To evaluate the efficacy and safety of antenatal manual pelvic floor physical therapy (focused primarily on the deep muscles layer of the pelvic floor and sacrococcygeal mobility) and perineal (superficial muscles layer) physical therapy in reducing perineal trauma, episiotomy rates, instrumental deliveries, and second-stage duration.
The partially randomized controlled trial comprised two main parts. Part 1 involved a prospective, double-blinded, randomized controlled trial with 49 primiparous women who were randomly allocated to two groups: pelvic floor physical therapy (N=24) and perineal physical therapy (N=25). Part 2 consisted of a retrospective matched case-control study that compared these participants to an untreated control group of 98 primiparous women selected from birth registration records. The interventions included three pre-delivery sessions scheduled at 36, 38, and 39 weeks of gestation, with additional treatment provided for women experiencing dyspareunia at 37 weeks. Outcome measures assessed were the degree of perineal trauma, rates of episiotomy, instances of instrumental deliveries, and the duration of the second stage of labor.
About 40% of primiparous women in each intervention group reported experiencing dyspareunia. In the comparison of the intervention groups, a significantly lower rate of perineal trauma outcomes was observed in the pelvic floor physical therapy group than in the perineal physical therapy group (p=0.021). Furthermore, manual pelvic floor physical therapy was more effective than perineal physical therapy alone in reducing episiotomy rates (p=0.028). In retrospective comparison to untreated controls, a significantly lower rate of perineal trauma outcomes was also observed in perineal trauma outcomes in the pelvic floor physical therapy group than in the untreated group (p=0.024). No significant difference was observed between the perineal physical therapy and untreated groups (p=0.594). A separate analysis of episiotomy rates found a significant difference between the pelvic floor physical therapy and untreated groups (p=0.006). No significant difference was observed between the perineal physical therapy group and the untreated group (p=0.927).
The findings suggest that antenatal pelvic floor physical therapy is more effective than perineal physical therapy or no treatment in preventing perineal trauma during childbirth in primiparous women. This therapy was safe for women with a normal pregnancy progression, with no reported adverse events associated with the interventions. Further research with larger sample sizes is warranted to determine its long-term benefits and effectiveness across diverse populations.
An antenatal manual pelvic floor physical therapy may offer an effective and safe intervention for reducing perineal trauma and improving childbirth outcomes in primiparous women and should be recommended to pregnant women.
Pelvic floor
Antenatal physical therapy
