xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06005077</url>
    </required_header>
    <id_info>
      <org_study_id>2018/13</org_study_id>
      <nct_id>NCT06005077</nct_id>
    </id_info>
    <brief_title>Perineal Massage and Warm Application in Labor</brief_title>
    <official_title>Evaluation of the Effect of Perineal Massage and Warm Application on Perineal Trauma, Pain and Birth Comfort in Labor</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Saglik Bilimleri Universitesi Gulhane Tip Fakultesi</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Saglik Bilimleri Universitesi Gulhane Tip Fakultesi</source>
    <oversight_info>
      <has_dmc>Yes</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        The aim of this study is to determine the effect of perineal massage and warm compress&#xD;
        application at first and second stage of labor on perineal trauma, pain and delivery comfort.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Perineal trauma is the damage caused by rupture, laceration or episiotomy during birth.&#xD;
        Birth-related perineal trauma can lead to many short and long-term physical and psychological&#xD;
        morbidities that affect the woman's life. Problems such as pain, bleeding and delay in the&#xD;
        attachment of mother and newborn appear in the early postpartum period. In the following&#xD;
        period problems such as prolapse, incontinence, sexual dysfunction and anxiety may be&#xD;
        experienced.&#xD;
  &#xD;
        This randomised controlled study was executed at a research hospital between May 2018 -&#xD;
        September 2019. The sample of study is made consisted of three intervention groups and a&#xD;
        control group of total 120 pregnant women by randomisation method. Perineal massage, perineal&#xD;
        warm compress application, perineal massage and warm compress was done to the intervention&#xD;
        groups respectively. Nothing was done to the control group. Perineal massage was given for 10&#xD;
        minutes, warm compress application was done 30 minutes three times when cervical dilatation&#xD;
        3-4 cm, 5-7 cm and 8-10 cm respectively. The data was collected by using Socio-Demographic&#xD;
        and Obstetric Data Collection Form, First and Second Stage of Labor Stage Data Collection&#xD;
        Form, Childbirth Comfort Scale, Newborn Data Collection Form, Perineal Trauma and Bleeding&#xD;
        Monitorisation/ Measurement Form, Visual Analogue Scale, Birth Satisfaction Scale and&#xD;
        Perineal Massage and Perineal Warm Compress Application Satisfaction Evaluation Form. When&#xD;
        evaluating the data; number, percentage, mean, standard deviation, median, ANOVA Test, Tukey&#xD;
        Test, Kruskal Wallis Test, Paired Sample T Test, Friedman Test, Ki-Square Test and Fisher's&#xD;
        Exact was used.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Completed</overall_status>
    <start_date type="Actual">May 1, 2018</start_date>
    <completion_date type="Actual">September 1, 2019</completion_date>
    <primary_completion_date type="Actual">June 1, 2019</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Prevention</primary_purpose>
      <masking>Single (Outcomes Assessor)</masking>
      <masking_description>The patients and principle investigator knew which group they were assigned to. Only the outcome assessor didn't know which patient was assigned to which group.</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>Socio-Demographic and Obstetric Data Collection Form</measure>
      <time_frame>Baseline</time_frame>
      <description>The Socio-Demographic and Obstetric Data Form was used to determine the socio-demographic and obstetric characteristics of the participants. This form, created by the investigators, includes 15 questions on age, height, weight, education level, and gestational week of the pregnant women, the way pregnancy occured, and the health problems experienced during pregnancy.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>First and Second Stage of Labor Stage Data Collection Form</measure>
      <time_frame>During procedure</time_frame>
      <description>The First and Second Stage of Labor Data Form and the Newborn Data Form were used to note down the applications performed on the pregnant woman during the first and second stages of labor and on the newborn after delivery. The form created by the investigators following the review of the literature consists of three parts. In the first part, there are questions regarding the applications such as dilatation, wiping, drugs used in the first stage, amniotomy, and bladder catheterization performed when the pregnant woman is admitted into the delivery room. In the second part, there are questions on the application of local anesthesia in the second stage of labor, protection of the perineum, and the type of pushing. The third part consists of questions regarding the height, weight and APGAR measurement of the newborn. This form includes 33 questions in total.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Childbirth Comfort Scale</measure>
      <time_frame>During the procedure</time_frame>
