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POLTEKKES KEMENKES JAMBI
PRODI RPL SARJANA TERAPAN KEBIDANAN BIDAN

KELAS MERANGIN
JURNAL PENJAHITAN LUKA PERENIUM
DOSEN PENGAMPU : Lia Artika Sari,,Bdn, M.Keb
DI SUSUN OLEH
NANI DARMIZA
NIM : PO71241230212
POLTEKKES KEMENKES JAMBI

JURUSAN KEBIDANAN
2023/2024
Tugas Kuliah
Nama Mahasiswa : Nani Darmiza
Nim : PO71241230212
Dosen : Lia Artika Sari,,Bdn, M.Keb
Judul, Penulis, Metode/Populasi/

Hasil Tela’ah
NO Tahun Tujuan Sampel/Teknik Link Jurnal
Jurnal
Penelitian
1 Title: Penelitian ini Method: Sebanyak 6487 https://
Effect of Prenatal bertujuan untuk literatur tentang subjek dalam 16 www.hindawi.co
Perineal Massage membandingkan hubungan antara pijat penelitian m/journals/
on Postpartum efek pijat perineum prenatal dan dilibatkan, dengan cmmm/
Perineal Injury perineum cedera serta 3211 subjek 2022/3315638/
and Postpartum tentang cedera komplikasi perineum menerima pijat
Complications: A erineum dan pascapersalinan perineum dan 3276
Meta-Analysis komplikasinya hingga April 2022 tidak.
Author:
Qiuxia Chen,
Xiaocui Qiu,
Aizhen Fu, and
Yanmei Han
Year:
2022
2 Title: Tujuan penelitian Method: Ditemukan bahwa https://

Effect of Dry Heat ini adalah untuk Penelitian ini kelompok panas www.hindawi.co
Application on mengetahui merupakan penelitian kering memiliki m/journals/ogi/
Perineal Pain and pengaruh kuasi-eksperimental, peningkatan 2023/9572354/
Episiotomy pengaplikasian dua kelompok, pra- penyembuhan luka
Wound Healing panas kering pasca-tes episiotomi yang
among Primipara terhadap nyeri dilakukan di bangsal signifikan dalam
Women perineum dan rawat inap hal kemerahan
penyembuhan pascakelahiran dan perineum, edema
Author: luka episiotomi klinik rawat jalan daerah perineum,
Naglaa Zaki pada wanita Rumah Sakit ekimosis,
Hassan Roma , primipara. Universitas Bersalin keluarnya luka, dan
Rasha Mohamed El-Shatby di perkiraan tepi luka
Essa , Zohour Alexandria. pada tanggal 5 (P
Ibrahim <0,001, P <0,001,
Rashwan , and P < 0,007, P
Afaf Hassan <0,003, dan P
Ahmed <0,001, masing-
masing) dan hari ke
Year: 10 setelah
2022 intervensi (P
<0,001, P <0,001,
P <0,001, P
<0,005, dan P
<0,001, masing-
masing)
dibandingkan
kelompok panas
lembab.
3 Title: Tujuan penelitian Sampel : Seluruh ibu Rata-rata https://
Differences in the ini adalah untuk nifas yang mengalami penyembuhan luka www.semanticsch
Healing of melihat perbedaan luka perineum di perineum dengan olar.org/search?
Perineal Wounds enyembuhan luka Poliklinik Kelas II teknik oles lebih q=Suturing%20of
in Postpartum perineum pada Klinik T dan BPM D cepat %20perineal
Mothers and ibu nifas dengan berjumlah 20 orang. penyembuhannya %20wounds&sort
Hecting Using the teknik interupsi (15,20) =relevance
Dotted Technique dan teknik dibandingkan
and the Basting subtikular di dengan teknik dot
Technique Klinik T dan (17,40)
BPM D
Author: Kabupaten Deli
Mesrida Serdang Tahun
Simarmata 2020. Desain
penelitian ini
Year: adalah
2022 eksperimen
dengan
pendekatan waktu
memanjang
Hindawi
Obstetrics and Gynecology International

Volume 2023, Article ID 9572354, 10 pages
https://doi.org/10.1155/2023/9572354
Research Article
Effect of Dry Heat Application on Perineal Pain and Episiotomy
Wound Healing among Primipara Women
Naglaa Zaki Hassan Roma ,1

Rasha Mohamed Essa ,2 Zohour Ibrahim Rashwan
,3,4 and Afaf Hassan Ahmed 1
1
Obstetric and Gynecological Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
2
Obstetric and Gynecological Nursing Department, Faculty of Nursing, Damanhour University, Damanhour, Egypt
3
Pediatric Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
4
Nursing Department, College of Health Sciences, University of Bahrain, Zallaq, Bahrain
Correspondence should be addressed to Naglaa Zaki Hassan Roma; ngla_roma@yahoo.com
Received 22 July 2022; Revised 11 October 2022; Accepted 21 November 2022; Published 4 January 2023
Academic Editor: Manvinder Singh
Copyright © 2023 Naglaa Zaki Hassan Roma et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. Women who undergo perineal episiotomy can be afected by several complications such as bleeding, infection,
perineal pain, dyspareunia, reduction of sexual desire, as well as urinary and anal incontinence. Perineal pain related to
episiotomy has been reported to interfere with women’s daily activities postpartum and can prevent proper breastfeeding, proper
rooming-in, and maternal-infant bonding. The purpose of this study was to determine the efect of dry heat application on
perineal pain and episiotomy wound Healing among primipara women. Method. A quasi-experimental, two-group, pre-post-test
research study was conducted at the postnatal inpatient ward and the outpatient clinic of the El-Shatby Maternity University
Hospital in Alexandria. A sample of 100 parturient women was divided into the following two groups at random: dry heat and
moist (control) heat. Women in the moist heat group were advised to sit in a basin (tub) of warm water for 10 minutes, while
those in the dry heat group were instructed to set an infrared light (230 volts) at a distance of 45 cm from the perineum after 12
hours post episiotomy. Both interventions were applied twice a day for ten consecutive days. They evaluated the severity of
their perineal pain at baseline and repeated it on the 5th and 10th days after obtaining the interventions while the episiotomy
wound healing was assessed on the 5th and 10th days. Results. It was discovered that the dry heat group had a significantly
improved episiotomy wound healing as regards perineal redness, edema of the perineal area, ecchymosis, wound discharge,
and approximation of wound edges on the 5th (P < 0.001, P < 0.001, P < 0.007, P < 0.003, and P < 0.001, respectively) and
10th day after intervention (P < 0.001, P < 0.001, P < 0.001, P < 0.005, and P < 0.001, respectively) than the moist heat group.
The primipara women had significantly lower perineal pain intensity in the dry heat group on the 5th and 10th days after
intervention than in the moist heat group (MHP < 0.001 for the dry heat group and MHP 0.004 for the moist heat group).
Conclusion. The application
� of dry heat promoted episiotomy wound healing among primipara women and reduced their
perineal pain during early postpartum days than moist heat.
1. Introduction Although the postpartum period is a wonderful and

