The role of thumb and index finger placement in manual perineal protection
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Models, Biological MeSH
- Biomechanical Phenomena MeSH
- Humans MeSH
- Perineum injuries MeSH
- Computer Simulation MeSH
- Parturition MeSH
- Fingers * MeSH
- Wounds and Injuries prevention & control MeSH
- Delivery, Obstetric methods MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION AND HYPOTHESIS: Comparison of the modifications of the Viennese method of manual perineal protection (VMPP) and hands-off delivery techniques by applying basic principles of mechanics with assessments of tensions within perineal structures using a novel biomechanical model of the perineum. Evaluation of the role of the precise placements of the accoucheur's posterior (dominant) thumb and index finger in perineal tissue tension when performing a modified Viennese method of MPP. METHODS: We carried out an experimental study on a biomechanical model of the perineum at NTIS (New Technologies for Information Society, Pilsen, Czech Republic). Hands-off and 38 variations of VMPP were simulated during vaginal delivery with the finite element model imitating a clinical lithotomy position. RESULTS: The main outcome measures were quantity and extent of strain/tension throughout the perineal body during vaginal delivery. Stress distribution between modifications of VMPP showed a wide variation in peak perineal tension from 72 to 102 % compared with 100 % for the "hands-off" technique. Extent of reduction depended on the extent of finger movement across a horizontal, transverse x-axis, and on final finger position on a vertical, antero-posterior y-axis. The most effective modification of VMPP was initial position of fingers 12 cm apart (x = ±6) on the x-axis, 2 cm anteriorly from the posterior fourchette (y = +2) on the y-axis with 1cm movement of both finger and thumb toward the midline on the x-axis (Δx = 1) with no movement on the y-axis (Δy = 0). CONCLUSIONS: In a biomechanical assessment with simulation of vaginal delivery, exact placement of fingertips on the perineal skin, together with their co-ordinated movement, plays an important role in the extent of reduction of perineal tension.
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