Top

Published in:

01-10-2015 | Review Article

Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review

Authors: Luiz Gustavo Oliveira Brito, Cristine Homsi Jorge Ferreira, Geraldo Duarte, Antonio Alberto Nogueira, Alessandra Cristina Marcolin

Published in: International Urogynecology Journal | Issue 10/2015

Abstract

Introduction and hypothesis

In this systematic review we aimed to assess if the Epi-No birth trainer used during antepartum could prevent perineal trauma in nulliparous women.

Methods

We searched CENTRAL, MEDLINE, EMBASE, Scielo, and Conference abstracts, looking for randomized controlled studies (RCT). High heterogeneity (i² > 50 %) was corrected with random models. All studies were analyzed according to their quality and risk of bias. Nulliparous women or women whose previous pregnancy ended before 21 weeks’ gestation were included and the main outcome measures were: episiotomy rates, perineal tears, severe (3rd/4th) perineal tears, and intact perineum.

Results

Five studies were included (1,369 participants) for systematic review and two of them (932 participants) were eligible for meta-analysis. Epi-No did not reduce episiotomy rates (RR 0.92 [95%CI 0.75–1.13], n = 710, p =0.44; two studies; fixed model) and second stage of labor (MD −12.50 [95%CI −29.62, –4.62], n = 162, p = 0.54; one study; fixed model), and did not increase intact perineum (RR 1.15 [95 % CI 0.81–1.64], n = 705, p = 0.43; two studies; random model). No influence of Epi-No on reducing all perineal tears (RR 0.99 [95%CI 0.84–1.17], n = 705, p = 0.93, two studies; fixed model) or severe (3rd/4th) perineal tears (RR 1.31 [95%CI 0.72–2.37], n = 705, p = 0.38, two studies; fixed model). Mean birthweight of the Epi-No group was higher than that of the control group in both studies, with no statistical significance.

Conclusion

Epi-No birth trainer is a device that did not reduce episiotomy rates and had no influence on reducing perineal tears.

Oliveira LS, Brito LG, Quintana SM, Duarte G, Marcolin AC (2014) Perineal trauma after vaginal delivery in healthy pregnant women. Sao Paulo Med J 132(4):227–234CrossRef

Borrelo-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108(4):863–872CrossRef

Carroli G, Mignini L (2009) Episiotomy for vaginal birth. Cochrane Database Syst Rev 1:CD000081PubMed

Christianson LM, Bovberg VE, McDavitt EC, Hullfish KL (2003) Risk factors for perineal injury during delivery. Am J Obstet Gynecol 189:255–260CrossRefPubMed

Krause HG, Natukunda H, Singasi I, Hicks SS, Goh JT (2014) Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda. Int Urogynecol J 25(11):1555–1559 doi:10.1007/s00192-014-2442-6 CrossRefPubMed

Beckmann MM, Stock OM (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 4:CD005123PubMed

Assheim V, Nilsen AB, Lukasse M, Reinar LM (2011) Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 12:CD006672

Hillebrenner J, Wagenpfeil S, Schuchardt R, Schelling M, Schneider KT (2001) Initial experiences with primiparous women using a new kind of Epi-no labor trainer. Z Geburtshilfe Neonatol 205(1):12–19CrossRefPubMed

Moher C, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCentralCrossRefPubMed

10.

Ruckhaberle E, Jundt K, Bauerle M et al (2009) Prospective randomized multicenter trial with the birth trainer EPI-NO for the prevention of perineal trauma. ANZOG 49:478–483

11.

Shek KL, Chantarasorn V, Langer S, Phipps H, Dietz HP (2011) Does the Epi-No birth trainer reduce levator trauma? A randomized controlled trial. Int Urogynecol J 22:1521–1528CrossRefPubMed

12.

Dietz HP, Langer S, Kamisan Atan I, Shek KL, Caudwell-Hall J, Guzman Rojas R (2014) Does the Epi-No prevent pelvic floor trauma? A multicentre randomised controlled trial. ICS Abstracts. Available at: http://www.ics.org/Abstracts/Publish/218/000394.pdf

13.

Kok J, Tan KH, Koh S et al (2004) Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore. Singap Med J 45(7):318–323

14.

Kovacs GT, Health P, Healther C (2004) First Australian trial of the birth-training device Epi-No: a highly significantly increased chance of an intact perineum. ANZJOG 44:347–348PubMed

15.

Higgins JPT, Altman DG, Sterne JAC (2011) Chapter 8: assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from www.cochrane-handbook.org

16.

Nakamura MU, Sass N, Elito Junior J et al (2014) Parturient perineal distensibility tolerance assessed by EPI-No: an observational study. Einstein 12(1):22–26CrossRefPubMed

17.

Kubotani JS, Moron AF, Araujo-Junior E, Zanetti MR, Soares VC, Elito-Junior J (2014) Perineal distensibility using Epi-No in twin pregnancies: comparative study with singleton pregnancies. ISRN Obstet Gynecol 2014:124206. doi:10.1155/2014/124206 PubMedCentralCrossRefPubMed

18.

Edozien L, Gurol-Urganci I, Cromwell D et al (2014) Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG 121(13):1695–1703. doi:10.1111/1471-0528.12886 CrossRefPubMed

19.

Pergialiotis V, Vlachos D, Protopapas A, Pappa K, Vlachos G (2014) Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet 125(1):6–14CrossRefPubMed

20.

Manzanares S, Cobo D, Moreno-Martinez MD, Sanchez-Gila M, Pineda A (2013) Risk of episiotomy and perineal lacerations recurring after first delivery. Birth 40(4):307–311CrossRefPubMed

21.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560PubMedCentralCrossRefPubMed

Title: Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review
Authors: Luiz Gustavo Oliveira Brito
Cristine Homsi Jorge Ferreira
Geraldo Duarte
Antonio Alberto Nogueira
Alessandra Cristina Marcolin
Publication date: 01-10-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 10/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2687-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2015

Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study

Postoperative groin pain and success rates following transobturator midurethral sling placement: TVT ABBREVO® system versus TVT™ obturator system

Disclosures, conflict of interest, and funding issues in urogynecology articles: a bibliometric study

Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study

Gold standard: a failed concept

The management of massive haematomas after insertion of retropubic mid-urethral slings