{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:48:34Z","timestamp":1789177714352,"version":"build-2803163510"},"reference-count":60,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T00:00:00Z","timestamp":1431648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,8]]},"abstract":"Background<\/jats:title>Genital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS<\/jats:styled-content>). Debate continues regarding the effectiveness of perineal support during childbirth in reducing the risk of trauma.<\/jats:p><\/jats:sec>Objectives<\/jats:title>This review aimed to assess the effect of routine \u2018hands\u00a0on\u2019\/manual perineal support (MPS<\/jats:styled-content>) during childbirth, versus ad\u00a0hoc\/no perineal support (\u2018hands\u00a0off\/poised\u2019), on the risk and degree of perineal trauma.<\/jats:p><\/jats:sec>Search strategy<\/jats:title>This review is registered on PROSPERO<\/jats:styled-content> (http:\/\/www.crd.york.ac.uk\/PROSPERO\/display_record.asp?ID=CRD42014007058<\/jats:ext-link>). We searched the CENTRAL<\/jats:styled-content>, Embase, Medline, CINAHL<\/jats:styled-content>, and OVID<\/jats:styled-content>s midwifery and infant care databases (from inception to December\u00a02014).<\/jats:p><\/jats:sec>Selection criteria<\/jats:title>Published randomised controlled trials (RCT<\/jats:styled-content>s) and non\u2010randomised studies (NRS<\/jats:styled-content>s) evaluating any \u2018hands\u00a0on\u2019 perineal support technique during childbirth.<\/jats:p><\/jats:sec>Data collection and analysis<\/jats:title>Two reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer.<\/jats:p><\/jats:sec>Main results<\/jats:title>We included five RCT<\/jats:styled-content>s and seven NRS<\/jats:styled-content>s in the review. Meta\u2010analysis of RCT<\/jats:styled-content>s did not demonstrate a statistically significant protective effect of MPS<\/jats:styled-content> on the risk of OASIS<\/jats:styled-content> (three studies, 6647 women; relative risk, RR<\/jats:styled-content>\u00a01.03; 95% confidence interval, 95%\u00a0CI<\/jats:styled-content> 0.32\u20133.36; statistical test for heterogeneity I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a071%). Meta\u2010analysis of NRS<\/jats:styled-content>s showed a significant reduction in the risk of OASIS<\/jats:styled-content> with MPS<\/jats:styled-content> (three studies, 74\u00a0744 women; RR<\/jats:styled-content>\u00a00.45; 95%\u00a0CI<\/jats:styled-content> 0.40\u20130.50; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a032%).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS<\/jats:styled-content> policies, ensuring controlled childbirth, is urgently needed.<\/jats:p><\/jats:sec>Tweetable abstract<\/jats:title>Manual perineal support at birth may be protective against anal sphincter injuries.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13431","type":"journal-article","created":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T09:26:19Z","timestamp":1431681979000},"page":"1157-1165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":90,"title":["Manual perineal support at the time of childbirth: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"122","author":[{"given":"S","family":"Bulchandani","sequence":"first","affiliation":[{"name":"Birmingham Women's NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Watts","sequence":"additional","affiliation":[{"name":"Medical School University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Sucharitha","sequence":"additional","affiliation":[{"name":"The Royal Wolverhampton NHS Trust Wolverhampton West Midlands UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Yates","sequence":"additional","affiliation":[{"name":"Birmingham Women's NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KM","family":"Ismail","sequence":"additional","affiliation":[{"name":"Birmingham Women's NHS Foundation Trust Birmingham UK"},{"name":"The Birmingham Centre of Women's and Children's Health School of Clinical and Experimental Medicine College of Medical and Dental Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,5,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10004.x"},{"key":"e_1_2_6_3_1","volume-title":"The Management of Third and Fourth Degree Perineal Tears","author":"Fernando RJ","year":"2007"},{"key":"e_1_2_6_4_1","unstructured":"KettleC TohillS.Perineal Care. 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