, upon reasonable request.

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Authors and Affiliations

  1. Tabriz University of Medical Sciences, Tabriz, Iran

    Mahsa Maghalian & Maryam Alikamali

  2. Medical School, Ardabil University of Medical Sciences, Ardabil, Iran

    Mahsan Nabighadim

  3. Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Mojgan Mirghafourvand

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  1. Mahsa Maghalian
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Contributions

MM: Conceptualization, methodology, data curation, writing original draft. MA: Conceptualization, methodology, data curation writing. MN: Conceptualization, methodology, data curation writing. MM: Visualization, investigation, supervision, software, validation, writing review and editing. All authors read and approved the final draft.

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Correspondence to Mojgan Mirghafourvand.

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Maghalian, M., Alikamali, M., Nabighadim, M. et al. The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis. Arch Gynecol Obstet 309, 843–869 (2024). https://doi.org/10.1007/s00404-023-07195-2

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