BACKGROUND: The exact positioning of the dominant hand at the time of manual perineal protection (MPP) is not clearly specified. The main aim of this work was to identify the place on the perineum where pressure needs to be applied to achieve optimal forward fetal head displacement away from the anal sphincters using the bregma to posterior fourchette distance (BFD) and the perineal body length (PBL). METHODS: This was a two-center prospective cohort study. Term cephalic singleton nulliparous women having spontaneous vaginal delivery were considered eligible for recruitment into the study. Once crowning was diagnosed and just prior the initiation of manual perineal protection (MPP) or cutting an episiotomy, the BFD and PBL were measured using a standardized measurement protocol. RESULTS AND DISCUSSION: A total of 100 women (50 women in each center) were recruited into the study. The overall mean BFD was 2.8 ± 0.5 cm. The overall mean PBL was 4.4 ± 0.8 cm. There were no statistically significant differences between the measurements taken in both units regarding BFD or PBL (p = 0.81 and 0.10 respectively). There was a weak correlation between both measurements. Based on our measured parameters, it seems that the most effective point to apply perineal pressure to displace the head away from the anus is approximately 1 - 1.5 cm anterior to the anal margin. CONCLUSION: Measurements generated by this study will form the bases of future biomechanical studies to confirm their validity.

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

Department of Obstetrics and Gynecology Agaplesion General Hospital Hagen Hagen Germany

Department of Obstetrics and Gynecology Faculty of Medicine Ain Shams University 38 Abbassia Next to the Al Nour Mosque Cairo 1181 Egypt

Department of Obstetrics and Gynecology Faculty of Medicine in Pilsen Charles University Alej Svobody 76 Pilsen 304 60 Czech Republic

Department of Obstetrics and Gynecology Feldkirch Academic Teaching Hospital Carinagasse 47 Feldkirch 6800 Austria

Department of Obstetrics and Gynecology University Hospital Pilsen Czech Republic

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