Efficacy of intrapartum bundles and interventions in reducing vaginal delivery-related perineal trauma: a systematic review

Objective: The aim of this systematic review is to summarize the current evidence on preventive interventions and bundles, including combinations of multiple techniques, aimed at reducing vaginal delivery-related perineal injury. Methods: A systematic research of literature was independently conducted on different databases (PubMed, MEDLINE, EMBASE) by the authors, using a combination of the identified keywords and index terms as per current PRISMA guidelines. The research was restricted to papers published in English starting by 2000. Similar papers as previously published reviews and metanalysis satisfying the inclusion criteria were used as cross-reference to check for potential further inclusions. Findings: In total 14 papers have been identified to be included in our review, divided into 2 randomized controlled trials and 12 cohort studies (4 prospective cohort studies, 6 retrospective cohort studies, 1 prospective case-control study and 1 multicenter step-wedge cluster study). Conclusions: Bundles and interventions, including combinations of techniques and tools aimed at enhancing intrapartum perineal care are effective in reducing adverse perineal outcome after vaginal delivery. Most common features include training programs for labor professionals, pushing instructions and communication, hands-on technique for both reducing speed of delivery and perineal support, and restrictive use of medio-lateral episiotomy.