Effectiveness of Perineal Protection Devices in Reducing Birth-Related Perineal Trauma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and GRADE Assessment Article Swipe

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Salma Allam , Omar Khalid Samir Abdelkader , Rana Mansour , Nour El-Sayed , Hind Elshiekh , Joudi Tarabishi , Sara Mohammad Hegazy , Amr Arafa , Ahmed Kertam , Salma Allam , Omar Khalid Samir Abdelkader , Rana Mansour , Nour El-Sayed , Hind Elshiekh , Joudi Tarabishi , Sara Mohammad Hegazy , Amr Arafa , Ahmed Kertam ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.1007/s00192-025-06364-y

Background Perineal trauma during childbirth is a common complication with significant short- and long-term maternal consequences. Perineal protection devices (PPDs) have been developed as a potential preventive strategy, yet their clinical effectiveness remains under evaluation. Aim To assess the effectiveness of perineal protection devices in reducing the incidence and severity of birth-related perineal trauma. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Eligible studies were identified from PubMed, Scopus, Web of Science, and Embase. Primary outcomes included rates of intact perineum, perineal tears (grade ≥ 2), labial tears, episiotomy, and Apgar scores. Secondary outcomes included adverse effects and feasibility. The Cochrane Risk of Bias tool 2 and GRADE assessment were used to evaluate study quality. Results Five RCTs involving 2331 participants were included. PPD use was associated with a significantly increased rate of intact perineum (RR 1.41; 95% CI 1.18–1.69; p < 0.001). No significant differences were found for grade 1 (RR 1.05; p = 0.48), grade 2 (RR 0.92; p = 0.32), or grade 3–4 perineal tears (RR 0.76; p = 0.26). Labial tears showed no significant reduction overall (RR 0.90; p = 0.64), but sensitivity analysis revealed a benefit after excluding one study (RR 0.72; p = 0.02). No significant differences were found in episiotomy rates (RR 0.96; p = 0.62) or Apgar scores < 7 at 5 min (RR 0.99; p = 0.93). Conclusion PPDs appear safe and effective in increasing intact perineum rates without adverse neonatal outcomes. Further large-scale, standardized trials are needed to confirm their role in obstetric practice. Graphical Abstract

Related Topics

Medicine

Episiotomy

Perineum

Randomized Controlled Trial

Concepts

Medicine Episiotomy Perineum Randomized controlled trial Meta-analysis Adverse effect Tears Childbirth Incidence (geometry) Obstetrics Complication Cochrane Library Surgery Apgar score Clinical trial MEDLINE Systematic review Clinical effectiveness Pelvic floor Pregnancy Physical therapy Stage (stratigraphy)

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Type: article
Language: en
Landing Page: https://doi.org/10.1007/s00192-025-06364-y
PDF: https://link.springer.com/content/pdf/10.1007/s00192-025-06364-y.pdf
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References: 22
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DOI: https://doi.org/10.1007/s00192-025-06364-y

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Title: Effectiveness of Perineal Protection Devices in Reducing Birth-Related Perineal Trauma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and GRADE Assessment

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Publication year: 2025

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Publication date: 2025-11-19

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Authors: Salma Allam, Omar Khalid Samir Abdelkader, Rana Mansour, Nour El-Sayed, Hind Elshiekh, Joudi Tarabishi, Sara Mohammad Hegazy, Amr Arafa, Ahmed Kertam, Salma Allam, Omar Khalid Samir Abdelkader, Rana Mansour, Nour El-Sayed, Hind Elshiekh, Joudi Tarabishi, Sara Mohammad Hegazy, Amr Arafa, Ahmed Kertam

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Landing page: https://doi.org/10.1007/s00192-025-06364-y

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Concepts: Medicine, Episiotomy, Perineum, Randomized controlled trial, Meta-analysis, Adverse effect, Tears, Childbirth, Incidence (geometry), Obstetrics, Complication, Cochrane Library, Surgery, Apgar score, Clinical trial, MEDLINE, Systematic review, Clinical effectiveness, Pelvic floor, Pregnancy, Physical therapy, Stage (stratigraphy)

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