      <description>The Childbirth Comfort Scale (CCS) is used to determine the comfort level at birth. This scale is a 5-point Likert type scale and consists of 14 items. Each item is rated between 1-5 (1: Strongly disagree, 2: Mostly disagree, 3: Partially agree, 4: Mostly agree, 5: Completely agree). The scale has a four-factor structure: physical, psychospiritual, social and environmental.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Birth Satisfaction Scale</measure>
      <time_frame>In the first 1 hour after birth</time_frame>
      <description>The Birth Satisfaction Scale (BSS) is used to evaluate birth satisfaction. This scale is a 5-point Likert-type scale and consists of 30 items. The three main themes of the scale are quality of care, personal characteristics of the women, and stress experienced during childbirth. A minimum of 30 and a maximum of 150 points can be obtained from the scale. Higher scores indicate higher levels of satisfaction.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Perineal Trauma and Bleeding Monitorisation/Measurement Form</measure>
      <time_frame>In the first 1 hour after birth</time_frame>
      <description>The Perineal Trauma, Postpartum Bleeding and Episiotomy Length Evaluation Form was used to record data on perineal trauma and amount of bleeding. The form, created by theinvestigators, consists of 13 questions evaluating conditions such as episiotomy, type of perineal trauma, location and degree of trauma, and postpartum bleeding.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Visual Analogue Scale</measure>
      <time_frame>During procedure</time_frame>
      <description>The Visual Analog Scale (VAS) is a one-dimensional measurement tool used to show perceived pain and its severity. One end of the scale indicates &quot;painlessness (0)&quot; and the other end indicates &quot;the most severe pain possible (10)&quot; .</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Birth Satisfaction Scale</measure>
      <time_frame>In the first 1 hour after birth</time_frame>
      <description>The Newborn Characteristics Data Collection Form consists of 7 questions including the newborn's height, weight and APGAR assessment.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Perineal Massage and Perineal Warm Compress Application Satisfaction Evaluation Form</measure>
      <time_frame>In the first 1 hour after birth</time_frame>
      <description>This form was used to record the phases, periods and durations of perineal massage and perineal heat application, as well as to evaluate the satisfaction with the application. A visual scale graded from 0 to 10 was used in the satisfaction evaluation. It was rated as &quot;0&quot; not at all satisfied, &quot;10&quot; very satisfied.In addition, the participants were asked whether the application was beneficial, whether participants would prefer it when they gave birth again, and whether they would recommend it to others. It was created by the researcher and expert approval was obtained.</description>
    </primary_outcome>
    <number_of_arms>4</number_of_arms>
    <enrollment type="Actual">120</enrollment>
    <condition>Perineal Injury</condition>
    <condition>Pain</condition>
    <condition>Labor</condition>
    <arm_group>
      <arm_group_label>Control group</arm_group_label>
      <arm_group_type>No Intervention</arm_group_type>
      <description>After the hospitalization procedures were completed, the pregnant women in the control group were informed and their written consents were obtained. No intervention was performed on these pregnant women other than routine hospital practices. Data collection forms were applied.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Perineal Massage</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>While the pregnant woman was in the lithotomy position, massage was applied with two fingers and rhythmic U-shaped movements starting from the side walls 3-4 cm inside the vagina and towards the rectum. This implementation was done for 10 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Perineal Warm Compress Application</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Sterile compresses kept in hot water of 40 C were placed on the perineum. Compresses that cooled down and became dirty were changed every 5-8 minutes. This implementation was done for 30 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Perineal Massage and Perineal Warm Compress Application</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>When the cervical dilatation was 3-4 cm, 30 minutes of warm compress and 10 minutes of perineal massage were performed. These two methods were applied when the cervical dilatation was 5-7 cm and 8-10 cm as well.</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Perineal Massage Group</intervention_name>
      <description>While the pregnant woman was in the lithotomy position, massage was applied with two fingers and rhythmic U-shaped movements starting from the side walls 3-4 cm inside the vagina and towards the rectum. This implementation was done for 10 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.</description>
      <arm_group_label>Perineal Massage</arm_group_label>
      <arm_group_label>Perineal Massage and Perineal Warm Compress Application</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Perineal Warm Compress Application Group</intervention_name>
