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Comparison on the Effect of “Hands on” versus “ Hands Off” Method on Perineal Trauma and Delivery Outcome among Nulliparous Women

Elsie I. Yap-Icamina, MD; Amethyst Ypil, MD, FPOGS; Pherdes Galbo, MD, FPOGS, FSGOP; Ma. Asuncion Tremedal, MD, FPOGS; Larisa Julia Diaz-Roa, MD, FPOGS
Department of Obstetrics and Gynecology, Cebu Doctors’ University Hospital

Objectives: The study aims to determine the degree of perineal trauma, postpartum perineal pain and fetal outcome in both groups using different maneuvers: “hands on” and “hands off” during the late second stage of labor among nulliparous women without episiotomy.

Design: Prospective Randomized Research Study

Setting: This study was conducted at the Labor / Delivery room complex from June 2012 to February 2013.

Methods: In the second stage of labor, nulliparous women (120) giving birth were randomly allocated to “hands on”(the fetal head delivery was performed by using a towel-draped, gloved hand exerting forward pressure on the chin of the fetus through the perineum just in front of the coccyx) and “hands off” (the OB resident observed the parturient woman and did not touch perineum during the second stage of labor and the other hand exerts pressure superiorly against the occiput while the fetus was delivering) group. The two groups were compared as to their demographic characteristics, perineal trauma, postpartum pain and neonatal outcomes.

Results: All women were nulliparous, term, without episiotomy and had similar demographic characteristics. Pain scores were collected in both groups after delivery. No significant difference in the postpartum pain scale values at 24 hours (p=0.134), 7 days (p=0.866), to 10 days (p=0.77) in both groups. Perineal trauma showed no significant association between laceration (p=0.212). Differences in APGAR Score as a measure of neonatal outcome was similar in both groups.

Conclusions: This study showed that perineal trauma, postpartum perineal pain and neonatal outcome between the “hands on” versus “hands off” have no significant difference. Therefore, it is not necessary to use “hands on” technique on all women in labor during the second stage of labor.