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Perineal protection devices (PPDs) have been developed as a potential preventive strategy, yet their clinical effectiveness remains under evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To assess the effectiveness of perineal protection devices in reducing the incidence and severity of birth-related perineal trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Eligible studies were identified from PubMed, Scopus, Web of Science, and Embase. Primary outcomes included rates of intact perineum, perineal tears (grade\u2009\u2265\u20092), labial tears, episiotomy, and Apgar scores. Secondary outcomes included adverse effects and feasibility. The Cochrane Risk of Bias tool 2 and GRADE assessment were used to evaluate study quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five RCTs involving 2331 participants were included. PPD use was associated with a significantly increased rate of intact perineum (RR 1.41; 95% CI 1.18\u20131.69;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant differences were found for grade 1 (RR 1.05;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.48), grade 2 (RR 0.92;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.32), or grade 3\u20134 perineal tears (RR 0.76;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.26). Labial tears showed no significant reduction overall (RR 0.90;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.64), but sensitivity analysis revealed a benefit after excluding one study (RR 0.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). No significant differences were found in episiotomy rates (RR 0.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.62) or Apgar scores\u2009&lt;\u20097 at 5\u00a0min (RR 0.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.93).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PPDs appear safe and effective in increasing intact perineum rates without adverse neonatal outcomes. Further large-scale, standardized trials are needed to confirm their role in obstetric practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-025-06364-y","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:37:09Z","timestamp":1763555829000},"page":"261-275","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of Perineal Protection Devices in Reducing Birth-Related Perineal Trauma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and GRADE Assessment"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2749-8982","authenticated-orcid":false,"given":"Salma","family":"Allam","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7255-5255","authenticated-orcid":false,"given":"Omar Khalid Samir","family":"Abdelkader","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8820-5480","authenticated-orcid":false,"given":"Rana","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4698-9201","authenticated-orcid":false,"given":"Nour","family":"Elsayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5567-6374","authenticated-orcid":false,"given":"Hind","family":"Elshiekh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5325-482X","authenticated-orcid":false,"given":"Joudi","family":"Tarabishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2853-6874","authenticated-orcid":false,"given":"Sara Mohammad","family":"Hegazy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5135-5166","authenticated-orcid":false,"given":"Amr","family":"Arafa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9038-7901","authenticated-orcid":false,"given":"Ahmed","family":"Kertam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"6364_CR1","doi-asserted-by":"crossref","unstructured":"Lucena da Silva M, Andressa Bastos Primo de Sousa Santos T, Wane Carvalho Leite L, Emanoel Chaves da Silva C, Oliveira do Nascimento A, Teixeira Alves A, et al. 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