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PregnancyEAPFPTCNCT02582580

Effects of Antenatal Pelvic Floor Preparation Techniques for Childbirth

A study testing Perineal massage, Vaginal Dilator and Pelvic floor muscles training in people with Pregnancy, run by Universidade Federal de Sao Carlos at 1 site in Brazil.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Perineal trauma during childbirth is an important etiological factor of various undesirable complications to women's health, with emphasis on pelvic floor dysfunction. Thus, methods that preserve the perineal integrity have been a challenge to practices among health professionals working in the gravid-puerperal cycle… Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Pregnancy
What is being tested?
Perineal massage, Vaginal Dilator and Pelvic floor muscles training
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
63 participants
Where
1 siteBrazil
Study dates
15 Oct 2015to 30 Aug 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • usual risk primigravidae women
  • primigravidae women from the 32nd gestational week
  • wishing to have a vaginal delivery

Who cannot join

  • pregnant women with pelvic or vaginal surgeries
  • presence of pelvic organ prolapse
  • intolerance to vaginal palpation
  • inability to contract the pelvic floor muscles
  • vaginal infections
  • neurological and/or cognitive impairments that prevent an understanding of the proposed procedures
  • pregnant women who used antenatal pelvic floor methods of preparation prior to study enrollment

Trial locations and contacts

1 site in 1 country.

Brazil1 site
  • Federal University of São Carlos - Physical therapy Department

    São Carlos, São Paulo, 13.565-905

Other trials in Brazil

About this study

Official title: Effects of Perineal Massage, Vaginal Dilator and Pelvic Floor Muscles Training on the Perineal Integrity Primiparous: A Randomized Controlled Trial Protocol

Perineal trauma during childbirth is an important etiological factor of various undesirable complications to women's health, with emphasis on pelvic floor dysfunction. Thus, methods that preserve the perineal integrity have been a challenge to practices among health professionals working in the gravid-puerperal cycle assistance. Despite the remarkable importance of beneficial effects of pelvic floor preparation prior to vaginal birth on prevention of perineal trauma, there are few studies in the literature that point which is the best method to be used to reduce the chances of perineal lesions. Therefore, there is need for more studies to compare existing methods. The objective this present study is to compare the effects of perineal massage, the vaginal dilator and training of the muscles of the pelvic floor to prepare the pelvic floor for vaginal birth on perineal integrity of primiparous. Primigravidae women are selected over 18 years, from the 32th gestational week and wishing to have a vaginal birth. Women will be randomly allocated into 3 groups: perineal massage, vaginal dilator and pelvic floor muscles training and should practice the technique from the 34th week of pregnancy until the time of delivery. All the women will be subject to clinical evaluation, functional assessment of pelvic floor and perineal integrity assessment prior to the beginning of the practice of the technique and between 45 and 60 days after childbirth.

Read the detailed description

METHODS:

Participants: Primigravidae women over 18 years old will be selected, from the 32th gestational week and wishing to have a vaginal delivery.

Interventions: Pregnant women will be randomly allocated into three groups: perineal massage, vaginal dilator and pelvic floor muscles training. The technique should be practiced from the 34th week of pregnancy until the beginning of labor. Randomization will be done by a researcher who was not involved with the recruitment, assessment and treatment of the participants. All participants will undergo a clinical and functional assessment of the pelvic floor before the beginning of the technique practice, as well as a reassessment of these items and an assessment of perineal integrity between 45 and 60 days after delivery for a blind physiotherapist regarding the interventional procedures.

Objective: To compare the effects of perineal massage, vaginal dilator and pelvic floor muscles training on the perineal integrity of primiparae women.

Outcome: The perineal integrity will be verified by the presence or absence of perineal laceration as well as their characteristics observed immediately after delivery.

Randomization: Participants randomization will be done from a sequence generated by a computer program.

Blinding: The evaluative procedures will be done by a 'blinded' physiotherapist in relation to the intervention procedures and the randomization procedure by a researcher who was not involved with the recruitment, evaluation and participant's treatment.

Discussion: The knowledge of the effects of antenatal pelvic floor preparation techniques on the perineal integrity and pelvic floor muscles function after delivery, will allow a better choice about which approach is the best to pregnant women to prevent perineal trauma.

Conditions
Pregnancy
Being tested
Perineal massage, Vaginal Dilator, Pelvic floor muscles training
Keywords
pelvic floor, perineal trauma, physiotherapy, perineal integrity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Perineal massageOther

    Also called Perineal massage for prevention of perineal trauma

    Perineal massage should be practiced once a day, from the 34th week of gestation until the beginning of labor. It should obey the following sequence: the pregnant woman must be positioned comfortably and use intimate water based lubricant at her fingertips; start the massage in the outdoor area of the vulva with circular movements of the skin and connective tissue around the vagina and at the central tendon of the perineum, clockwise, clitoris to clitoris; introduce two thumb fingers or index and middle fingers into the vagina at a distance of approximately 4 centimeters; perform internal massaging with laterally semicircles towards the anus for 20 to 30 seconds; put pressure down towards the anus and to each side of the vagina until feeling a slight burning or stretching sensation and hold the position for 2 minutes; massage the lower half of the vaginal introitus in a movement simulating the letter "U". All movements should be repeated four times.

