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Modified Ritgen's maneuver for anal sphincter injury at delivery: a randomized controlled trial.

Jönsson, Eva Rubin; Elfaghi, Ibtesam; Rydhström, Håkan and Herbst, Andreas LU (2008) In Obstetrics and Gynecology 112(2 Pt 1). p.212-217
Abstract
OBJECTIVE: To investigate whether Ritgen's maneuver decreases the risk of third- to fourth-degree perineal tears compared with simple perineal support. METHODS: A total of 1,623 nulliparous women in term labor, singleton pregnancy, and cephalic presentation were randomly assigned to Ritgen's maneuver or standard care. Ritgen's maneuver denotes extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery. Ritgen's maneuver was performed during a uterine contraction, rather than, as originally recommended, between contractions. Our standard care entailed perineal support with one hand and control of the speed of crowning with... (More)
OBJECTIVE: To investigate whether Ritgen's maneuver decreases the risk of third- to fourth-degree perineal tears compared with simple perineal support. METHODS: A total of 1,623 nulliparous women in term labor, singleton pregnancy, and cephalic presentation were randomly assigned to Ritgen's maneuver or standard care. Ritgen's maneuver denotes extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery. Ritgen's maneuver was performed during a uterine contraction, rather than, as originally recommended, between contractions. Our standard care entailed perineal support with one hand and control of the speed of crowning with the other, and use of Ritgen's maneuver only on specific indications. Women delivered by cesarean delivery (n=10) or instrumentally (n=142) were excluded, as well as 39 erroneously included women (parous or in preterm labor), six inaccurately assigned participants, one with missing data, and two participants who withdrew consent. For the remaining 1,423 women, the result was analyzed according to intention to treat. RESULTS: Ritgen's maneuver was performed in 554 (79.6%) of 696 women randomly assigned to this procedure and in 31 (4.3%) of 727 women randomly assigned to simple perineal support. The rate of third- to fourth-degree tears was 5.5% (n=38) in women assigned to Ritgen's maneuver and 4.4% (n=32) in those assigned to simple perineal support (relative risk 1.24; 95% confidence interval 0.78-1.96). CONCLUSION: Ritgen's maneuver does not decrease the risk of anal sphincter injury at delivery, at least not when performed during a contraction. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Obstetrics and Gynecology
volume
112
issue
2 Pt 1
pages
212 - 217
publisher
Lippincott Williams & Wilkins
external identifiers
  • WOS:000258237100002
  • PMID:18669713
  • Scopus:51649083597
ISSN
1873-233X
DOI
10.1097/AOG.0b013e31817f2867
language
English
LU publication?
yes
id
2c6ba9ab-8c76-4754-8038-99be1a9b3e0f (old id 1223635)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18669713?dopt=Abstract
date added to LUP
2008-09-11 13:36:59
date last changed
2016-10-13 04:35:20
@misc{2c6ba9ab-8c76-4754-8038-99be1a9b3e0f,
  abstract     = {OBJECTIVE: To investigate whether Ritgen's maneuver decreases the risk of third- to fourth-degree perineal tears compared with simple perineal support. METHODS: A total of 1,623 nulliparous women in term labor, singleton pregnancy, and cephalic presentation were randomly assigned to Ritgen's maneuver or standard care. Ritgen's maneuver denotes extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery. Ritgen's maneuver was performed during a uterine contraction, rather than, as originally recommended, between contractions. Our standard care entailed perineal support with one hand and control of the speed of crowning with the other, and use of Ritgen's maneuver only on specific indications. Women delivered by cesarean delivery (n=10) or instrumentally (n=142) were excluded, as well as 39 erroneously included women (parous or in preterm labor), six inaccurately assigned participants, one with missing data, and two participants who withdrew consent. For the remaining 1,423 women, the result was analyzed according to intention to treat. RESULTS: Ritgen's maneuver was performed in 554 (79.6%) of 696 women randomly assigned to this procedure and in 31 (4.3%) of 727 women randomly assigned to simple perineal support. The rate of third- to fourth-degree tears was 5.5% (n=38) in women assigned to Ritgen's maneuver and 4.4% (n=32) in those assigned to simple perineal support (relative risk 1.24; 95% confidence interval 0.78-1.96). CONCLUSION: Ritgen's maneuver does not decrease the risk of anal sphincter injury at delivery, at least not when performed during a contraction.},
  author       = {Jönsson, Eva Rubin and Elfaghi, Ibtesam and Rydhström, Håkan and Herbst, Andreas},
  issn         = {1873-233X},
  language     = {eng},
  number       = {2 Pt 1},
  pages        = {212--217},
  publisher    = {ARRAY(0x986e820)},
  series       = {Obstetrics and Gynecology},
  title        = {Modified Ritgen's maneuver for anal sphincter injury at delivery: a randomized controlled trial.},
  url          = {http://dx.doi.org/10.1097/AOG.0b013e31817f2867},
  volume       = {112},
  year         = {2008},
}