BACKGROUND: Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP. METHODS: Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPP. RESULTS: Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6 s. In 20% it lasted < 5 s. The overall mean values of the average and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later. CONCLUSIONS: MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.

Biomedical Center Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Gynecology and Obstetrics University Hospital alej Svobody 76 304 60 Pilsen Czech Republic

New Technologies Research Centre University of West Bohemia Pilsen Czech Republic

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Fodstad K, Staff AC, Laine K. Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma. Int Urogynecol J. 2016;27:1513–1523. doi: 10.1007/s00192-016-3015-7. PubMed DOI

Necesalova P, Karbanova J, Rusavy Z, Pastor Z, Jansova M, Kalis V. Mediolateral versus lateral episiotomy and their effect on postpartum coital activity and dyspareunia rate 3 and 6 months postpartum. Sex Reprod Healthc. 2016;8:25–30. doi: 10.1016/j.srhc.2016.01.004. PubMed DOI

Laine K, Skjeldestad FE, Sandvik L, Staff AC. Prevalence and risk indicators for anal incontinence among pregnant women. ISRN Obstet Gynecol. 2013;2013:1–8. doi: 10.1155/2013/947572. PubMed DOI PMC

Aglialoro M. The contribution of the Salerno School to the historical evolution of protection and suturing of the perineum in labor. Minerva Med. 1970;61:5201–5203. PubMed

De Wees WB. Relaxation and management of the perineum during parturition. J Am Med Assoc. 1889;XIII:804. doi: 10.1001/jama.1889.02401190010002c. DOI

Ismail KMK, Paschetta E, Papoutsis D, Freeman RM. Perineal support and risk of obstetric anal sphincter injuries: a Delphi survey. Acta Obstet Gynecol Scand. 2016;94:165–174. doi: 10.1111/aogs.12547. PubMed DOI

McCandlish R, Bowler U, Asten H, Berridge G, Winter C, Sames L, et al. A randomised controlled trial of care of the perineum during second stage of normal labour. BJOG. 1998;105:1262–1272. doi: 10.1111/j.1471-0528.1998.tb10004.x. PubMed DOI

Mayerhofer K, Bodner-Adler B, Bodner K, Rabl M, Kaider A, Wagenbichler P, et al. Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1,076 women. J Reprod Med. 2002;47:477–482. PubMed

Bulchandani S, Watts E, Sucharitha A, Yates D, Ismail K. Manual perineal support at the time of childbirth: a systematic review and meta-analysis. BJOG. 2015;122:1157–1165. doi: 10.1111/1471-0528.13431. PubMed DOI

Naidu M, Sultan AH, Thakar R. Reducing obstetric anal sphincter injuries using perineal support: our preliminary experience. Int Urogynecol J. 2017;28:381–389. doi: 10.1007/s00192-016-3176-4. PubMed DOI

Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol. 2014;210(1):59.e1-6. doi: 10.1016/j.ajog.2013.08.043. PubMed DOI

Laine K, Rotvold W, Staff AC. Are obstetric anal sphincter ruptures preventable?- large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway. Acta Obstet Gynecol Scand. 2013;92:94–100. doi: 10.1111/aogs.12024. PubMed DOI

Hals E, Øian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, et al. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstet Gynecol. 2010;116:901–908. doi: 10.1097/AOG.0b013e3181eda77a. PubMed DOI

Laine K, Pirhonen T, Rolland R, Pirhonen J. Decreasing the incidence of anal sphincter tears during delivery. Obstet Gynecol. 2008;111:1053–1057. doi: 10.1097/AOG.0b013e31816c4402. PubMed DOI

Stedenfeldt M, Øian P, Gissler M, Blix E, Pirhonen J. Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme. BJOG. 2014;121:83–91. doi: 10.1111/1471-0528.12274. PubMed DOI

Laine K, Skjeldestad FE, Sandvik L, Staff AC. Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open. 2012;2:e001649. doi: 10.1136/bmjopen-2012-001649. PubMed DOI PMC

Jansova M, Kalis V, Rusavy Z, Zemcik R, Lobovsky L, Laine K. Modeling manual perineal protection during vaginal delivery. Int Urogynecol J. 2014;25:65–71. doi: 10.1007/s00192-013-2164-1. PubMed DOI

Kleprlikova H, Kalis V, Lucovnik M, Rusavy Z, Blaganje M, Thakar R, et al. Manual perineal protection: the know-how and the know-why. Acta Obstet Gynecol Scand. 2020;99:445–450. doi: 10.1111/aogs.13781. PubMed DOI

Kleprlikova H, Kalis V, Lucovnik M, Rusavy Z, Blaganje M, Thakar R, et al. Slowing of fetal head descent is an integral component of manual perineal protection. Acta Obstet Gynecol Scand. 2020;99:558–559. doi: 10.1111/aogs.13799. PubMed DOI

Jansova M, Kalis V, Lobovsky L, Hyncik L, Karbanova J, Rusavy Z. The role of thumb and index finger placement in manual perineal protection. Int Urogynecol J. 2014;25:1533–1540. doi: 10.1007/s00192-014-2425-7. PubMed DOI

Jansova M, Kalis V, Rusavy Z, Räisänen S, Lobovsky L, Laine K. Fetal head size and effect of manual perineal protection. PLoS One. 2017;12:e0189842. doi: 10.1371/journal.pone.0189842. PubMed DOI PMC

Tolar D, Bischofová R, Hynčík L, Gallo J. Wireless system for monitoring body temperature. In: IFMBE Proceedings; 2015. pp. 150–153.

Zemčík R, Karbanova J, Kalis V, Lobovský L, Jansová M, Rusavy Z. Stereophotogrammetry of the perineum during vaginal delivery. Int J Gynecol Obstet. 2012;119:76–80. doi: 10.1016/j.ijgo.2012.05.018. PubMed DOI

Ali-Masri H, Hassan S, Fosse E, Zimmo KM, Zimmo M, Ismail KMK, et al. Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study. BMC Med Educ. 2018;18:258. doi: 10.1186/s12909-018-1363-3. PubMed DOI PMC

Birth and Regulation of head Extension to Guide Manual perineal Assistance (BREGMA) study: a prospective cohort study

Is the Finnish grip tight enough? A manometric study of two manual perineal protection techniques