  • Vaginal DilatorDevice

    Also called Epi-No Vaginal Dilator

    Vaginal dilator Epi-No® should be used once a day for 15 minutes, from the 34th week of pregnancy until the beginning of labor. It should be coated with a condom and intimate water based lubricant and then be inserted into the vaginal canal in such way that the balloon stays two centimeters away from the vaginal introitus. The device will be inflated by manual pumping until the tolerable woman's limit. The pregnant woman will be encouraged to daily inflate a greater volume of compressed air into the balloon so that the amount of air is greater than the quantity in the previous day, achieving, day after day, a greater stretching of perivaginal structures, always respecting the individual tolerance limit. The amount of manual pumping imposed to inflate the balloon should be written in an Intervention Diary so that the next use, the pregnant woman will be sure that pumped the device more times than in the previous session.

  • Pelvic floor muscles trainingOther

    Also called Pelvic floor training for promotion of perineal integrity

    Pregnant women allocated to this group will perform pelvic floor muscles training. The progression of the protocol of this study will occur gradually in view of the peculiarities that involve the pelvic floor in the gestational stage and the ultimate goal is the promotion of an intact perineum after vaginal delivery. The exercises will obey a sequence, according to the gestation week, considering the following factors/parameters: exercise position, number and sustaining period of slow and fast contractions, and relaxation time between contractions. All contractions should be during the expiratory phase of breathing associated with an isometric contraction of the abdominal muscles and at the end of each series of contractions, perform a one minute interval between sets and in that time perform the diaphragmatic breathing exercise to promote overall relaxation. This protocol should be practiced once a day, every day from the 34th week of gestation until the beginning of labor.

Study groups in NCT02582580
Study groupRoleWhat they receive
Perineal MassageActive comparatorMassage is made in the perineum and vagina using your fingers to promote stretching of pelvic floor structures, making them more flexible and distensíveis, avoiding trauma during vaginal birth.
Receives: Other: Perineal massage
Vaginal DilatorActive comparatorThis device consists of a silicone balloon in an eight shape that, after inserted into the vagina, is inflated by manual pumping, promoting a stretching of the structures around it (hymenal edge, connective tissues and muscles perivaginal). This equipment assists the stretching of tissues around the vagina and the pelvic floor muscles, minimizing the risk of injury from the birth canal during the passage of the baby.
Receives: Device: Vaginal Dilator
Pelvic floor muscles trainingActive comparatorExercises emphasizing conscious muscle relaxation, i.e., considering a resting time based on the contraction time. The resting time was double of the sustaining time of each contraction up to the 38th week of pregnancy, after remaining fixed this relaxation time up to the moment of delivery. This time was chosen because during the expulsive labor phase, there is a need for the pelvic floor muscles to consciously relax during a long period, in order to facilitate the descendants and rotational movements of the baby's head and consequently, its passage. This exercises does not aim only muscle strength but also contraction promotion, which aims body and perineal awareness, muscle tone, coordination and appropriate motor control to allow an active muscle relaxation in the second labor stage.
Receives: Other: Pelvic floor muscles training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Perineal Perineal integrity assessed by the absence or presence of perineal lacerations

    Perineal integrity assessed by the absence or presence of perineal lacerations as well as the description of its characteristics: type: classified as single or multiple considering the anterior and posterior perineum region and vaginal wall; Location: classified according to the affected region. Being the anterior region of the perineum, involving the clitoris, left little lip, small right lip, left vestibular region and right vestibular region. The posterior perineum region will be considered when involving left, right and middle region. The vaginal wall will be considered when it presents anterior, back, left back and right back lacerations; Degree of perineal laceration; Laceration form: It will be considered solely for the lacerations affecting posterior perineal region and should be classified as linear, branched and "U" shaped.

    Measured: This assessment will be done until 60 days after delivery

Secondary outcomes (1)
  1. Function of the pelvic floor muscles evaluated by the PERFECT method

    Function of the pelvic floor muscles evaluated by the PERFECT method between 45 and 60 days after delivery. This method is a functional assessment of the pelvic floor muscles allowing to analyze the muscle contraction and condition of the fibers. The contraction of pelvic floor muscles will be requested during expiration.

