The Effect of Guided Virtual Perineal Exercises on the Incidence and Severity of Birth Canal Tearing in Normal Vaginal Delivery
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Perineal tearing is a common complication of normal vaginal delivery and is associated with short- and long-term maternal morbidity, including pain, infection, dyspareunia, and pelvic floor dysfunction. Although perineal exercises are recommended to reduce perineal trauma, their effectiveness in routine practice is often limited by inadequate guidance and low adherence. This study aimed to examine the effect of guided virtual perineal exercises on the incidence and severity of birth canal tearing in normal vaginal delivery. A quasi-experimental study with a control group was conducted among pregnant women in the third trimester (28-36 weeks of gestation). Participants were allocated to an intervention group receiving guided virtual perineal exercises or a control group receiving standard antenatal care. The intervention consisted of structured pelvic floor and perineal stretching exercises delivered through a virtual platform using recorded instructional modules and periodic live guidance by trained healthcare professionals. The primary outcome was the incidence and degree of perineal tearing, classified using standardized clinical criteria. Data were analyzed using descriptive statistics, bivariate tests, and multivariate logistic regression to control for confounding variables, including parity, maternal age, neonatal birth weight, episiotomy use, and duration of labor. The incidence of perineal tearing was lower in the intervention group compared to the control group. Participants who followed the guided virtual perineal exercise program experienced predominantly no or mild perineal tears, while moderate tears were more frequent in the control group. After adjustment for confounding factors, guided virtual perineal exercises remained significantly associated with a reduced risk of perineal tearing. Improved adherence to perineal exercises was observed among women in the intervention group. Guided virtual perineal exercises are an effective, safe, and non-invasive antenatal intervention for reducing the incidence and severity of birth canal tearing in normal vaginal delivery. The findings support the integration of virtual perineal exercise programs into routine maternal health services to enhance antenatal education, improve maternal comfort, and promote better childbirth outcomes.
##plugins.themes.bootstrap3.article.details##
Ali-Masri, H., Hassan, S., Fosse, E., Zimmo, K. M., Zimmo, M., Ismail, K. M. K., Vikanes, Å., & Laine, K. (2018). Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study. BMC Medical Education, 18(1), 258.
Aliem, R. S., & Ramadan, E. (2018). Effect of Intervention Guidelines on Enhanced Postpartum Recovery after Cesarean Section. International Journal of Nursing Didactics, 8(07), 77–89.
Arigo, D., Pagoto, S., Carter-Harris, L., Lillie, S. E., & Nebeker, C. (2018). Using social media for health research: Methodological and ethical considerations for recruitment and intervention delivery. Digital Health, 4, 2055207618771757.
Bick, D. E., Ismail, K. M., Macdonald, S., Thomas, P., Tohill, S., & Kettle, C. (2012). How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC Pregnancy and Childbirth, 12(1), 57.
Burkow, T. M., Vognild, L. K., Johnsen, E., Bratvold, A., & Risberg, M. J. (2018). Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD. BMC Medical Informatics and Decision Making, 18(1), 136.
Cioffi, J., Schmied, V., Dahlen, H., Mills, A., Thornton, C., Duff, M., Cummings, J., & Kolt, G. S. (2010). Physical activity in pregnancy: women’s perceptions, practices, and influencing factors. Journal of Midwifery & Women’s Health, 55(5), 455–461.
East, C. E., Sherburn, M., Nagle, C., Said, J., & Forster, D. (2012). Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery, 28(1), 93–97.
Hallam, S. M. (2012). Enhancing self-efficacy and pelvic floor muscle exercise adherence through sEMG biofeedback: a randomised study. University of Salford (United Kingdom).
Heapy, A. A., Higgins, D. M., Cervone, D., Wandner, L., Fenton, B. T., & Kerns, R. D. (2015). A systematic review of technology-assisted self-management interventions for chronic pain: looking across treatment modalities. The Clinical Journal of Pain, 31(6), 470–492.
Ioannidis, J. P. A. (2007). Limitations are not properly acknowledged in the scientific literature. Journal of Clinical Epidemiology, 60(4), 324–329.
Jansson, M. H., Franzén, K., Hiyoshi, A., Tegerstedt, G., Dahlgren, H., & Nilsson, K. (2020). Risk factors for perineal and vaginal tears in primiparous women–the prospective POPRACT-cohort study. BMC Pregnancy and Childbirth, 20(1), 749.
Ketterer, M. L. (2020). Utilizing Video Education to Increase Knowledge and Awareness of Perinatal Anxiety and Depression. The University of Arizona.
Mahadevan, V. (2016). Anatomy of the pelvis and perineum. Oxford Textbook of Fundamentals of Surgery, 17.
Marshall, G., & Jonker, L. (2011). An introduction to inferential statistics: A review and practical guide. Radiography, 17(1), e1–e6.
Musie, M. R., Peu, M. D., & Bhana-Pema, V. (2019). Factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital. African Journal of Primary Health Care & Family Medicine, 11(1), 1–8.
Narayan, B. (2014). Study of Factors Contributing to Adverse Outcomes in Obstetrics & Gynaecology. Rajiv Gandhi University of Health Sciences (India).
No, G. G. (2015). The management of third-and fourth-degree perineal tears. MIDIRS, 2, 9.
Obstet, I. J. G. (2021). S001. 2| VACUUM AND FORCEPS: BENEFITS AND RISKS.
Pourhoseingholi, M. A., Baghestani, A. R., & Vahedi, M. (2012). How to control confounding effects by statistical analysis. Gastroenterology and Hepatology from Bed to Bench, 5(2), 79.
Rosser, B. A., Vowles, K. E., Keogh, E., Eccleston, C., & Mountain, G. A. (2009). Technologically-assisted behaviour change: a systematic review of studies of novel technologies for the management of chronic illness. Journal of Telemedicine and Telecare, 15(7), 327–338.
Silva-Jose, C., Sánchez-Polán, M., Díaz-Blanco, Á., Pérez-Medina, T., Carrero Martínez, V., Alzola, I., Barakat, R., Refoyo, I., & Mottola, M. F. (2021). Influence of a virtual exercise program throughout pregnancy during the COVID-19 pandemic on perineal tears and episiotomy rates: A randomized clinical trial. Journal of Clinical Medicine, 10(22), 5250.
Sveinsdottir, E., Gottfredsdottir, H., Vernhardsdottir, A. S., Tryggvadottir, G. B., & Geirsson, R. T. (2019). Effects of an intervention program for reducing severe perineal trauma during the second stage of labor. Birth, 46(2), 371–378.
Waiswa, P., Manzi, F., Mbaruku, G., Rowe, A. K., Marx, M., Tomson, G., Marchant, T., Willey, B. A., Schellenberg, J., & Peterson, S. (2017). Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda. Implementation Science, 12(1), 89.
Waldenström, U., & Ekéus, C. (2017). Risk of obstetric anal sphincter injury increases with maternal age irrespective of parity: a population-based register study. BMC Pregnancy and Childbirth, 17(1), 306.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.