      <description>Sterile compresses kept in hot water of 40 C were placed on the perineum. Compresses that cooled down and became dirty were changed every 5-8 minutes. This implementation was done for 30 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.</description>
      <arm_group_label>Perineal Warm Compress Application</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Perineal Massage and Perineal Warm Compress Application Group</intervention_name>
      <description>When the cervical dilatation was 3-4 cm, 30 minutes of warm compress and 10 minutes of perineal massage were performed. These two methods were applied when the cervical dilatation was 5-7 cm and 8-10 cm as well .</description>
      <arm_group_label>Perineal Massage and Perineal Warm Compress Application</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Primiparous&#xD;
  &#xD;
            -  38&quot;week of pregnancy&#xD;
  &#xD;
            -  Singleton pregnancy&#xD;
  &#xD;
            -  Cervical dilatation 3&quot;cm&#xD;
  &#xD;
            -  Cephalic presentation&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Chronic disease&#xD;
  &#xD;
            -  Presence of fetal macrosomia&#xD;
  &#xD;
            -  Presence of uterin surgery&#xD;
  &#xD;
            -  Presence of fetal anomaly&#xD;
        </textblock>
      </criteria>
      <gender>Female</gender>
      <gender_based>Yes</gender_based>
      <gender_description>Only women who were going to give birth were included in the study.</gender_description>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>40 Years</maximum_age>
      <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Gamze Acavut</last_name>
      <role>Principal Investigator</role>
      <affiliation>Ankara Medipol University</affiliation>
    </overall_official>
    <location>
      <facility>
        <name>Gamze Acavut</name>
        <address>
          <city>Ankara</city>
          <zip>06010</zip>
          <country>Turkey</country>
        </address>
      </facility>
    </location>
    <location_countries>
      <country>Turkey</country>
    </location_countries>
    <reference>
      <citation>Ducarme G, Pizzoferrato AC, de Tayrac R, Schantz C, Thubert T, Le Ray C, Riethmuller D, Verspyck E, Gachon B, Pierre F, Artzner F, Jacquetin B, Fritel X. Perineal prevention and protection in obstetrics: CNGOF clinical practice guidelines. J Gynecol Obstet Hum Reprod. 2019 Sep;48(7):455-460. doi: 10.1016/j.jogoh.2018.12.002. Epub 2018 Dec 12.</citation>
      <PMID>30553051</PMID>
    </reference>
    <reference>
      <citation>Fukami T, Koga H, Goto M, Ando M, Matsuoka S, Tohyama A, Yamamoto H, Nakamura S, Koyanagi T, To Y, Kondo H, Eguchi F, Tsujioka H. Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. PLoS One. 2019 Jan 9;14(1):e0208873. doi: 10.1371/journal.pone.0208873. eCollection 2019.</citation>
      <PMID>30625154</PMID>
    </reference>
    <reference>
      <citation>Barasinski C, Debost-Legrand A, Lemery D, Vendittelli F. Practices during the active second stage of labor: A survey of French midwives. Midwifery. 2018 May;60:48-55. doi: 10.1016/j.midw.2018.02.001. Epub 2018 Feb 8.</citation>
      <PMID>29494852</PMID>
    </reference>
    <reference>
      <citation>Difranco JT, Romano AM, Keen R. Care practice #5: spontaneous pushing in upright or gravity-neutral positions. J Perinat Educ. 2007 Summer;16(3):35-8. doi: 10.1624/105812407X217138.</citation>
      <PMID>18566649</PMID>
    </reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>January 30, 2023</study_first_submitted>
    <study_first_submitted_qc>August 14, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 22, 2023</study_first_posted>
    <last_update_submitted>August 29, 2023</last_update_submitted>
    <last_update_submitted_qc>August 29, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 31, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Saglik Bilimleri Universitesi Gulhane Tip Fakultesi</investigator_affiliation>
      <investigator_full_name>Gamze Acavut</investigator_full_name>
      <investigator_title>Asst. Prof</investigator_title>
    </responsible_party>
    <keyword>Labor</keyword>
    <keyword>Perineal massage</keyword>
    <keyword>Perineal warm compress</keyword>
    <keyword>Perineal Trauma</keyword>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06005077
  org study id: 2018/13
  nct id: NCT06005077
  lead sponsor: 
  has dmc: Yes
  is fda regulated drug: No
  is fda regulated device: No
  The aim of this study is to determine the effect of perineal massage and warm compress
        application at first and second stage of labor on perineal trauma, pain and delivery comfort.
  Perineal trauma is the damage caused by rupture, laceration or episiotomy during birth.
        Birth-related perineal trauma can lead to many short and long-term physical and psychological
        morbidities that affect the woman's life. Problems such as pain, bleeding and delay in the
        attachment of mother and newborn appear in the early postpartum period. In the following
        period problems such as prolapse, incontinence, sexual dysfunction and anxiety may be
        experienced.