    Measured: This assessment will be done at the time of initial evaluation (before the intervention) and between 45 and 60 days after delivery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Oct 2015 (estimated)
  2. Study start15 Oct 2015
  3. Primary completion30 Aug 2017
  4. Study completion30 Aug 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Investigator
Enrolment
63 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02582580
Sponsor's protocol ID
FAPESP #2015/02244-0
Other IDs
1.218.385
Acronym
EAPFPTC
Status last verified
Apr 2019
First submitted
14 Oct 2015
Last updated
23 Apr 2019
Results posted
No
Data monitoring committee
No

Publications

  • Aasheim V, Nilsen AB, Lukasse M, Reinar LM. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD006672. doi: 10.1002/14651858.CD006672.pub2.

    PubMed 22161407
  • Riesco MLG, Costa ASC, Almeida SFS, Basile ALO, Oliveira SMJV. Episiotomia, laceração e integridade perineal em partos normais: análise de fatores associados. Rev. Enferm. UERJ 2011; 19(1): 77-83.

  • Shek KL, Chantarasorn V, Langer S, Phipps H, Dietz HP. Does the Epi-No Birth Trainer reduce levator trauma? A randomised controlled trial. Int Urogynecol J. 2011 Dec;22(12):1521-8. doi: 10.1007/s00192-011-1517-x. Epub 2011 Aug 2.

    PubMed 21809156
  • Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013 Apr 30;2013(4):CD005123. doi: 10.1002/14651858.CD005123.pub3.

    PubMed 23633325
  • Oliveira LS, Brito LG, Quintana SM, Duarte G, Marcolin AC. Perineal trauma after vaginal delivery in healthy pregnant women. Sao Paulo Med J. 2014;132(4):231-8. doi: 10.1590/1516-3180.2014.1324710.

    PubMed 25055069
  • Kovacs GT, Heath P, Heather C. First Australian trial of the birth-training device Epi-No: a highly significantly increased chance of an intact perineum. Aust N Z J Obstet Gynaecol. 2004 Aug;44(4):347-8. doi: 10.1111/j.1479-828X.2004.00265.x.

    PubMed 15282009
  • Herbert J. Pregnancy and childbirth: the effects on pelvic floor muscles. Nurs Times. 2009 Feb 24-Mar 2;105(7):38-41.

    PubMed 19326654
  • Foroughipour A, Firuzeh F, Ghahiri A, Norbakhsh V, Heidari T. The effect of perineal control with hands-on and hand-poised methods on perineal trauma and delivery outcome. J Res Med Sci. 2011 Aug;16(8):1040-6.

    PubMed 22279480
  • Kopas ML. A review of evidence-based practices for management of the second stage of labor. J Midwifery Womens Health. 2014 May-Jun;59(3):264-76. doi: 10.1111/jmwh.12199.

    PubMed 24850283
  • Zhou F, Wang XD, Li J, Huang GQ, Gao BX. Hyaluronidase for reducing perineal trauma. Cochrane Database Syst Rev. 2014 Feb 5;2014(2):CD010441. doi: 10.1002/14651858.CD010441.pub2.

    PubMed 24497276
  • Brito LG, Ferreira CH, Duarte G, Nogueira AA, Marcolin AC. Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review. Int Urogynecol J. 2015 Oct;26(10):1429-36. doi: 10.1007/s00192-015-2687-8. Epub 2015 Apr 8.

    PubMed 25851585
  • Du Y, Xu L, Ding L, Wang Y, Wang Z. The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review with meta-analysis. Int Urogynecol J. 2015 Oct;26(10):1415-27. doi: 10.1007/s00192-015-2654-4. Epub 2015 Feb 25.

    PubMed 25711728
  • Salvesen KA, Morkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ. 2004 Aug 14;329(7462):378-80. doi: 10.1136/bmj.38163.724306.3A. Epub 2004 Jul 14.

    PubMed 15253920
  • Agur W, Steggles P, Waterfield M, Freeman R. Does antenatal pelvic floor muscle training affect the outcome of labour? A randomised controlled trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jan;19(1):85-8. doi: 10.1007/s00192-007-0391-z. Epub 2007 May 26.

    PubMed 17530154
  • Bo K, Fleten C, Nystad W. Effect of antenatal pelvic floor muscle training on labor and birth. Obstet Gynecol. 2009 Jun;113(6):1279-1284. doi: 10.1097/AOG.0b013e3181a66f40.

    PubMed 19461423

Questions about this trial

What is this clinical trial studying?

A study testing Perineal massage, Vaginal Dilator and Pelvic floor muscles training in people with Pregnancy, run by Universidade Federal de Sao Carlos at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 23 Apr 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Perineal Perineal integrity assessed by the absence or presence of perineal lacerations (time frame: This assessment will be done until 60 days after delivery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02582580, which also lists 42 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Apr 2019.

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