joyful experience for mothers, it is life-challenging and
full of many stressful events [1]. Many health It occurs in 42% of women after spontaneous delivery
problems may arise during the postpartum period and persists after the first three months. Perineal
and, if not treated promptly and efectively, can lead pain worsens following instrumental delivery,
to ill health and even death of the mother, her spontaneous tears, or episiotomy [3].
neonate, or both [2]. Perineal discomfort is the most An episiotomy or perineotomy is a deliberate
common problem encountered in the postnatal surgical incision to the perineum, made either during
period. the second stage of labor or just before delivery, to
widen the vaginal orifice [4]. It is the most common
surgical procedure performed during the labor of
primiparous women and was
Obstetrics and Gynecology 2
International
introduced to clinical practice in the eighteenth performance of Kegel’s exercise, dry heat (infrared
century [5]. There are four types of episiotomies; therapy), and moist heat topical appli- cations (sitz
median, mediolateral left or right, lateral, and J- bath) [14].
shape [6]. Globally, the prevalence of episiotomy has Moist heat is one of the techniques that can
a wide geographic variation between countries and alleviate
perineal pain and enhance wound healing. It requires
institutions because of diferences in attitudes and
im- mersion of the perineal area and buttocks for
training. Up to now, high episiotomy rates are still
15 to 20 minutes in warm water at a temperature of
being reported in many countries [7]. In Egypt,
110°–115°F. It can be used to lessen perineal
according to the Statistical Department of the
discomfort, itching, or muscle spasms [15]. Moist heat
postnatal inpatient ward and the outpatient clinic of
can also facilitate wound healing by soaking the
the El-Shatby Maternity University Hospital, the
perineum and anus, improving circulation, decreasing
episiotomy rate was 94% of vaginal births in 2015,
edema, and inflammation, and promoting muscle
while in 2016 it was 93% of vaginal births [8]. Despite
relaxation [16]. It seems that heat stimulates heat
the World Health Organization [9] recommending a
receptors of the skin and deeper tissues, and it may
reduction in the episiotomy rate to 10% for
reduce pain, as proposed in gate control theory [17].
normal vaginal deliveries, the procedure is still
On the other hand, dry heat using the infrared lamp
performed by 30% to 50% of women [9]. Episiotomy
is a special type of
is associated with clinically relevant morbidities for
newly delivered women including perineal trauma, therapy in which episiotomy is treated using the
the need for suturing, and healing complications [4]. healing efect of light. At a distance of 45–50 cm and
Episiotomy-related morbidity can influence the for 10–15 minutes, the incision site or the diseased
physical, psychological, and social well-being of portion of the perineum is exposed to infrared
women, both in the immediate and long-term radiation with a light source of 230 volts. Therefore,
postnatal period [10]. Women who undergo perineal these rays relax muscles, promote circulation, and
episiotomy can consequently be af- fected by provide pain relief [18]. Recently, studies have shown
several complications, such as bleeding, infection, conflicting findings on the most efective strategies to
damage to the anal sphincter and mucosa, wound alleviate pain from episiotomy and improve wound
opening, dyspareunia, reduction of sexual desire, healing [19, 20]. Therefore, this study was carried out
perineal pain, as well as urinary and anal to compare the efects of dry heat versus moist heat
incontinence. Perineal pain and discomfort application in reducing perineal pain and promoting
related to episiotomy have been reported to in- episi- otomy wound healing among primiparous
terfere with women’s daily activities, such as sitting, women.
walking, and lifting the neonate. Moreover, it can
interrupt proper breastfeeding, rooming-in, as well
as maternal-infant 1.1. Aim of the Study. This study aimed to determine the
bonding [11]. efect of dry heat application on perineal pain and episi-
Postpartum is a sensitive time when mothers otomy wound Healing among primipara women.
must juggle their recovery while dealing with the
needs of their new- borns. Efective episiotomy
1.2. Research Hypothesis. Primipara women who receive dry
management is a major aspect of postpartum care heat application on their episiotomy wound exhibit
that can positively afect women’s lives [12]. Several episiotomy wound healing and lower perineal pain intensity
interventions are available for relieving perineal than those who receive moist heat.
discomfort, promoting healing, and reducing perineal
edema, redness, and pain. These interventions
1.3. Research Design and Setting. A quasi-experimental, two-
include perineal hygiene, keeping the wound dry, and
group, pre-post-test research study was conducted at the
using various pharmacological and postnatal inpatient ward and the outpatient clinic of the El-
nonpharmacological treatments [13]. The maternity Shatby Maternity University Hospital in Alexandria. This
nurse should be aware of efficient episiotomy wound setting was chosen as it is the largest maternity health
management which can decrease the sufering of agency in Alexandria and also episiotomy procedure is
postpartum mothers and improve healing. Many routinely performed on all primipara attending for
delivery.
nonpharmacological measures are assisting the
healing process, which encompasses acupuncture,
cryotherapy, laser therapy, electrical stimulation, the 1.4. Subjects. The study used a convenience sample of 100
parturient women who met the following inclusion
International
criteria; had a normal vaginal delivery with episiotomy;
primipara during the first 2 hours after delivery;
complained of perineal discomfort (pain); and agreed to
participate in the study. While illiterate women and those
who used any pain- relieving drug (painkillers may mask
the impact of the intervention), had labor or postpartum
complications, di- abetes and anemia were excluded from
the study.
In the beginning, the researchers spoke with 900
parturient women to identify individuals who fit
the pre- requisites. 127 parturient women were
among the instances that were found. The sample
size was calculated using the Epi Info program
version 10 with the following parameters: a
population size of 127, a confidence level of 95%, an
expected frequency of 50%, and an acceptable error
of 5%. 100 parturient women made up the
required minimum sample size.
During the study period (January 2021–May
2021), a sample of 100 out of 127 parturient-eligible
women was randomly assigned to two equal parallel
groups in the postpartum inpatient ward and the
outpatient clinic from 8 AM to 1 PM, three days a
week. As shown in Figure 1, one participant was
placed in the dry heat group, while the next was
placed in the moist heat group.
International
Parturient women delivered and meet the

inclusion criteria and agreed to participate in the
study (n=127)
Dry Heat Group Moist Heat Group

(n=64) (n=63)
Used painkillers
(9)
Withdrawn (n=4)
Used painkillers
(8)
Withdrawn (n=6)
Dry Heat Group Moist Heat Group
(n=50) (n=50)
FIgurE 1: Flow chart of participants’ recruitment process.
1.5. Instrument
(a) Redness: 0 � none, 1 � mild within 0.25 cm of in-
�
1.5.1. Tool I: Visual Analog Scale (VAS) cision, 2 moderate
� within 0.5 cm of incision bi-
laterally, and 3 severe beyond 0.5 cm of incision
(i) This tool was adopted by Melzack and Katz (1994) bilaterally.
to measure pain intensity. It is a self-reported scale
con- sisting of a horizontal line used for the (b) Edema: 0 � none, 1 mild perineal, less than 1 cm
subjective es- timation of a patient’s pain. It is from the incision, 2�moderate perineal and\or
comprised of a 10-point numerical scale, vulvar, between 1 and 2 cm from the incision, and
corresponding to the degree of pain, with zero 3 �severe perineal and\or vulvar, greater than 2
representing no pain and 10 representing the worst cm from an incision
degree of pain. Scores 1, 2, and 3 indicate mild (c) Ecchymosis: 0 �none, 1 mild within 0.25 cm bi-
pain, while scores 4, 5, and 6 indicate moderate laterally or 0.5 cm unilaterally, 2 �
moderate between
pain, and scores 7, 8, and 9 indicate severe pain; 0.25 and 1 cm bilaterally or between 0.5 and 2
finally, a score of 10 indicates the worst unbearable � 3 severe greater than 1 cm
pain [21].
cm unilaterally, and
bilaterally or 2 cm unilaterally.
(ii) The sociodemographic data such as age, level of
education, occupation, current residence, and type (d) Discharge: (0 � none, 1 � serous, 2 � serosanguinous,
of family as well as data about episiotomy such as and 3 � bloody, purulent)
indications of episiotomy and type of episiotomy (e) Approximation: 0 �closed, 1 mild skin separation
were attached to this tool. of 3 mm or less, 2� moderate skin and subcutaneous
fat separation, and 3�severe skin and subcutaneous
fat and fascial layer separation).
1.5.2. Tool II: The Standardized REEDA Scale (REEDA)
(ii) Total REEDA score ranges between 0 and 15. A
(i) The REEDA scale was originally developed by higher score indicates poor wound healing while
(Davidson, 1974). Then, it was adapted by (Alvar- a lower score indicates good wound healing. The
enga et al., 2015). It is an observational checklist used total score of the REEDA scale was categorized as
for assessing episiotomy wound healing. It can be follows:
used to assess all types of postpartum perineal (a) Completely healed from 0 to 2
trauma. It has five components, namely, redness, (b) Moderately healed from 3 to 5
edema, ecchymosis, discharge, and approximation
(c) Mildly healed from 6 to 8
of the wound edges. Each component takes a score
ranging from 0 to 3 as follows: (d) Not healed from 9 to 15
International
The kappa coefficient was used in the reliability encouraged the women to carry out the interventions
analysis of the REEDA scale by Alvarenga et al. they had given them by reassuring them of their
(2015), where the discharge item (0.75 < Kappa ≥ advantages and the necessity of follow-up.
0.88), assessment of edema (0.16 < Kappa ≥ 0.46),
ecchymosis (0.25 < Kappa ≥ 0.42), and redness (0.46 < 2.2. Follow-Up. The researchers contacted the parturient
Kappa ≥ 0.66). For the item correspondence, the women of the two groups daily and ascertained that they had
agreement decreased from excellent in the first performed the interventions. They were also instructed to
assessment to good in the last assessment. In the attend the outpatient clinic of the El-Shatby Maternity
fourth evaluation, the assessment of all items University Hospital on the 5th and 10th days after the first
session during the morning shift for follow-up where the
displayed excellent or good agreement among the
evaluators. episiotomy wound healing process and perineal pain
intensity were reassessed. The perineal area was
2. Method observed for redness, edema, ecchymosis, discharge,
and approximation of the skin as well as perineal
The parturient woman was initially addressed by the pain.
researchers, who established a report and collected
the sociodemographic information during the initial
15–20 minute interview that occurred within the first 2.3. Ethical Considerations. On 13 December 2020, ap-
two hours after delivery at the hospital stay in the provals for performing the study were gotten from the
Ethical Research Committee review board of the Faculty of
postpartum inpatient ward. Additionally, the degree Nursing, Alexandria University, and ClinicalTrials.gov also
of episiotomy wound healing and baseline perineal reported the study as having received approval (https://
pain intensity were evaluated. Fol- lowing the clinicaltrials.gov/ct2/show/NCT05186532). The relevant
evaluation, the researchers gave the participants a authorities of the studied area provided the researchers with
health education session while using illustrative authorization to perform the study. The 7th revision of the
pamphlets for both groups. Declaration of Helsinki’s Principles guided the study’s
conduct (World Medical Association, 2013). Prior to
implementing the interventions, the researchers spoke with
2.1. Interventions. For the moist heat group, women were parturient women who met the inclusion requirements and
encouraged to sit in a basin (tub) of warm water (110°– gave them a thorough explanation of the nature of the in-
115°F) without pressure on the perineum and with their feet terventions, their advantages, and any potential hazards.
flat on the floor for 10 minutes twice a day for ten Additionally, researchers confirmed that participation in the
consecutive days [15]. The researchers demonstrated to study is completely voluntary. Also highlighted was their
each woman how to do a warm sitz bath, and it was ability to decline participation or exit from the study at any
followed by demonstrations and discussions. After 12 hours moment without any impact on the quality of treatment they
of episiotomy, this procedure was carried out in the got. The anonymity and privacy of the obtained women
morning and evening for ten consecutive days [15]. were guaranteed. The participants completed a written
For the dry heat group, an infrared lamp was informed consent form after reaching an agreement.
placed at a distance of 45 cm from the perineum, and
the heat was produced at 230 volts for ten minutes. 2.4. Statistical Analysis. Data analysis was done using SPSS
But the women were checked after the first five version 20.0 (Statistical Package for Social Sciences). De-
minutes to make sure that the heat temperature was scriptive statistics such as frequencies, percentages, mean,
suitable. The researchers demonstrated to each and standard deviations were used to describe parturient
woman how to use the infrared lamp, and it was women’s sociodemographics. Data were tested for
normality using the Kolmogorov–Smirnov test, and all
followed by redemonstrations and discussions.
variables showed non-normal distribution. As for
After 12 hours of episiotomy, this procedure was diferential statistics, a comparison between the parturient
carried out in the morning and evening for ten women in the two studied groups regarding their mean
consecutive days. The researcher gave the infrared age was made using the T-test (T), The severity of perineal
lamp device to each woman and then restored it pain before and on the fifth and tenth days after the
after the completion of the study. interventions, as well as the evaluation of episiotomy
wound healing on the fifth and tenth days, were all assessed
The researchers provided each woman with
using Mann–Whitney (Z) tests. All of the statistical
health education regarding the value of follow-up at analyses were considered significant at P < 0.05.
the conclusion of the session in order to ensure
compliance with the interventions they had
assigned to them and to evaluate wound healing. 3. Results
Through daily phone calls, the researchers Table 1 displays that 58% of parturient women in the
dry heat group and 64% of the moist heat group
International
were 20 to less than 30 years old. The mean age of
parturient women in the dry heat group was 26.444
± 4.785 years and
25.08 ± 5.014 years in the moist heat group. The vast
majority (92% and 86%) of them, respectively, were
housewives. However, majorities (82% and 72%) of
dry and moist heat groups were rural residents,
about two-fifths (46% and 40%) of them,
respectively, live with their extended family.
Figure 2 exhibits that in about three-quarters of
dry heat and moist heat groups, respectively (80%
and 83%), their indication of episiotomy was
primipara.
International
TaBlE 1: Sociodemographic data of primipara women.
Moist(
Dry heat group (n � 50) heat group
Characteristics No. (%) n � 50)
No. (%) Significance
Age (years)
18 < 20 6 (12.0) 10 (20.0) X 2 � 3.278
20 ≤ 30 29 (58.0) 32 (64.0) P � 0.194
30–35 15 (30.0) 8 (16.0)
T � 1.3916
Mean ± SD 26.44 ± 4.79 25.08 ± 5.01
P � 0.167
Education
Primary/preparatory 9 (18.0) 7 (14.0) X 2 � 0.934
Secondary 30 (60.0) 28 (56.0) P � 0.627
University or more 11 (22.0) 15 (30.0)
Occupation
Housewife 46 (92.0) 43 (86.0) X 2 � 0.919
Working 4 (8.0) 7 (14.0) P � 0.338
Residence
Urban 9 (18.0) 14 (28.0) X 2 � 1.412
Rural 41 (82.0) 36 (72.0) P � 0.235