  
        This randomised controlled study was executed at a research hospital between May 2018 -
        September 2019. The sample of study is made consisted of three intervention groups and a
        control group of total 120 pregnant women by randomisation method. Perineal massage, perineal
        warm compress application, perineal massage and warm compress was done to the intervention
        groups respectively. Nothing was done to the control group. Perineal massage was given for 10
        minutes, warm compress application was done 30 minutes three times when cervical dilatation
        3-4 cm, 5-7 cm and 8-10 cm respectively. The data was collected by using Socio-Demographic
        and Obstetric Data Collection Form, First and Second Stage of Labor Stage Data Collection
        Form, Childbirth Comfort Scale, Newborn Data Collection Form, Perineal Trauma and Bleeding
        Monitorisation/ Measurement Form, Visual Analogue Scale, Birth Satisfaction Scale and
        Perineal Massage and Perineal Warm Compress Application Satisfaction Evaluation Form. When
        evaluating the data; number, percentage, mean, standard deviation, median, ANOVA Test, Tukey
        Test, Kruskal Wallis Test, Paired Sample T Test, Friedman Test, Ki-Square Test and Fisher's
        Exact was used.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Prevention
  masking: Single (Outcomes Assessor)
  masking description: The patients and principle investigator knew which group they were assigned to. Only the outcome assessor didn't know which patient was assigned to which group.
  measure: Socio-Demographic and Obstetric Data Collection Form
  time frame: Baseline
  description: The Socio-Demographic and Obstetric Data Form was used to determine the socio-demographic and obstetric characteristics of the participants. This form, created by the investigators, includes 15 questions on age, height, weight, education level, and gestational week of the pregnant women, the way pregnancy occured, and the health problems experienced during pregnancy.
  measure: First and Second Stage of Labor Stage Data Collection Form
  time frame: During procedure
  description: The First and Second Stage of Labor Data Form and the Newborn Data Form were used to note down the applications performed on the pregnant woman during the first and second stages of labor and on the newborn after delivery. The form created by the investigators following the review of the literature consists of three parts. In the first part, there are questions regarding the applications such as dilatation, wiping, drugs used in the first stage, amniotomy, and bladder catheterization performed when the pregnant woman is admitted into the delivery room. In the second part, there are questions on the application of local anesthesia in the second stage of labor, protection of the perineum, and the type of pushing. The third part consists of questions regarding the height, weight and APGAR measurement of the newborn. This form includes 33 questions in total.
  measure: Childbirth Comfort Scale
  time frame: During the procedure
  description: The Childbirth Comfort Scale (CCS) is used to determine the comfort level at birth. This scale is a 5-point Likert type scale and consists of 14 items. Each item is rated between 1-5 (1: Strongly disagree, 2: Mostly disagree, 3: Partially agree, 4: Mostly agree, 5: Completely agree). The scale has a four-factor structure: physical, psychospiritual, social and environmental.
  measure: Birth Satisfaction Scale
  time frame: In the first 1 hour after birth
  description: The Birth Satisfaction Scale (BSS) is used to evaluate birth satisfaction. This scale is a 5-point Likert-type scale and consists of 30 items. The three main themes of the scale are quality of care, personal characteristics of the women, and stress experienced during childbirth. A minimum of 30 and a maximum of 150 points can be obtained from the scale. Higher scores indicate higher levels of satisfaction.
  measure: Perineal Trauma and Bleeding Monitorisation/Measurement Form
  time frame: In the first 1 hour after birth
  description: The Perineal Trauma, Postpartum Bleeding and Episiotomy Length Evaluation Form was used to record data on perineal trauma and amount of bleeding. The form, created by theinvestigators, consists of 13 questions evaluating conditions such as episiotomy, type of perineal trauma, location and degree of trauma, and postpartum bleeding.
  measure: Visual Analogue Scale
  time frame: During procedure
  description: The Visual Analog Scale (VAS) is a one-dimensional measurement tool used to show perceived pain and its severity. One end of the scale indicates "painlessness (0)" and the other end indicates "the most severe pain possible (10)" .
  measure: Birth Satisfaction Scale
  time frame: In the first 1 hour after birth
  description: The Newborn Characteristics Data Collection Form consists of 7 questions including the newborn's height, weight and APGAR assessment.
  measure: Perineal Massage and Perineal Warm Compress Application Satisfaction Evaluation Form
  time frame: In the first 1 hour after birth
  description: This form was used to record the phases, periods and durations of perineal massage and perineal heat application, as well as to evaluate the satisfaction with the application. A visual scale graded from 0 to 10 was used in the satisfaction evaluation. It was rated as "0" not at all satisfied, "10" very satisfied.In addition, the participants were asked whether the application was beneficial, whether participants would prefer it when they gave birth again, and whether they would recommend it to others. It was created by the researcher and expert approval was obtained.
