RESEARCH PAPER
Ritgen’s maneuver in childbirth care: A case-control study in a Central Italian setting
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1
UOC di Ostetricia e Patologia
Ostetrica, Dipartimento di
Scienze della Salute della Donna
e del Bambino e di Sanità
Pubblica, Fondazione Policlinico
Universitario ‘A. Gemelli’, IRCCS,
Roma, Italia
2
Università Cattolica del Sacro
Cuore, Roma, Italia
These authors had equal contribution to this work
Submission date: 2024-04-28
Final revision date: 2024-08-15
Acceptance date: 2024-08-28
Publication date: 2024-11-01
Corresponding author
Silvia Salvi
Dipartimento di
Scienze della Salute della Donna
e del Bambino e di Sanità
Pubblica, Fondazione Policlinico
Agostino Gemelli IRCCS, Largo
Agostino Gemelli, 8, 00168
Roma, Italia
Eur J Midwifery 2024;8(November):65
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Vaginal delivery can cause genital tract trauma and lacerations of different
severity. This study aims to establish if routinary use of Ritgen’s maneuver decreases the
prevalence and severity of perineal lacerations compared to the traditional manual perineal
protection (MPP).
Methods:
This prospective case-control study was conducted in the labor ward of
Fondazione Policlinico A. Gemelli, Rome, Italy. One hundred sixteen women who met
inclusion criteria were included. The study group (n=58) consisted of women who were
assisted using the Ritgen maneuver, whereas the women who gave birth immediately
afterward were selected as the control group (n=58). All information was retrieved through
electronic medical records.
Results:
In all, 22% women of the study group reported no perineal lacerations compared
with 5% of the control group (p=0.007). Regarding the degree of lacerations, the study
group exhibited more first-degree lacerations and fewer second-degree lacerations, while
the control group exhibited the opposite trend. Among women who received epidural
analgesia, 24% of the study group did not experience perineal lacerations, compared to
4.5% of the control (OR=0.15; 95% CI: 0.03–0.72; p=0.008). Similarly, 23.4% of cases in
the study group with oxytocin-enhanced labor, experienced no perineal trauma while none
in the control group had no perineal trauma in cases of oxytocin augmentation (p=0.005).
Conclusions:
Our results suggest that using Ritgen’s maneuver in childbirth care may
reduce the incidence and severity of perineal lacerations, even in the presence of known
risk factors for perineal lacerations such as oxytocin augmentation and epidural analgesia.
ACKNOWLEDGEMENTS
We would like to thank all the women and their babies, who
participated in the study. We also would like to thank the Italian
Ministry of Health: current research year 2024.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form
for disclosure of Potential Conflicts of Interest and none was
reported.
FUNDING
There was no source of funding for this research.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval was obtained from the Institutional Review Board
of the Institute of Obstetrics and Gynecology of the Catholic
University of the Sacred Heart, Rome, where the project has
been developed (Approval number: IST CICOG-04-03-19/14).
Participants provided informed consent.
DATA AVAILABILITY
The data supporting this research are available from the authors
on reasonable request.
AUTHORS' CONTRIBUTIONS
SS, MD, AR and JP: conceived the study and conducted data
collection. SS conducted the statistical analysis, collaborated on
drafting the article, and reviewed the final version. FTA drafted the
article, and edited and reviewed the final version. RR, SB and FS
assisted with data collection, collaborated on drafting the article,
and reviewed the final version. AL, JP, GA and MD supervised data
collection, and edited and reviewed the final version. All authors
read and agreed on the final version of the manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
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