Hands-On Versus Hands-Off Techniques for Perineal Protection in Childbirth: A Systematic Review of Randomized Controlled Trials
Abstract
ABSTRACT
Background: Perineal trauma during vaginal delivery is common and can lead to severe complications such as incontinence, chronic pelvic pain, and sexual dysfunction. Protecting the perineum during childbirth is essential to reduce the risk of maternal morbidity. Hands-on and hands-off techniques are two methods used to protect the perineum, yet the effectiveness of these methods remains debated in previous research.
Objective: This article aims to compare the effectiveness of hands-on versus hands-off techniques in preventing perineal tears and episiotomy during vaginal delivery.
Methods: The study followed the PRISMA guidelines for systematic reviews. Steps included developing a PICO framework to guide the review question, searching for articles in three databases—PubMed, ScienceDirect, and Cochrane Library—and using the search engines Google Scholar and WILEY Online Library. Articles were critically appraised using the Joanna Briggs Institute (JBI) tool for assessing RCTs, and the risk of bias was evaluated using the Cochrane Risk of Bias tool. Data analysis followed the Synthesis Without Meta-analysis (SWiM) guidelines.
Results: Out of 1,724 articles, three met the inclusion and exclusion criteria. Eight hundred laboring women participated in the studies included in this systematic review. The analysis revealed that perineal tears were lower among women who delivered with the hands-off technique than with the hands-on technique. Additionally, the hands-off technique reduced the incidence of episiotomy compared to the hands-on technique.
Conclusion: Despite some variations in study outcomes and characterics of the respondents, the systematic review found that the hands-off technique is more optimal in protecting the perineum. Further meta-analysis and studies with more homogeneous sample characteristics are needed to confirm these findings and identify the optimal technique for perineal protection during childbirth.
Keywords: Hands-on, hands-off, technique, perineal tears, episiotomy, vaginal delivery
References
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