  arm group label: Control group
  arm group type: No Intervention
  description: After the hospitalization procedures were completed, the pregnant women in the control group were informed and their written consents were obtained. No intervention was performed on these pregnant women other than routine hospital practices. Data collection forms were applied.
  arm group label: Perineal Massage
  arm group type: Experimental
  description: While the pregnant woman was in the lithotomy position, massage was applied with two fingers and rhythmic U-shaped movements starting from the side walls 3-4 cm inside the vagina and towards the rectum. This implementation was done for 10 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.
  arm group label: Perineal Warm Compress Application
  arm group type: Experimental
  description: Sterile compresses kept in hot water of 40 C were placed on the perineum. Compresses that cooled down and became dirty were changed every 5-8 minutes. This implementation was done for 30 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.
  arm group label: Perineal Massage and Perineal Warm Compress Application
  arm group type: Experimental
  description: When the cervical dilatation was 3-4 cm, 30 minutes of warm compress and 10 minutes of perineal massage were performed. These two methods were applied when the cervical dilatation was 5-7 cm and 8-10 cm as well.
  intervention type: Other
  intervention name: Perineal Massage Group
  description: While the pregnant woman was in the lithotomy position, massage was applied with two fingers and rhythmic U-shaped movements starting from the side walls 3-4 cm inside the vagina and towards the rectum. This implementation was done for 10 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.
  arm group label: Perineal Massage
  arm group label: Perineal Massage and Perineal Warm Compress Application
  intervention type: Other
  intervention name: Perineal Warm Compress Application Group
  description: Sterile compresses kept in hot water of 40 C were placed on the perineum. Compresses that cooled down and became dirty were changed every 5-8 minutes. This implementation was done for 30 minutes in three stages according to cervical dilatation. It was applied when the cervical dilatation was 3-4 cm, 5-7 cm, and 8-10 cm.
  arm group label: Perineal Warm Compress Application
  intervention type: Other
  intervention name: Perineal Massage and Perineal Warm Compress Application Group
  description: When the cervical dilatation was 3-4 cm, 30 minutes of warm compress and 10 minutes of perineal massage were performed. These two methods were applied when the cervical dilatation was 5-7 cm and 8-10 cm as well .
  arm group label: Perineal Massage and Perineal Warm Compress Application
  criteria: 
  gender: Female
  gender based: Yes
  gender description: Only women who were going to give birth were included in the study.
  minimum age: 18 Years
  maximum age: 40 Years
  healthy volunteers: Accepts Healthy Volunteers
  last name: Gamze Acavut
  role: Principal Investigator
  affiliation: Ankara Medipol University
  facility: 
  country: Turkey
  citation: Ducarme G, Pizzoferrato AC, de Tayrac R, Schantz C, Thubert T, Le Ray C, Riethmuller D, Verspyck E, Gachon B, Pierre F, Artzner F, Jacquetin B, Fritel X. Perineal prevention and protection in obstetrics: CNGOF clinical practice guidelines. J Gynecol Obstet Hum Reprod. 2019 Sep;48(7):455-460. doi: 10.1016/j.jogoh.2018.12.002. Epub 2018 Dec 12.
  PMID: 30553051
  citation: Fukami T, Koga H, Goto M, Ando M, Matsuoka S, Tohyama A, Yamamoto H, Nakamura S, Koyanagi T, To Y, Kondo H, Eguchi F, Tsujioka H. Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. PLoS One. 2019 Jan 9;14(1):e0208873. doi: 10.1371/journal.pone.0208873. eCollection 2019.
  PMID: 30625154
  citation: Barasinski C, Debost-Legrand A, Lemery D, Vendittelli F. Practices during the active second stage of labor: A survey of French midwives. Midwifery. 2018 May;60:48-55. doi: 10.1016/j.midw.2018.02.001. Epub 2018 Feb 8.
  PMID: 29494852
  citation: Difranco JT, Romano AM, Keen R. Care practice #5: spontaneous pushing in upright or gravity-neutral positions. J Perinat Educ. 2007 Summer;16(3):35-8. doi: 10.1624/105812407X217138.
  PMID: 18566649
  responsible party type: Principal Investigator
  investigator affiliation: Saglik Bilimleri Universitesi Gulhane Tip Fakultesi
  investigator full name: Gamze Acavut
  investigator title: Asst. Prof
  sharing ipd: No