Do manual therapies to the perineum during the second stage of labor reduce the incidence of genital tract trauma during vaginal deliveries?

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EVIDENCE-BASED ANSWERWarm compresses and perineal massage in the second stage of labor each reduce incidence of third- and fourthdegree lacerations compared with usual care (SOR: A, systematic review of RCTs). “Hands off” reduces the incidence of episiotomy (SOR: B, systematic review and single RCT). Perineal massage does not reduce the incidence of postpartum perineal pain (SOR: B, single RCT). The modified Ritgen maneuver does not reduce perineal trauma (SOR: B, systematic review containing a single RCT).

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