COMPARATIVE ANALYSIS OF WARM COMPRESSES AND THE MODIFIED RITGEN’S TECHNIQUE IN MINIMIZING PERINEAL INJURY DURING THE SECOND STAGE OF LABOR

Abstract

Background: Perineal trauma is a common complication of vaginal birth and may cause postpartum pain, bleeding, infection, dyspareunia, and pelvic-floor dysfunction. Warm perineal compresses and the modified Ritgen’s technique are commonly used to reduce such injury during the second stage of labor. Objective: To compare the frequency and severity of perineal trauma between women managed with warm perineal compresses and those managed with the modified Ritgen’s technique. Methods: This randomized controlled trial included 300 term pregnant women undergoing vaginal delivery at Holy Family Hospital, Rawalpindi. Participants were randomized equally to warm perineal compresses or the modified Ritgen’s technique. This was also studied in Civil Hospital Quetta, Quetta, Pakistan. Maternal characteristics, parity, duration of the second stage, neuraxial analgesia, and perineal outcomes were recorded. Perineal tears were classified by degree, and categorical outcomes were compared using the Chi-square or Fisher’s exact test. Results: Spontaneous perineal tears occurred in 57/150 women (38.0%) receiving warm compresses and 74/150 (49.3%) receiving the modified Ritgen’s technique (p=0.048). An intact perineum was observed in 51.3% versus 40.7%, respectively. Third-degree tears occurred in 3.3% and 5.3%, while no fourth-degree tears occurred in either group. Episiotomy, periurethral injury, neuraxial analgesia use, and second-stage duration were comparable. Conclusion: Warm perineal compresses were associated with fewer overall spontaneous perineal tears than the modified Ritgen’s technique and represent a simple, practical strategy for perineal protection during vaginal delivery, without increasing severe injury or altering anesthetic management.