Type of family
Nuclear 27 (54.0) 30 (60.0) X 2 � 0.367
Extended 23 (46.0) 20 (40.0) P � 0.545
X 2: chi-square test, FET: Fisher’s exact test, T (P): T-test, and P for T-test, significant at P ≤ 0.05.
It is evident from Figure 3 that most of the dry respectively). On the 5th day after intervention, there
and moist heat groups, respectively (90% and 94%), was a statistically significant diference between both
had Mediolateral episiotomy. groups on 5th day after intervention as regards all
Table 2 reveals that 28% and 40% of parturient components of the REEDA scale as presented by
women in the dry heat group and 38% and 36% in redness, edema, ecchymosis, discharge, and
the moist heat groups, respectively, had experienced approximation where (P < 0.001, P < 0.001, P < 0.007,
moderate and severe perineal pain intensity before P < 0.003, and P < 0.001, respectively). Furthermore, sig-
applying the interventions. On the 5th day after the nificant diferences were observed between both
intervention, there was an obvious decline in groups on the 10th day after intervention as regards
perineal pain intensity among both groups in favor of all components of the REEDA scale as presented by
the dry heat group, where 24% of the dry heat group redness, edema, ecchymosis, discharge, and
had severe perineal pain intensity, compared to 28% approximation where (P < 0.001, P < 0.001,
of the moist heat group, respectively. However, on P < 0.001, P < 0.005, and P < 0.001,
the 10th day after the intervention, it was observed respectively).
that only 6% of the dry heat group had severe
pain compared to 10% of the moist heat group.
Significant diferences were found between the
within groups on the 5th day and 10th day (MHP <
0.001 for the dry heat group
MHP�0.004
and for the moist heat group).
Table 3 manifests there were no significant

diferences between both groups regarding all
�
components of the REEDA scale before �
intervention
� � P 0.5,
(P 0.89, P 0.96, P 0.82, P 0.5, and
Table 4 shows an obvious decline in the mean
International
perineal healing scores among the dry and moist
heat groups on the 5th day (2.34 ± 1.661 and 6.24 ±
3.274) and 10th day after the
interventions (0.84 ± 0.739 and 3.32 ± 2.645), with
highly significant diferences (P < 0.001) between
them in the favor of the dry heat group. Where, on
the 5th day after intervention more than three-
quarters (78%) of the dry heat group had complete
healing of episiotomy wounds compared to only
20% of the moist heat group. Furthermore, on the
10th day after intervention, most (96%) of the dry
heat group did achieve complete healing of
episiotomy wounds compared to 52% of the moist
heat group. Significant differences were found
within the dry heat group (P < 0.001c) and within
the moist heat group (P < 0.021a) on the 5th day
and the 10th day after the interventions,
respectively, in favor of the dry heat group.
4. Discussion
Giving birth is a powerful and life-changing event
with a lasting impact on women and their families.
To facilitate the birthing process and prevent
perineal tears during vaginal delivery, episiotomy is
done. Unfortunately, such a kind of wound is
associated with many complications. Women who
underwent this procedure were at greater risk for
greater blood loss during labor, delayed wound
healing, and increased perineal pain during the early
postpartum period. Moreover, poor episiotomy
healing can influence the physical, psychological,
and social well-being of women throughout the
postnatal period [10]. With proper episiotomy
care, the infection can be prevented and healing
takes place more quickly. Healthcare is a dynamic
field where maternity nurses are ever-spiraling
towards greater improvement and adopting
innovative technologies and
International
90
83%
80%
80
70
60
50
18%
(%) 10%
40 7%
2%
30
Dry heat Moist Heat
20
Large Baby
10 Prematurity
Primigravida
0
FIgurE 2: Graphical presentation of dry and moist heat groups according to their indications of episiotomy.
100 94%
90%
90
80
(%) 70
60
50 10%
6%
40 Dry heat Moist Heat
30 Mediolateral
Medial
20
10
FIgurE 3: Graphical presentation of dry and moist heat groups according to their type of episiotomy.
TaBlE 2: Total scores of perineal pain intensity before and after the intervention of dry and moist heat groups.
Dry heat group (n � 50) Moist heat group (n � 50)

Before 5th day 10th day Sig Before 5th day 10th day Sig
International No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) 0
Total perineal pain intensity
No pain (0) 0 (0.0) 2 (2.0) 15 (30.0)
Mild (1–3) 6 (12.0) 12 (24.0) 20 (40.0) 0 (0.0) 0 (0.0) 0 (0.0)
Moderate (4–6) 14 (28.0) 20 (40.0) 12 (24.0)
MHP < 0.001c MHP � 0.004b
7 (14.0) 3 (6.0) 30 (60.0)
19 (38.0) 25 (50.0) 9 (18.0)
Severe (7–9) 20 (40.0) 12 (24.0) 3 (6.0) 18 (36.0) 14 (28.0) 5 (10.0)

