Perineal preparation in prenatal care for the prevention of perineal lacerations: An integrative review
DOI:
https://doi.org/10.62827/fb.v27i9.1338Keywords:
Pregnant Women; Pelvic Floor; Physical Therapy; Lacerations; Prenatal Care.Abstract
Introduction: Perineal trauma is a common occurrence during vaginal delivery and may be associated with pain, pelvic floor dysfunction, and a reduced quality of life for the mother. Perineal preparation strategies, such as massage during pregnancy and during the second stage of labor, can help prevent these complications. Objective: To analyze the available evidence on the effectiveness of pelvic floor muscle training and/or perineal massage during prenatal care in preventing perineal tears during vaginal delivery. Methods: An integrative literature review was conducted in the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and BVS (Virtual Health Library) databases, considering studies published between 2021 and 2026. Studies evaluating interventions for pelvic floor and perineal preparation through perineal massage during pregnancy and during labor were included; duplicate articles and studies in which interventions were performed after delivery were excluded. The methodological quality of the studies was analyzed using the AMSTAR 2, SANRA, and JBI tools. Results: Nine studies were included. Antenatal perineal massage showed more consistent results, being associated with a reduction in severe perineal tears, episiotomies, and perineal pain. Pelvic floor muscle training showed mixed results, although recent studies have demonstrated a reduction in severe obstetric tears. Conclusion: Perineal preparation during prenatal care may help reduce certain outcomes related to perineal trauma, with more consistent results observed for antenatal perineal massage.
References
Jones K, Webb S, Manresa M, Hodgetts-Morton V, Morris RK. The incidence of wound infection and dehiscence following childbirth-related perineal trauma: a systematic review of the evidence. Eur J Obstet Gynecol Reprod Biol. 2019;240:1-8. doi:10.1016/j.ejogrb.2019.05.038. Available from: https://pubmed.ncbi.nlm.nih.gov/31202973/.
World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience [Internet]. Geneva: World Health Organization; 2018 [cited 2026 Aug 6]. Available from: https://www.who.int/publications/i/item/9789241550215.
Oladapo O, Tunçalp Ö, Bonet M, Lawrie T, Portela A, Downe S, et al. WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing. BJOG. 2018;125(8):918-922. doi:10.1111/1471-0528.15237. Available from: https://pubmed.ncbi.nlm.nih.gov/29637727/.
Yin J, Chen Y, Huang M, Cao Z, Jiang Z, Li Y. Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024;24(1). doi:10.1186/s12884-024-06586-w. Available from: https://pubmed.ncbi.nlm.nih.gov/38831257/.
Zhang D, Bo K, Montejo R, Sánchez-Polán M, Silva-José C, Palacio M, et al. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: systematic review and meta-analysis of randomized clinical trials. Acta Obstet Gynecol Scand. 2024;103(6):1015-1027. doi:10.1111/aogs.14744. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11103147/.
Chen, Q., Qiu, X., Fu, A., & Han, Y. Effect of Prenatal Perineal Massage on Postpartum Perineal Injury and Postpartum Complications: A Meta-Analysis. Computational and mathematical methods in medicine. 2022, 3315638. Available from: https://doi.org/10.1155/2022/3315638.
Priscilla C, Lo TK. Women's knowledge, attitudes and interest in antenatal perineal massage: a cross-sectional survey. J Obstet Gynaecol. 2025;45(1).doi:10.1080/01443615.2025.2555880. Available from: https://pubmed.ncbi.nlm.nih.gov/40926322/.
İncebıyık M, Palalı İ, Er Y, Tammo Ö, Kızıldemir YZ, Adak İH, et al. The effect of a pelvic floor training program on perineal trauma during birth: a patient-preference controlled clinical trial. Sci Rep. 2026;16(1):16493 [cited 2026 Aug 6].doi:10.1038/s41598-026-47603-6. Available from: https://pubmed.ncbi.nlm.nih.gov/41942674/.
Zhang L, Li X, Shan S, Liang M, Duan Y, Huang R, et al. Impact of antenatal perineal massage in primiparous women on the occurrence of childbirth-related perineal trauma: a propensity score matched retrospective cohort study. Midwifery. 2026;160:104869 [cited 2026 Aug 6]. doi:10.1016/j.midw.2026.104869. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-42229096.
Villani F, Cristian F, Mazzucato B, Cavalieri A, Cristina TO, Ciobanu V, et al. Antenatal Perineal Training for Injuries Prevention: Follow Up after Puerperium. [Internet]. Medicina (Kaunas). 2024 [cited 2026 Aug 6].doi:10.3390/medicina60081264. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-39202545.
Álvarez-González M, Leirós-Rodríguez R, Álvarez-Barrio L, López-Rodríguez AF. Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial. [Internet]. Medicina (Kaunas). 2022 [cited 2026 Aug 6].doi:10.3390/medicina58101485. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-36295645.
Gomes Lopes L, Maia Dutra Balsells M, Teixeira Moreira Vasconcelos C, Leite de Araújo T, Teixeira Lima FE, de Souza Aquino P. Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta‐analysis. International Journal of Gynecology & Obstetrics [Internet]. 2021 Aug 4 [cited 2026 Aug 6];157(2):248–54.doi:10.1002/ijgo.13826. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-34270799.
Azón E, Mir E, Hernández J, Aguilón JJ, Torres AM, Satústegui PJ. Update on the effectiveness and evidence of ante-natal perineal massage. An Sist Sanit Navar. 2021;44(3):437-444 [cited 2026 Aug 6].doi:10.23938/ASSN.0976. Available from: https://pubmed.ncbi.nlm.nih.gov/34703032/.
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Copyright (c) 2026 Luciany Maria Pereira de Almeida, Lívia Fagundes dos Anjos Araújo, Letícia Alves Azevedo, Nathália Carvalho de Almeida, Silvia Araujo Teodorico (Autor)
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