Multidisciplinary Journal of Science and Technology

THE EFFECTIVENESS OF PRENATAL PELVIC FLOOR MUSCLE EXERCISES AND BIOTECHNOLOGICAL APPROACHES IN PREVENTING PERINEAL TRAUMA IN PRIMIPAROUS WOMEN

Saidova Z.SH,

Samarkand State Medical University

Zakirova N.I

Samarkand State Medical University

Keywords: perineal trauma, primiparous women

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Abstract

Perineal trauma, including spontaneous tears and episiotomies, affects 35–55% of primiparous women during vaginal delivery, leading to acute and chronic complications such as pain, incontinence, and reduced quality of life. In Uzbekistan, where primiparous births account for 62% of deliveries, high trauma rates (45%) reflect limited prenatal interventions. This randomized controlled trial (RCT) assessed the efficacy of prenatal pelvic floor muscle exercises (PFME), biotechnological approaches (Epi-No perineal massage device), and their combination in reducing perineal trauma among 200 primiparous women aged 18–35 across Tashkent, Andijan, Samarkand, and Bukhara maternity clinics from January 2023 to October 2024. Participants were randomized into four groups: PFME, biotechnology, combined intervention, and standard care (control). Primary outcomes were perineal tear rates (1st–4th degree) and episiotomy incidence. Secondary outcomes included labor duration, pain scores, postpartum continence, sexual function, quality of life, and intervention compliance at 6 weeks, 3 months, and 6 months post-delivery. The combined approach reduced severe tears by 40% (7% vs. 18% in controls, p<0.001) and episiotomies by 30% (15% vs. 42%, p<0.001). PFME alone lowered tears by 25%, and biotechnology reduced episiotomies by 20%. At 6 months, 90% of the combined group reported full continence versus 65% in controls. Compliance was highest in PFME (88%) and combined groups (85%). These results advocate integrating PFME and biotechnology into Uzbekistan’s maternity care, offering a cost-effective, scalable model for low- to middle-income countries (LMICs) to enhance maternal health outcomes globally.

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References

1. Smith, L.A., Price, N., Simonite, V. et al. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth 13, 59 (2013). https://doi.org/10.1186/1471-2393-13-59

2. McDonald, E. A., & Brown, S. J. (2013). Quality of life after perineal trauma: A longitudinal study. Birth, 40(4), 252–259. https://doi.org/10.1111/birt.12056

3. Makhkamova, M. T., & Rakhimova, N. K. (2020). Perineal trauma outcomes in Uzbekistan: A hospital-based study. Central Asian Journal of Medical Sciences, 6(2), 45–52.

4. Uzbekistan State Statistics Committee. (2024). Demographic and health indicators: Uzbekistan 2023. Tashkent: SSC.

5. Priddis H, Schmied V, Dahlen H. Women's experiences following severe perineal trauma: a qualitative study. BMC Womens Health. 2014 Feb 21;14(1):32. doi: 10.1186/1472-6874-14-32. PMID: 24559056; PMCID: PMC3933507.

6. Boyle R, Hay-Smith EJ, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review. Neurourol Urodyn. 2014 Mar;33(3):269-76. doi: 10.1002/nau.22402. Epub 2013 Apr 24. PMID: 23616292.

7. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD003882. DOI: 10.1002/14651858.CD003882.pub4

8. Chen Q, Qiu X, Fu A, Han Y. Effect of Prenatal Perineal Massage on Postpartum Perineal Injury and Postpartum Complications: A Meta-Analysis. Comput Math Methods Med. 2022 Jul 14;2022:3315638. doi: 10.1155/2022/3315638. PMID: 35872935; PMCID: PMC9303122.

9. Ashton-Miller, J. A., & DeLancey, J. O. L. (2009). Biomechanics of the female pelvic floor. Annals of the New York Academy of Sciences, 1101, 123–136. https://doi.org/10.1111/j.1749-6632.2009.04087.x

10. Ibragimova Xanifa Matkarimovna, Ubaydullayeva Dilfuza Djurabayevna HEALTHCARE SYSTEM IN UZBEKISTAN AND ITS LEGAL FRAMEWORK // Мировая наука. 2018. №12 (21). URL: https://cyberleninka.ru/article/n/healthcare-system-in-uzbekistan-and-its-legal-framework (дата обращения: 14.04.2025).

11. Villot A, Deffieux X, Demoulin G, Rivain AL, Trichot C, Thubert T. Prise en charge des périnées complets (déchirure périnéale stade 3 et 4) : revue de la littérature [Management of third and fourth degree perineal tears: A systematic review]. J Gynecol Obstet Biol Reprod (Paris). 2015 Nov;44(9):802-11. French. doi: 10.1016/j.jgyn.2015.06.005. Epub 2015 Jul 2. PMID: 26143094.

12. Sharma, B.B., Jones, L., Loxton, D.J. et al. Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia. BMC Pregnancy Childbirth 18, 327 (2018). https://doi.org/10.1186/s12884-018-1964-1

13. Ahmedov, Mohir & Azimov, Ravshan & Mutalova, Zulkhumor & Huseynov, Shahin & Tsoyi, Elena & Rechel, Bernd. (2014). Uzbekistan: health system review. Health systems in transition. 16. 1-137.

14. World Bank. (2020). Maternal health in Central Asia: A regional analysis. Washington, DC: World Bank Group.

15. Rakhimova Sadohat Mechanisms of state support for the medical services market // Бюллетень науки и практики. 2018. №11. URL: https://cyberleninka.ru/article/n/mechanisms-of-state-support-for-the-medical-services-market (дата обращения: 14.04.2025).

16. Beckmann, M. M., & Garrett, A. J. (2006). Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews, (1), CD005123. https://doi.org/10.1002/14651858.CD005123.pub2

17. Woodley, S. J., Boyle, R., Cody, J. D., et al. (2020). Pelvic floor muscle training for preventing and treating incontinence. Cochrane Database of Systematic Reviews, (5), CD005407. https://doi.org/10.1002/14651858.CD005407.pub4

18. World Health Organization. (2018). WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: WHO.