The effectiveness of care bundles for preventing or reducing perineal trauma during childbirth: A systematic review and meta-analysis.

BACKGROUND

Care bundles comprise of a set of evidence-based interventions that are combined and applied consistently during each care episode. Recently, care bundles for perineal protection during childbirth have been developed.

OBJECTIVE

To evaluate the effectiveness of perineal protection care bundles.

METHODS

A systematic review was performed. MEDLINE, CINAHL, Embase, and CENTRAL were searched from January 2000 to December 2024. The Effective Public Health Practice Project tool was used to assess study methodological quality. Data were extracted independently by two reviewers and combined using the generic inverse variance and a random effect model in RevMan version 5.4 software. Odds ratios (OR) with 95 % confidence intervals (CI) were calculated. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.

FINDINGS: Twelve studies reporting on six different types of perineal protection care bundles were included. Fewer obstetric anal sphincter injury (OASI) occurred with care bundle use (Odds Ratio (OR) 0.72, 95 % Confidence Interval (CI) 0.57-0.90, low certainty evidence). No differences between groups were found for second degree injury (OR 0.92, 95 % CI 0.68-1.25) or for episiotomy overall. Compliance to the bundles ranged from 35 % to 80 %.

DISCUSSION: The use of perineal protection care bundles may reduce OASI during childbirth. The evidence, however, is of low certainty and fraught with clinical and methodological heterogeneity.

CONCLUSION

Insufficient, high certainty evidence exists for use of perineal protection care bundles. A more standardised approach to care bundle development and evaluation is recommended.