Unbearable (10) 10 (20.0) 4 (8.0) 0 (0.0) 6 (12.0) 8 (16.0) 6 (12.0)
P: marginal homogeneity, test significant at bP < 0.01cP < 0.001.
MH
International
Obstetrics and Gynecology
TaBlE 3: Episiotomy wound healing assessment of dry and moist heat groups before and after the intervention.
Before
On 5th day On 10th day
Using REEDA Dry heat Moist heat Dry heat Moist heat Dry heat Moist heat
Sig Sig. Sig
scale group (n � 50) group (n � 50) group (n � 50) group (n � 50) group (n � 50) group (n � 50)
No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)
Redness
None 0 (0.0) 0 (0.0) X 2 �0.622 2 (4.0) 0 (0.0) F ET

34 (68.0) 12 (24.0) F ET
Mild 21 (42.0) 24 (48.0) P � 0.891 36 (72.0) 27 (54.0) P < 0.001c 16 (32.0) 30 (60.0) P < 0.001c
Moderate 23 (46.0) 22 (44.0) 12 (24.0) 13 (26.0) 0 (0.0) 5 (10.0)
Severe 6 (12.0) 4 (8.0) 0 (0.0) 10 (20.0) 0 (0.0) 3 (6.0)

Edema
None 0 (0.0) 0 (0.0) X 2 � 2.36 27 (54.0) 11 (22.0) F ET

50 (100) 21 (42.0) F ET
Mild 16 (32.0) 18 (36.0) P � 0.967 16 (32.0) 25 (50.0) P < 0.001b 0 (0.0) 23 (46.0) P < 0.001c
Moderate 19 (38.0) 19 (38.0) 7 (14.0) 8 (16.0) 0 (0.0) 6 (12.0)
Severe 15 (30.0) 13 (26.0) 0 (0.0) 6 (12.0) 0 (0.0) 0 (0.0)

Ecchymosis
ET ET ET
None 11 (22.0) 8 (16.0) F 35 (70.0) 20 (40.0) F 47 (94.0) 30 (60.0) F
Mild 26 (52.0) 28 (56.0) P � 0.815 14 (28.0) 24 (48.0) P < 0.007b 3 (6.0) 14 (28.0) P < 0.001c
Moderate 10 (20.0) 12 (24.0) 1 (2.0) 5 (10.0) 0 (0.0) 6 (12.0)
Severe 3 (6.0) 2 (4.0) 0 (0.0) 1 (2.0) 0 (0.0) 0 (0.0)

Discharge
7
ET ET ET
None 50 (100) 50 (100) F 37 (74.0) 19 (38.0) F 46 (92.0) 29 (58.0) F
Serum 0 (0.0) 0 (0.0) P � 0.5 12 (24.0) 18 (36.0) P < 0.003b 4 (8.0) 12 (24.0) P < 0.005b
Serosanguinous 0 (0.0) 0 (0.0) 1 (2.0) 11 (22.0) 0 (0.0) 9 (18.0)
Bloody/purulent 0 (0.0) 0 (0.0) 0 (0.0) 2 (4.0) 0 (0.0) 0 (0.0)

Approximation
ET ET ET
Closed 50 (100) 50 (100) F 23 (46.0) 9 (18.0) F 47 (94.0) 30 (60.0) F
Mild 0 (0.0) 0 (0.0) P � 0.5 15 (30.0) 10 (20.0) P < 0.001c 3(6.0) 9 (18.0) P < 0.001c
Moderate 0 (0.0) 0 (0.0) 10 (20.0) 23 (46.0) 0 (0.0) 7 (14.0)
Sever 0 (0.0) 0 (0.0) 2 (4.0) 8 (16.0) 0 (0.0) 4 (8.0)

X : chi-square test, F : Fisher’s exact test, significant at P < 0.01 P < 0.001.
2 ET b c
TaBlE 4: Total scores of perineal healing on the 5th and 10th days after intervention among dry and moist heat groups.
Dry heat group (n � 50) Moist heat group (n � 50)

th
5 day 10th day Sig 5th day 10th day Sig
No. (%) No. (%) No. (%) No. (%)

Total perineal healing score
Complete 39 (78.0) 48 (96.0) 10 (20.0) 26 (52.0)

MHP < 0.001c MHP � 0.031a
Moderate 7 (14.0) 2 (4.0) 10 (20.0) 15 (30.0)
Mild 4 (8.0) 0 (0.0) 16 (32.0) 8 (16.0)
No healing 0 (0.0) 0 (0.0) 14 (28.0) 1 (2.0)
Mean ± SD 2.34 ± 1.661 0.84 ± 0.739 6.24 ± 3.274 3.32 ±

2.645 Sig Z Wil � −3.46 (P ≤ 0.001c) Z Wil � -2.15 (P ≤ 0.021a)
MHP
: marginal homogeneity test, ZWil � Wilcoxon signed ranks test, significant at aP ≤ 0.05cP < 0.001.
interventions. Among these interventions, dry heat among the study group than the control one. In
and sitz baths are the most efective methods of addition, Gomathi et al.
relieving episiotomy discomfort, and pain as well as [25] reported that the infrared light application was
fostering wound healing [22]. The secondary outcomes efective
in relieving pain levels among postnatal mothers. They
of such interventions were to improve women’s
added that Infrared rays have a therapeutic efect
quality of life, fasten their resume to daily life
in ag- gregating the blood supply and releasing the
activities and decrease episiotomy-related morbidity.
pain. Moreover, a similar result was observed in Rani’s
Moreover, alleviating perineal pain enables the
[26] research, which found that there was a significant
mothers to sit comfortably and assume a proper
reduction in episiotomy pain score in the experimental
breastfeeding posture that ultimately would
group after infrared radiation therapy than in the
enhance the mother-infant bond.
control group. In addition, [27] concluded that both
On investigating the perineal pain level, the
dry heat and moist heat interventions were efective,
results of the present study revealed that the pain
but dry heat was more efective than moist heat with
was significantly reduced in the dry heat group than
sitz baths in reducing the severity of episiotomy-
in the moist heat group on the 5th and 10th days after
associated pain among postnatal mothers.
the interventions. The pain reduction could be
On the contrary, Chandraleka et al. [19] indicated
attributed to the fact that heat application induces
that the sitz bath is more efective in reducing the level
vasodilatation and increases blood circulation to the
of episiotomy pain among postnatal mothers. They
area. This could enhance tissue oxygenation, reduce
attributed the
muscle spasms, accelerate waste product removal,
reduce inflammation, and promote episiotomy
wound healing. Moreover, the heat application had
soothing efects on the superficial sensory nerve
endings. The results of the present study agree with
the findings of Boddupalli [23]; who reported that
the intensity of pain decreased with the infrared light
fomentation on episiotomy, and pain relief was seen
at the end of the 4th day of follow-up. The author
further added that dry heat is superior due to the
fact that it continues for a longer duration than a
moist one, keeps the wound dry, and improves
healing. The present finding is also consistent with
the study done by El-Lassy and Madian [24]; who found
that the pain mean score was statistically significantly
lower after the application of infrared lamp therapy
pain relief to the sedative efect of the warm water mean wound healing score after infrared
sitz bath that inhibits perineal irritation and itching
in the genital area. It also prevents soreness and
burning sensations around the perineum, which
helps in reducing pain, itching, and discomfort. The
present study’s findings also contradict Huang et al.
[28]; who investigated the efect of far-infrared
radiation on perineal wound pain and sexual
function in primiparous women undergoing an
episiotomy. The study revealed no significant
diference between the intervention and comparison
groups regarding the perineal pain intensity
immediately after delivery, one week, or six weeks
postpartum.
Concerning episiotomy wound healing using the
REEDA scale, the present study indicated highly
significant statistical diferences between both
groups in favor of the dry heat group on the 5th and
10th days after the intervention. This improvement in
episiotomy wound healing may be due to the
penetration of the emitted infrared light energy up
to
8.75 cm. This promotes nitric oxide release and thereby
leads to vasodilatation of vessels, which stimulates
the lymphatic system, increases circulation, removes
toxins, and delivers higher levels of oxygen and
nutrients to the injured cells [29]. Fostering the
elimination of toxins and cellular waste products
and helping to reduce inflammation. From another
perspective, the infrared heat application keeps the
episiotomy wound dry, absorbs fluids, plummets
edema, prevents the growth of microorganisms,
and hastens the cure of the episiotomy wound [22].
It also has the benefits of improving metabolism,
helping in the regeneration of the body’s cells, and
developing pH in the body, so it can aid in healing
damaged tissue [29].
The result of the current study is in agreement
with the study [30] about the efectiveness of
infrared lamp therapy in the healing of episiotomy
wounds among postnatal mothers admitted to
Adesh Hospital. They revealed that there was a
significant statistical diference between the pre-test
and post- test overall healing scores of episiotomy
wounds between experimental and control groups.
They concluded that the episiotomy wound healing
is faster in the experimental group as the day
progresses than in the control one. In addition, the
present finding is consistent with a study conducted
by Gomathi et al. [25] who revealed that infrared
light application was efective in enhancing wound
healing among postnatal mothers. Moreover, it is in
accordance with a previously mentioned study by
Rani [26]; who reported a significant decline in the
Obstetrics and Gynecology International 9
Authors’ Contributions
radiation therapy. Further, a similar result was
observed in Khosla p (2017) research, which added All authors have contributed equally to the
that infrared radiation therapy is a simple and publication of this work.
painless treatment when it is applied to the
episiotomy injury site and painful areas because it References
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4.1. Limitations of the Study. The researchers faced the

challenge of maintaining blindness during data collection
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Application of the Primipara women of dry heat
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5.1. Recommendations. According to the present study’s

findings, it is advised that dry heat be included in the
postnatal units’ protocol as a useful nonpharmacological
intervention to promote episiotomy wound healing and
lessen perineal pain during the postpartum period.
Data Availability
The authors confirm that the data supporting the
findings of this research are available within the
article.
Conflicts of Interest
The authors declare that they have no conflicts of
interest.
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Hindawi
Computational and Mathematical Methods in

