Introduction
Perineal trauma is an extremely common and expected complication of
vaginal birth. More than 85% of women having a vaginal birth suffer
some degree of perineal trauma.1 Perineal tears occur
with varying degrees. In first-degree tear, superficial injury to the
vaginal mucosa that may involve the perineal skin, whereas in
second-degree tear lacerations extend to the vaginal mucosa and perineal
body. In severe perineal tears (third- and fourth-degree), the anal
sphincter and rectal mucosa are torn, respectively.2-3Among different degrees of perineal tears, severe perineal tears are
linked to the greatest morbidity, including pain, dyspareunia, faecal
incontinence, urinary problems.1,4-5 For women who
experience severe perineal trauma during childbirth, their physical and
psychological outcomes can be complex, with some women experiencing
social isolation and marginalization due to their ongoing
symptomatology.6 Therefore, prevention of perineal
trauma, and third- and fourth-degree lacerations in particular is
essential.
Different techniques have been reported to prevent perineal lacerations,
including warm compresses,7-8 perineal
massage,7,9 hands-on technique,7,10Ritgen’s maneuver,7,11 and lubricant
gel.12 Among these techniques, warm compresses and
perineal massage showed a positive effect in reducing third-degree and
fourth-degree perineal tears.7-9 Hands-on technique
and Ritgen’s maneuver did not show any effect on severe perineal
tears.7,10-11 The effects of the use of lubricant have
been unclear and is still subject of debate.12Lubricants can effectively reduce the friction of the vaginal wall, may
facilitate the delivery of the fetus and reduce perineal trauma. The aim
of this systematic review and meta-analysis of randomized controlled
trials (RCTs) was to evaluate whether or not the use of lubricants
during vaginal delivery decreases perineal trauma, to inform the
recommendations of Chinese guideline on clinical practice guides for
prevention and management of perineal laceration in vaginal delivery.