The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes : a systematic review and meta-analysis

Introduction and hypothesis: The current data on the effectiveness of antenatal pelvic floor muscle exercises (PFME) on childbirth outcomes are limited. Therefore, in this study the effect of antenatal PFMEs on labour and birth outcomes was assessed by undertaking a meta-analysis. Methods: Databases were systematically searched from 1988 until June 2019. Randomised controlled trials (RCTs) and quasi-experimental studies were included. The methodological quality of studies was assessed using Cochrane Collaboration tools. The outcomes of interest were: duration of first and second stage of labour, episiotomy and perineal outcomes, mode of birth (spontaneous vaginal birth, instrumental birth and caesarean section) and fetal presentation. The mean difference (MD) and risk ratio RR) with the corresponding 95% confidence intervals (CIs) were calculated to assess the association between PFME and the childbirth outcomes. Results: A total of 16 articles were included (n = 2,829 women). PFME shortened the duration of the second stage of labour (MD: −20.90, 95%, CI: −31.82 to −9.97, I2: 0%, p = 0.0002) and for primigravid women (MD: -21.02, 95% CI: −32.10 to −9.94, I2: 0%, p = 0.0002). PFME also reduced severe perineal lacerations (RR 0.57, 95% CI: 0.38 to 0.84, I2: 30%, p = 0.005). No significant difference was seen in normal vaginal birth, caesarean section, instrumental birth and episiotomy rate. Most of the studies carried a moderate to high risk of bias. Conclusion: Antenatal PFME may be effective at shortening the second stage of labour and reducing severe perineal trauma. These findings need to be interpreted considering the included studies’ risk of bias. More high-quality RCTs are needed