Medicine Volume 2022, Article ID 3315638, 10 pages
https://doi.org/10.1155/2022/3315638
Research Article
Effect of Prenatal Perineal Massage on Postpartum Perineal
Injury and Postpartum Complications: A Meta-Analysis
Qiuxia Chen,1 Xiaocui Qiu,2 Aizhen Fu,3 and Yanmei Han 2
1
Department Obstetrics, Hainan Women and Children’s Medical Center, Haikou, 570216 Hainan, China
2
Department of Medical Genetics, Haikou Maternal and Child Health Hospital, Haikou, 570203 Hainan,
China 3Department Obstetrics, Haikou Maternal and Child Health Hospital, Haikou, 570203 Hainan, China
Correspondence should be addressed to Yanmei Han; hanyanmei669@163.com
Received 27 May 2022; Revised 25 June 2022; Accepted 29 June 2022; Published 14 July 2022
Academic Editor: Xi Lou
Copyright © 2022 Qiuxia Chen et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. The efficacy of perineal massage is controversial. The study was aimed at comparing the effects of perineal
massage on perineal injury and complications. Methods. PubMed, Embase, the Cochrane Library, and ISI Web of Science were
searched for literature on the relationship between prenatal perineal massage and postpartum perineal injury and complications
until April 2022. Indicators included postpartum perineal tears, perineotomy, postpartum perineal pain, natural labour, and
postpartum incontinence. Finally, RevMan5.4 software was used to analyze the extracted data. Results. A total of 6487 subjects
in 16 studies were included, with 3211 who received perineal massage and 3276 did not. There was no significant di fference in
1-2 degree perineal tearing between the intervention group and the control group (RR = 0:96, 95% CI [0.90, 1.03], P = 0:30),
and there was no heterogeneity between studies (P = 0:62, I2 = 0%), indicating publication bias. Compared with the control
group, prenatal perineal massage significantly reduced the incidence of 3-4 degree perineal tears (RR = 0:56, 95% CI [0.47, 0.67], P <
0:00001), and there was no heterogeneity between studies (P = 0:16, I2 = 30%), indicating publication bias. Compared with the
control group, prenatal perineal massage reduced the risk of lateral perineal resection (RR = 0:87, 95% CI [0.80, 0.95], P =
0:001), and there was no heterogeneity between studies (P = 0:14, I2 = 31%), and there was no publication bias. Compared with
the control group, prenatal perineal massage reduced the risk of postpartum pain at 3 months (RR = 0:64, 95% CI [0.51,
0.81], P = 0:0002). There was no significant heterogeneity among studies (P = 0:23, I2 = 31%). Conclusion. Compared with no
prenatal perineal massage, prenatal perineal massage can reduce the risk of perineal injury, the incidence of lateral perineal
resection, and the incidence of long-term pain.
1.Introduction delivery [1]. It can cause perineal pain, difficulty in

sexual intercourse, urinary incontinence, and other
Perineal injury, which refers to the injury that occurs complications that greatly impact the physical and
in the genital area associated with laceration during mental health of pregnant women. Although
delivery, has a high incidence of 30-85% in vaginal perineum incision is often offered preemptively to
avoid perineum injury, the evidence supporting its
Perineal massage is a well-known treatment
efficacy remains elusive. Moreover, the utility of
modality that has been shown [2] to stimulate nerve
perineal incision is also limited by associated
endings in the skin, enhance perineal blood
complications and psychologically decreases a
circulation, improve the elasticity and ductility of
woman’s sexual desire and esteem. Currently,
perineal tissue, broaden the vaginal opening, reduce
routine perineum incision is no longer
the probability of perineal incision, and reduce
recommended.
perineal tear. In addition, it facilitates vaginal delivery
and probably reduces the risk of perineal injury by
stimulating the child’s head during childbirth.
Currently, studies [3, 4] about the effect of prenatal
perineal massage on the incidence of perineal tears
and episiotomy reported inconsistent results. For
instance, Ibrahim [5] reported that prenatal perineal
massage did not benefit the mother more than Kegel
exercises. The efficacy of antenatal perineal massage
is controversial. To further explore the impact of
prenatal perineal
Computational and Mathematical Methods in 2
massage on postpartum perineal injury and P > 0:05 and I2 < 50%. Otherwise, the random effect model was
postpartum complications, we conducted this employed for significant interstudy heterogeneity. Sub-
systematic review and meta-analysis to update the
available evidence to determine whether prenatal
perineal massage can reduce the risk of perineal
trauma and postpartum complications.
2.Materials and Methods

2.1. Literature Search. PubMed, Embase, the Cochrane
Library, ISI Web of Science, and other databases were
searched. The search time was set from its establishment to
April 2022. Articles and studies about the impact of
prenatal perineal massage on postpartum perineal injury
and postpartum complications were collected. The search
terms were “Antenatal perineal massage”, “Perineal
trauma”, “Episiot- omy”, and other similar phrases. The
joint search was carried out with subject words and free
words. References to the target literature were also
examined.
2.2. Inclusion and Exclusion Criteria. Inclusion criteria
were as follows: (1) study type: randomized controlled
studies (RCTs); (2) participants: primipara or
postmenopausal women undergoing prenatal care; (3)
intervention group: prenatal perineal massage at 34-36
weeks of pregnancy; (4) control group: no perineal massage
before delivery; and (5) results: the main results included
the risk of perineal tear, the incidence of perineal incision,
and natural vaginal delivery. Secondary outcomes were
perineal pain (assessed by visual analogue scale (VAS)),
urinary incontinence, and fecal incontinence at 3 months
postpartum. Exclusion criteria were as follows: (1)
nonrandomized trials, in vitro study, or animal study; (2)
study overlap; (3) literature with incomplete data or no
research indicators; and (4) unrelated studies.
2.3. Data Extraction and Quantitative Evaluation. Two
researchers screened the data from the included literature.
Controversies emerged were solved through discussion or
consultation the third researcher. The extracted data
included the first author, publication time and country, the
sample size of each group, and the expected primary and
secondary results.
We used the Cochrane bias risk assessment tool,
which was recommended by the Cochrane manual, to
assess the quality of methods included in the study.
This tool performed bias risk assessment from six
aspects: random allocation method, allocation
concealment scheme, blind method, integrity of
result data, selection report research results, and
other biases. The author’s judgment was divided into
“low risk,” “high risk,” and “unclear risk” of bias.
2.4. Statistical Method. RevMan5.4 software was used for
meta-analysis. Two-sided P < 0:05 indicates that the differ-
ence is statistically significant. The risk ratio (RR) and its
95% confidence interval (CI) were used to analyze the
dichotomous variables. The heterogeneity test was con-
ducted through I2. The fixed effect model was in the pres-
ence of no obvious interstudy heterogeneity as indicated by
group and sensitivity analyses were used to explore
the source of heterogeneity. The analysis result was
presented by the forest map, and the publication
bias was displayed by the funnel map and Egger’s
test.
3.Results
3.1. Literature Search Results. A total of 1522 English contri-
butions were obtained through database retrieval, of which
826 were included after screening and eliminating
duplicate literature. After reading the literature title and
abstract, 16 studies [3–18] were finally included. The flow
chart is shown in Figure 1.
3.2. Basic Information of the Included Studies. The

