Systematic review of pelvic floor interventions during pregnancy

Background: Pelvic floor interventions during pregnancy could reduce the impact of pregnancy and delivery on the pelvic floor. Objective: To determine the effects of pelvic floor interventions during pregnancy on childbirth-related and pelvic floor parameters. Search strategy: PubMed, Embase, and LILACS were searched for reports published during between 1990 and 2016 in English, Spanish, or Portuguese. The search terms were pregnancy, pelvic floor muscle training, and related terms. Selection criteria: Randomized controlled trials with healthy pregnant women were included. Data collection and analysis: Baseline and outcome data (childbirth-related parameters, pelvic floor symptoms) were compared for three interventions: EPI-NO (Tecsana, Munich, Germany) perineal dilator, pelvic floor muscle training, and perineal massage. Main results: A total of 22 trials were included. Two of three papers assessing EPI-NO showed no benefit. The largest study investigating pelvic floor muscle training reported a significant reduction in the duration of the second stage of labor (P<0.01), and this intervention also reduced the incidence of urinary incontinence (evaluated in 10 trials). Two of six trials investigating perineal massage reported that a lower rate of perineal pain was associated with this intervention. Conclusion: Pelvic floor muscle training and perineal massage improved childbirth-related parameters and pelvic floor symptoms, whereas EPI-NO showed no benefit.