included studies compared perineal massage versus no
perineal massage during prenatal care. All included
studies were conducted on pregnant women or their
partners at 34-36 weeks of gestation. The included
studies were reported from Asia, Europe, North America,
Africa, and Oceania. Four studies were from Egypt [3–
6], two from Canada [7, 8], and one from Australia [9],
Japan [10], Ireland [11], Spain [12], Austria [13], Turkey
[14], Iran [15], Nigeria [16], the UK [17], and the United
States [18], respectively. The largest sample size was
reported from Australia [9], with 1340 cases. A total of 6487
patients were included in the sample, including 3211 in
the intervention group and 3267 in the control group. The
basic characteristics of the literature and the assessment of
risk of bias were shown in Table 1.
3.3. Perineal Tear. A total of 16 literature compared the

effect of prenatal perineal massage on the perineal tear.
Sig- nificant interstudy heterogeneity (Chi2 = 42:15, P =
0:0002, I2 = 64%) was noted, for which the random
effect model was used. Compared with the control group,
prenatal perineal massage reduced the risk of perineal tear
(RR = 0:82, 95% CI [0.74-0.92], P < 0:001) (Figure 2).
The funnel plot and Egger’s test showed that the scatter
points were roughly symmetrically distributed, with no
publication bias (P > 0:05) (Figure 3). To explore the source
of heterogeneity, subgroup analysis was carried out
according to the degree of perineal tear. There was no
significant difference between the intervention group and
the control group (RR = 0:96, 95% CI [0.90, 1.03], P =
0:30), and there was no heterogeneity between the studies
(Chi2 = 10:84, P = 0:62, I2 = 0%) (Figure 4). The funnel plot
and Egger test showed that the scatter points were
biased to the left, and there was publication bias (P > 0:05)
(Figure 5). Compared with the control group, prenatal
perineal massage significantly reduced the incidence of 3-
4 degree tear of perineum (RR = 0:56, 95% CI [0.47,
0.67], P < 0:00001), and there was no heterogeneity among
the studies (Chi2 = 14:23, P = 0:16, I2 = 30%) (Figure 6). The
funnel plot and Egger test showed that the scatter points
were biased to the left, and there was publication bias (P >
0:05) (Figure 7).
3.4. Lateral Episiotomy. Compared with the control group,

prenatal perineal massage reduced the risk of lateral
episiotomy (RR = 0:87, 95% CI [0.80, 0.95], P = 0:001),
and the
Identification of studies via databases
Identification
Records removed before
Records identified from: screening:
Databases (n = 1522)
Duplicate records removed
(n = 696)
Records excluded after reading

Records screened (n = 826)
abstract (n = 484)
Reports sought for retrieval

Full text unavailable (n = 108)
Screening
(n = 342)
Reports assessed for eligibility Reports excluded:

(n = 234) Case report (n = 47)
Study type (n =
104)
Included
Reports of included
studies (n = 16)
FigurE 1: Flow chart of literature screening.
TABlE 1: Basic characteristics of the literature and assessment of risk of bias.
Perineal massage
No. of patients Control
Author Country Year Risk of basis
Ali H Egypt 2015 50 70 High
Amira S. Dieb Egypt 2019 200 200 High
B. Bodner-Adler Austria 2002 121 410 Uncertain
Dönmez S Turkey 2015 30 39 High
Elsebeiy Egypt 2018 37 43 Low
Georgina Stamp Australia 2001 708 632 Uncertain
Kate Davidson United States 2000 269 93 Uncertain
Labrecque Canada 1999 646 658 Uncertain
M. K. Shipman UK 1997 332 350 Low
Maeve Eogan Ireland 2006 100 79 High
María Álvarez-González Spain 2021 60 30 Uncertain
Michel Labrecque Canada 2000 470 479 Uncertain
Mohamed Egypt 2011 30 30 Uncertain
Shahoei R Iran 2016 75 75 Uncertain
Shimada Japan 2005 30 33 Low
Ugwu Nigeria 2018 53 55 High
heterogeneity test result was P = 0:14, I2 = 31% (Figure 3.5. Natural Childbirth. Compared with the control group,
8). There was no heterogeneity among the studies. there was no significant difference in vaginal natural
The funnel plot and Egger test showed that the delivery in the prenatal perineal massage group (RR = 1:01,
scatter points were roughly symmetrical with no 95% CI [0.97~1.04], P = 0:69). There was no heterogeneity
publication bias (P > 0:05) (Figure 9). between studies (Chi2 = 13:35, P = 0:69, I2 = 40%) (Figure
10). The
Perineal massage Contro Risk ratio Risk ratio

l
Study or subgroup Events Total Events Total Weight M-H, Random, 95% CI M-H, Random, 95% CI
Ali H 2015 21 50 49 70 5.9% 0.60 [0.42, 0.86]

Amira S. Dieb 2019 27 200 43 200 4.5% 0.63 [0.40, 0.97]
B. Bodner-Adler 2002 41 121 156 410 7.8% 0.89 [0.67, 1.18]
Dönmez S 2015 5 30 32 39 1.7% 0.20 [0.09, 0.46]
Elsebeiy 2018 10 37 6 43 1.4% 1.94 [0.78, 4.82]
Georgina Stamp 2001 324 708 294 632 13.0% 0.98 [0.88, 1.10]
Kate Davidson 2000 66 269 43 93 7.1% 0.53 [0.39, 0.72]
Labrecque 1999 318 646 347 658 13.3% 0.93 [0.84, 1.04]
M. K. Shipman 1997 229 332 263 350 13.6% 0.92 [0.84, 1.01]
MAEVE EOGAN 2006 29 100 21 79 4.0% 1.09 [0.68, 1.76]
Maria Álvarez-González 2021 17 60 12 30 2.9% 0.71 [0.39, 1.28]
Michel Labrecque 2000 236 470 262 479 12.8% 0.92 [0.81, 1.04]
Mohamed 2011 5 30 11 30 1.3% 0.45 [0.18, 1.15]
Shahoei R 2016 10 75 15 75 2.0% 0.67 [0.32, 1.39]
Shimada 2005 21 30 27 33 7.6% 0.86 [0.64, 1.14]
Ugwu 2018 6 53 7 55 1.1% 0.89 [0.32, 2.47]
Total (95% CI) 3211 3276 100.0% 0.82 [0.74, 0.92]

Total events 1365 1588
0.01 0.1 1 10 100
Heterogeneity: Tau2 = 0.02, Chi2 = 42.15, df = 15 (P = 0.0002); I2 = 64%
Test for overall effect: Z = 3.42 (P = 0.0006) Favours Favours
[Perineal massage] [Control]
FigurE 2: Forest map: effect of prenatal perineal massage on perineal tear.
SE (log[RR])
0.2
0.4
0.6
0.8
RR
1
1 10 100
0.01 0.1
FigurE 3: Funnel diagram: effect of prenatal perineal massage on perineal tear.

funnel plot and Egger test show that the scatter

tures (P > 0:05). There was no significant difference in
distribution is biased to the right, and there may
perineal pain between the intervention group and
be publication bias (P > 0:05) (Figure 11).
the control group at 3 days postpartum (RR = 1:00,
3.6. Perineal Pain. We analyzed the perineal pain of 95% CI [0.93, 1.07], P = 1:00), and there was no
parturients at 3 days and 3 months postpartum, significant heterogeneity among the studies (Chi2 =
respectively. The results showed that prenatal perineal 1:28, P = 0:53, I2 = 0%) (Figure 13). Egger’s test
massage reduced the pain risk of parturients at 3 months showed that there was no publication bias among the
postpartum (RR = 0:64 literatures (P > 0:05).
, 95% CI [0.51, 0.81], P = 0:0002) than the control
group. There was no significant heterogeneity among 3.7. Urinary Incontinence. Compared with the control
the studies (Chi2 = 2:90, P = 0:23, I2 = 31%) (Figure 12). group, there was no significant difference in urinary
Egger’s test showed that there was no publication incontinence at
bias among the litera- 3 months postpartum in the prenatal perineal massage
group (RR = 0:91, 95% CI [0.79~1.05], P = 0:21). There

l
Study or subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
Ali H 2015 11 50 22 70 1.8% 0.70 [0.37, 1.31]
Amira S. Dieb 2019 20 200 23 200 2.3% 0.87 [0.49, 1.53]
B. Bodner-Adler 2002 38 121 134 410 6.1% 0.96 [0.71, 1.29]

Dönmez S 2015
Kate Davidson 2000 0 269 0 93 Not estimable
Labrecque 1999 274 646 293 658 29.1% 0.95 [0.84, 1.08]
MAEVE EOGAN 2006 25 100 20 79 2.2% 0.99 [0.59, 1.64]
Mohamed 2011 5 30 9 30 0.9% 0.56 [0.21, 1.46]
Shahoei R 2016 10 75 15 75 1.5% 0.67 [0.32, 1.39]
Shimada 2005 17 30 16 33 1.5% 1.17 [0.73, 1.87]
Ugwu 2018 6 53 7 55 0.7% 0.89 [0.32, 2.47]
Total (95% CI) 2879 2926 100.0% 0.96 [0.90, 1,03]

Total events 957 1060 0.05 0.2 1 5 20
Heterogeneity:
Test Chi2 =Z10.84,
for overall effect: (P = 0.62); I2 = 0%
= 1.03df(P= =130.30)
Favours [Perineal Favours
massage] [Control]
FigurE 4: Forest map: effect of prenatal perineal massage on 1-2 degree perineal tear.
SE (log[RR])
0.2
0.4
0.6
RR
0.8
0.05 0.2 1 5 20
FigurE 5: Funnel diagram: effect of prenatal perineal massage on 1-2 degree perineal tear.
was no heterogeneity between studies (P = 0:94, I2 = 0%) (Figure 14). Egger’s test showed that there was no
publication bias among the literatures (P > 0:05).
4.Discussion
3.8. Fecal Incontinence. Compared with the control group, Although perineal injury, a common complication of
there was no significant difference in fecal incontinence vaginal delivery, is not life-threatening to both the
at 3 months postpartum in the prenatal perineal mas- mother, its associated symptoms such as perineal
sage group (RR = 0:75, 95% CI [0.51~1.11], P = 0:15) pain, urinary incontinence, fecal incontinence, and
(Figure 15). There was no heterogeneity between studies difficulty in sexual intercourse seriously affect the
(P = 0:42, I2 = 0%) (Figure 15). Egger’s test showed that patient’s physical and mental health [19]. In this
there was no publication bias among the literatures
(P > 0:05).
meta-analysis, the authors found that prenatal
perineal massage significantly reduced the incidence
of perineal tears and episiotomy, especially for 3rd-
4th degrees of perineal tears. In addition, prenatal
perineal massage could significantly reduce the
incidence of perineal pain 3 months after delivery.
There was no significant
Perineal massage Cont rol Risk ratio Risk ratio

Ali H 2015 10 50 27 70 8.7% 0.52 [0.28, 0.97]
Amira S. Dieb 2019 7 200 20 200 7.7% 0.35 [0.15, 0.81]
B. Bodner-Adler 2002 0 121 0 410 Not estimable
Dönmez S 2015 2 30 20 39 6.7% 0.13 [0.03, 0.51]
Elsebeiy 2018 0 37 0 43 Not estimable
Georgina Stamp 2001 12 708 24 632 9.8% 0.45 [0.23, 0.89]
Kate Davidson 2000 66 269 43 93 0.53 [0.39, 0.72]
Labrecque 1999 44 646 54 658 24.7% 0.83 [0.57, 1.22]
MAEVE EOGAN 2006 4 100 1 79 20.7% 3.16 [0.36, 27.71]
Mohamed 2011 0 30 2 30 14.2% 0.20 [0.01, 4.00]
Shahoei R 2016 0 75 0 75 1.0% Not estimable
Shimada 2005 4 30 11 33 0.40 [0.14, 1.12]
Ugwu 2018 0 53 0 55 4.0% Not estimable
Total (95% CI) 2879 2926 100.0% 0.56 [0.47, 0.67]

0.005 0.1 1 10 200
2 2
Heterogeneity: Chi = 14.23, df = 10 (P = 0.16); I =
Favours Favours
30% Test for overall effect: Z = 6.15 (P < 0.00001)
FigurE 6: Forest map: effect of prenatal perineal massage on 3-4 degree perineal tear.
SE (log[RR])
0.5
1.5
RR
2
0.005 0.1
1 10 200
FigurE 7: Funnel diagram: effect of prenatal perineal massage on 3-4 degree perineal tear.
difference in terms of incidence of vaginal delivery, perineal tear and perineal incision. Furthermore, our
perineal pain, urinary incontinence, and fecal study demonstrated the beneficial effect of prenatal
incontinence between the prenatal perineal massage perineal massage in reducing the risk of third- and
group and the control group. fourth-degree perineal tears, which is consistent with
Our study result is consistent with the previous that reported by Mohamed et al. [20]. However, in
studies [2, 20] that demonstrated that prenatal the systematic review of 2008 [21] and 2013 [2] by
perineal massage can reduce the incidence of Beck- mann et al., there was no difference in
different degrees of
perineal tear rate between prenatal perineal

massage and the control group. This disparity might
be explained by the fact that the study by Beckmann
et al. only included 4 studies with a total of 2497
pregnant women, which is obviously much smaller in
sample size as compared with the present study.
Perineum incision during delivery is also a common
cause of perineum injury. Our study showed that
prenatal perineum massage could reduce the risk of
perineum incision during delivery as compared with
the control group, which is consistent with the results
by Mohamed et al. and Beckmann et al. Moreover,
Aquino et al. [22] even found that perineum massage
during delivery could reduce the risk of perineum
incision. Theoretically, perineal massage can

l
Ali H 2015 17 50 30 70 3.2% 0.79 [0.50, 1.27]
Amira S. Dieb 2019 59 200 77 200 9.9% 0.77 [0.58, 1.01]
B. Bodner-Adler 2002 37 121 111 410 6.5% 1.13 [0.83, 1.54]
Dönmez S 2015 25 39 39 39 5.1% 0.65 [0.51, 0.82]
Georgina Stamp 2001 176 708 170 632 23.3% 0.91 [0.76, 1.09]
Labrecque 1999 146 646 170 658 21.7% 0.87 [0.72, 1.06]
MAEVE EOGAN 2006 38 100 28 79 4.0% 1.07 [0.73, 1.58]
Mohamed 2011 5 30 8 30 1.0% 0.63 [0.23, 1.69]
Shahoei R 2016 40 75 43 75 5.5% 0.93 [0.70, 1.24]
Shimada 2005 4 30 11 33 1.3% 0.40 [0.14, 1.12]
Ugwu 2018 20 53 32 55 4.0% 0.65 [0.43, 0.98]
Total (95% CI) 2522 2751 100.0% 0.87 [0.80, 0.95]

0.1 0.2 0.5 1 2 5 10
Heterogeneity: Chi2 = 15.94, df = 11 (P = 0.14); I2 =
31% Test for overall effect: Z = 3.19 (P = 0.001) Favours Favours
FigurE 8: Forest map: effect of prenatal perineal massage on lateral episiotomy.
SE (log[RR])
0
0.2
0.4
0.6
0.8
RR
1 0.1 0.2 0.5

1 2 5 10
FigurE 9: Funnel diagram: effect of prenatal perineal massage on lateral episiotomy.


l
B. Bodner-Adler 2002 111 121 391 410 9.3% 0.96 [0.91, 1.02]
Georgina Stamp 2001 569 708 501 632 27.7% 1.01 [0.96, 1.07]
Labrecque 1999 495 763 516 759 27.1% 0.95 [0.89, 1.02]
M. K. Shipman 1997 217 332 207 350 10.6% 1.11 [0.98, 1.24]
MAEVE EOGAN 2006 68 100 50 79 2.9% 1.07 [0.87, 1.33]
Mohamed 2011 28 30 25 30 1.3% 1.12 [0.93, 1.35]
Ugwu 2018 35 53 31 55 1.6% 1.17 [0.87, 1.59]
Total (95% CI) 2637 2824 100.0% 1.01 [0.97, 1.04]

0.5 0.7 1 1.5 2
Favours Favours
40% Test for overall effect: Z = 0.40 (P = 0.69)
FigurE 10: Forest map: effect of prenatal perineal massage on natural delivery.
SE (log[RR])
0.05
0.1
0.15
RR
0.2
0.5 0.7 1 1.5 2
FigurE 11: Funnel diagram: effect of prenatal perineal massage on natural delivery.
Perineal massage
Contro Risk ratio Risk ratio
l
Georgina Stamp 2001 43 503 54 436 36.2% 0.69 [0.47, 1.01]
Shahoei R 2016 4 75 15 75 9.4% 0.27 [0.09, 0.77]
Total (95% CI) 1038 982 100.0% 0.64 [0.51, 0.81]

0.2 0.5 1 2 5
FigurE 12: Forest map: effect of prenatal perineal massage on perineal pain 3 days after delivery.
Perineal massage
l
Georgina Stamp 2001 416 597 359 499

62.7% 0.97 [0.90, 1.05]
9.8% 1.03 [0.86, 1.25]
MAEVE EOGAN 2006 72 100 55 79
27.5% 1.06 [0.90, 1.25]
Michel Labrecque 2000 179 459 174 473
100.0 1.00 [0.93, 1.07]
%
Total (95% CI) 1156 1051

0.7 1 1.5
2 2
Heterogeneity: Chi = 1.28, df = 2 (P = 0.53); I =
Favours Favours
FigurE 13: Forest map: effect of prenatal perineal massage on perineal pain 3 months postpartum.
Perineal massage

l
Georgina Stamp 2001 123 503 115 436 43.3% 0.93 [0.74, 1.15]
Mohamed 2011 3 30 2 30 0.7% 1.50 [0.27, 8.34]
Ugwu 2018 3 48 4 50 1.4% 0.78 [0.18, 3.31]
Total (95% CI) 1051 995 100.0% 0.91 [0.79, 1.05]

0.05 0.2 1 5 20
FigurE 14: Forest map: effect of prenatal perineal massage on postpartum urinary incontinence.
Perineal massage Contro Odds ratio Odds ratio

l
Georgina Stamp 2001 36 503 35 436 58.7% 0.88 [0.54, 1.43]
Mohamed 2011 0 30 1 30 2.5% 0.32 [0.01, 8.24]
Ugwu 2018 2 48 8 50 12.7% 0.23 [0.05, 1.14]
Total (95% CI) 1039 977 100.0% 0.75 [0.51, 1.11]
Total events 50 60
0.01 0.1 1 10 100
Favours Favours
FigurE 15: Forest map: effect of prenatal perineal massage on postpartum fecal incontinence.
entailed to explore the effect of perineal massage on uri-

nary/fecal incontinence.
Reducing perineal injury caused by childbirth is
stimulate skin nerve endings, promote tissue blood pivotal for enhancing women’s physical and mental
circulation, improve the elasticity and ductility of health [19, 23]. According to our research, prenatal
perineal tissue, reduce perineal incision, and perineal massage can reduce the risk of perineal
improve perineal tear. tear, especially the risk of 3rd -4th degree perineal
Perineal injury during childbirth leads to different tear. It can also reduce the risk of perineal incision
complications for women, such as perineal pain. during delivery and perineal pain 3 months after
Then, we found that perineal massage could reduce delivery. Previous studies have confirmed that
the incidence of perineal pain at 3 months prenatal perineal massage could benefit pregnant
postpartum as compared with the control group. women [2, 8, 20]. However, factors like maternal self-
There was no significant difference in the incidence of esteem, obesity, and inconvenience make
perineal pain at 3 days postpartum. This is implementation of prenatal perineal massage
consistent with the results of Beckmann Michael and difficult [24]. Studies have
Stock Owen [2]. The decrease in perineal pain at 3
months postpartum may be related to the fact that
prenatal perineal massage can reduce the incidence
of perineal injury and perineal incision.
However, there were no significant differences
between the two groups with regard to other
secondary outcomes, such as the risk of urinary or
fecal incontinence at 3 months postpartum and the
incidence of spontaneous vaginal delivery. It may be
due to the long follow-up time and women’s self-
esteem. Thus, the follow-up of urinary incontinence
or fecal incontinence was difficult, and the data were
incomplete. Of the 16 experiments in this study,
only
4 reported urinary incontinence or fecal incontinence 3
months after delivery, and the number of samples was rel-
atively small. In the study by Mohamed et al. [20] that ana-
lyzed only 3 experiments, prenatal perineal massage
reduced the risk of anal incontinence (including fecal
incontinence and gas incontinence) but did not reduce
the risk of urinary incontinence. Given the relatively small
sample size, we believe that additional investigations are
shown that [25] the application of smartphone Apps

can better help pregnant women master and apply
this helpful technology and enable pregnant
women to adhere to the use of prenatal perineal
massage from the 34th week of pregnancy to
delivery. Obstetrics and gynecology medical staff can
learn from this method, publicize and popularize this
technology, and encourage and recommend
pregnant women to have a prenatal perineal
massage before 34 weeks of pregnancy.
The main advantages of this meta-analysis are
based on clear definition, strict inclusion and
exclusion criteria, a comprehensive retrieval
strategy, and a large sample size. According to the
retrieval, our research is the most and latest
sample in this field. Our limitation is the relatively
limited observation indicators included. For
example, the effect of prenatal perineum massage
on improving postpartum sexual satisfaction and
the risk of urinary incontinence and fecal
incontinence at 3 months after delivery needs to be
further confirmed. These outcomes are directly
related to the quality of life of patients and their
families that entail continued investigations.
5.Conclusion
Antenatal perineal massage reduces the risk of
perineal tears (especially 3rd-4th degree) during
vaginal delivery, episiotomy, and perineal pain 3
months postpartum. Therefore, obstetrics and
gynecology professionals should consider
popularizing prenatal perineal massage.
Data Availability
The data used to support the findings of this study
are included within the article.
Conflicts of Interest
The authors have no conflicts of interest to declare.
Authors’ Contributions
Qiuxia Chen and Xiaocui Qiu contributed equally to
this work.
Acknowledgments
The project was supported by the Hainan Province Clinical Medical Center.
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POLTEKKES KEMENKES JAMBI

PRODI RPL SARJANA TERAPAN KEBIDANAN BIDAN

JURNAL PENJAHITAN LUKA PERENIUM

DOSEN PENGAMPU : Lia Artika Sari,,Bdn, M.Keb

POLTEKKES KEMENKES JAMBI

Judul, Penulis, Metode/Populasi/

2 Title: Tujuan penelitian Method: Ditemukan bahwa https://

Obstetrics and Gynecology International

Naglaa Zaki Hassan Roma ,1

Correspondence should be addressed to Naglaa Zaki Hassan Roma; ngla_roma@yahoo.com

Academic Editor: Manvinder Singh

1. Introduction Although the postpartum period is a wonderful and

Parturient women delivered and meet the

Dry Heat Group Moist Heat Group

FIgurE 1: Flow chart of participants’ recruitment process.

Housewife 46 (92.0) 43 (86.0) X 2 � 0.919

Working 4 (8.0) 7 (14.0) P � 0.338

Urban 9 (18.0) 14 (28.0) X 2 � 1.412

Rural 41 (82.0) 36 (72.0) P � 0.235

Table 3 manifests there were no significant

40 Dry heat Moist Heat

Dry heat group (n � 50) Moist heat group (n � 50)

19 (38.0) 25 (50.0) 9 (18.0)

Severe (7–9) 20 (40.0) 12 (24.0) 3 (6.0) 18 (36.0) 14 (28.0) 5 (10.0)

None 0 (0.0) 0 (0.0) X 2 �0.622 2 (4.0) 0 (0.0) F ET

Moderate 23 (46.0) 22 (44.0) 12 (24.0) 13 (26.0) 0 (0.0) 5 (10.0)

Severe 6 (12.0) 4 (8.0) 0 (0.0) 10 (20.0) 0 (0.0) 3 (6.0)

None 0 (0.0) 0 (0.0) X 2 � 2.36 27 (54.0) 11 (22.0) F ET

Moderate 19 (38.0) 19 (38.0) 7 (14.0) 8 (16.0) 0 (0.0) 6 (12.0)

Severe 15 (30.0) 13 (26.0) 0 (0.0) 6 (12.0) 0 (0.0) 0 (0.0)

Moderate 10 (20.0) 12 (24.0) 1 (2.0) 5 (10.0) 0 (0.0) 6 (12.0)

Severe 3 (6.0) 2 (4.0) 0 (0.0) 1 (2.0) 0 (0.0) 0 (0.0)

Serosanguinous 0 (0.0) 0 (0.0) 1 (2.0) 11 (22.0) 0 (0.0) 9 (18.0)

Bloody/purulent 0 (0.0) 0 (0.0) 0 (0.0) 2 (4.0) 0 (0.0) 0 (0.0)

Moderate 0 (0.0) 0 (0.0) 10 (20.0) 23 (46.0) 0 (0.0) 7 (14.0)

Sever 0 (0.0) 0 (0.0) 2 (4.0) 8 (16.0) 0 (0.0) 4 (8.0)

Dry heat group (n � 50) Moist heat group (n � 50)

No. (%) No. (%) No. (%) No. (%)

Complete 39 (78.0) 48 (96.0) 10 (20.0) 26 (52.0)

Mild 4 (8.0) 0 (0.0) 16 (32.0) 8 (16.0)

No healing 0 (0.0) 0 (0.0) 14 (28.0) 1 (2.0)

Mean ± SD 2.34 ± 1.661 0.84 ± 0.739 6.24 ± 3.274 3.32 ±

4.1. Limitations of the Study. The researchers faced the

5.1. Recommendations. According to the present study’s

[4] G. Carroli and L. Mignini, “Episiotomy for vaginal birth,”

[11] A. Ahmed, “Continuous versus interrupted sutures for

[14] Z. Abedian, M. Navinezhad, J. Asili, and H. Esmaeili, “An

[16] J. Kapoor and Rita, “A comparative study to assess the ef-

[21] R. Melzack, “Pain measurement in persons in pain,”

Computational and Mathematical Methods in

Qiuxia Chen,1 Xiaocui Qiu,2 Aizhen Fu,3 and Yanmei Han 2

Correspondence should be addressed to Yanmei Han; hanyanmei669@163.com

Academic Editor: Xi Lou

1.Introduction delivery [1]. It can cause perineal pain, diﬃculty in

2.Materials and Methods

3.2. Basic Information of the Included Studies. The

3.3. Perineal Tear. A total of 16 literature compared the

3.4. Lateral Episiotomy. Compared with the control group,

Identification of studies via databases

Records excluded after reading

Reports sought for retrieval

Reports assessed for eligibility Reports excluded:

FigurE 1: Flow chart of literature screening.