Intervention Review

You have free access to this content

Hyaluronidase for reducing perineal trauma

  1. Fan Zhou1,
  2. Xiao Dong Wang1,*,
  3. Jing Li2,
  4. Gui Qiong Huang1,
  5. Bing Xin Gao1

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 5 FEB 2014

Assessed as up-to-date: 1 APR 2013

DOI: 10.1002/14651858.CD010441.pub2

How to Cite

Zhou F, Wang XD, Li J, Huang GQ, Gao BX. Hyaluronidase for reducing perineal trauma. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD010441. DOI: 10.1002/14651858.CD010441.pub2.

Author Information

  1. 1

    West China Second University Hospital, Sichuan University, Department of Obstetrics and Gynaecology, Chengdu, Sichuan, China

  2. 2

    West China Hospital, Sichuan University, Chinese Cochrane Centre, Chengdu, Sichuan, China

*Xiao Dong Wang, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Renmin Nan Road, Chengdu, Sichuan, 610041, China.

Publication History

  1. Publication Status: New
  2. Published Online: 5 FEB 2014



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Chatfield 1966 {published data only}
  • Chatfield WR, Moir DD. The effect of hyaluronidase on the perineum. A controlled trial of 200 primigravid patients in labour. Journal of Obstetrics and Gynaecology of the British Commonwealth 1966;73:670-1.
Colacioppo 2011 {published data only}
O'Leary 1965 {published data only}
  • O'Leary JA, Erez S. Hyaluronidase as an adjuvant to episiotomy. Obstetrics & Gynecology 1965;26(1):66-9.
Scarabotto 2008 {published data only}

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Giri 1969 {published data only}
  • Giri AK, Sarkar A, Banerjee P. Use of hyaluronidase with lignocaine hydrochloride for local infiltration during episiotomy. Journal of Obstetrics and Gynaecology of India 1969;19(6):705-9.
Nashar 2011 {published data only}
  • Nashar S, Nikolov A, Atanasova M, Garnizov T. [Efficiency of Cikatridina spray for healing of episiotomy and perineal ruptures]. [Bulgarian]. Akusherstvo i Ginekologiia 2011;50(3):20-5.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Aasheim 2011
Albers 2005
Albers 2006
Altman 2007
  • Altman D, Ragnar I, Ekstrom A, Tyden T, Olsson SE. Anal sphincter lacerations and upright delivery postures - a risk analysis from a randomized controlled trial. International Urogynecology Journal 2007;18(2):141-6.
Andrews 2006
Andrews 2007
  • Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia - a prospective study. European Journal of Obstetrics, Gynecology and Reproductive Biology 2007;137:152-6.
Attarha 2009
  • Attarha M, Vakilian K, Akbari Torkestani N, Heydari T, Bayatian Y. Effect of perineal massage during second phase of labor on episiotomy and laceration rates among nulliparous women. HAYAT 2009;15(3):15-22.
Barrett 2000
Beckmann 2013
Boyles 2009
  • Boyles SH, Li H, Mori T. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstetrics and Gynecology 2009;113(1):134-41.
Brement 2007
  • Brement S, Mossan S, Belery A, Racinet C. Delivery in lateral position. Randomized clinical trial comparing the maternal positions in lateral position and dorsal position for the second stage of labour. Gynecologie, Obstetrique and Fertilite 2007;35:637-44.
Byrd 2005
Carroli 2009
Carroll 2003
  • Carroll TG, Engelken M, Mosier MC, Nazir N. Epidural analgesia and severe perineal laceration in a community-based obstetric practice. Journal of the American Board of Family Practice 2003;16(1):1-6.
Christianson 2003
Dahlen 2007
Dahlen 2009
  • Dahlen HG,  Homer CS,  Cooke M,  Upton AM,  Nunn RA,  Brodrick BS. 'Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour. Midwifery 2009;25(2):39-48.
Dannecker 2004
  • Dannecker C, Hillemanns P, Strauss A, Hasbargen U, Hepp H, Anthuber C. Episiotomy and perineal tears presumed to be imminent: randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica 2004;83(4):364-8.
Davidson 2000
  • Davidson K, Jacoby S, Brown MS. Prenatal perineal massage: preventing lacerations during delivery. Journal of Obstetric, Gynecologic and Neonatal Nursing 2000;29(5):474-9.
Digonnet 1952
  • Digonnet L, Cahn J, Roy J, Boucet J. Effect of local injection of hyaluronidase on perineal distension in labor in primiparas. Therapie 1952;7:388-91.
Downe 2003
  • Downes S. Transition and the second stage of labour. Myles Textbook for Midwives. Edinburgh: Churchill Livingstone, 2003.
Eason 2002
Edwards 2006
  • EdwardsH, Grotegut C, Harmanli OH, Rapkin D. Is severe perineal damage increased in women with prior anal sphincter injury?. Journal of Maternal-fetal and Neonatal Medicine 2006;19(11):723-7.
Ekeus 2008
Eskandar 2009
Fenner 2003
  • Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. American Journal of Obstetrics and Gynecology 2003;189(6):1543-9.
Fitzpatrick 2003
Girish 2007
Goldberg 2003
  • GoldbergJ, Hyslop T, Tolosa JE, Sultana C. Racial differences in severe perineal lacerations after vaginal delivery. American Journal of Obstetrics and Gynecology 2003;188(4):1063-7.
Graham 2005
Hartman 2005
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from
Hirayama 2012
Kalichman 2008
Kudish 2008
  • KudishB, Sokol RJ, Kruger M. Trends in major modifiable risk factors for severe perineal trauma, 1996-2006. BJOG: an international journal of obstetrics and gynaecology 2008;102(2):165-70.
Lowder 2007
  • Lowder JL, Burrows LJ, Krohn MA, Weber AM. Risk factors for primary and subsequent anal sphincter lacerations: a comparison of cohorts by parity and prior mode of delivery. American Journal of Obstetrics and Gynecology 2007;196:344e1-344e5.
Macarthur 2004
  • Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. American Journal of Obstetrics and Gynecology 2004;191(4):1199-204.
Mayerhofer 2002
  • Mayerhofer K, Bodner-Adler B, Bodner K, Rabl M, Kaider A, Wagenbichler P, et al. Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1,076 women. Journal of Reproductive Medicine 2002;47(6):477-82.
McCandlish 1998
Menzel 1998
Mink 1955
  • Mink E. Experience with the softening effect of hyaluronidase on high and rigid perineum in primiparous. Geburtshilfe Frauenheilkd 1955;15(3):246-58.
Nakai 2006
  • Nakai A, Yoshida A, Yamaguchi S, Kawabata I, Hayashi M, Yokota A,  et al. Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients. Archives of Gynecology 2006;274(4):222-6.
Patrini 1956
  • Patrini G. Usefulness of hyaluronidase in labor as protector of the perineum. Rivista di Ostetricia e Ginecologia 1956;38:710-4.
Radestad 2008
Raisanen 2009
  • Raisanen S, Vehvilainen-Julkunen K, Gissler M, Heinonen S. The increased incidence of obstetric anal sphincter rupture? an emerging trend in Finland. Preventive Medicine 2009;49(6):535-40.
RCOG 2007
  • Fernando RJ, Williams AA, Adams EJ. The Management of Third and Fourth-Degree Perineal Tears. RCOG Green-top Guidelines. No 29. London: RCOG, 2007.
RevMan 2012
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Rodriguez 2008
  • Rodriguez A, Arenas EA, Osorio AL, Mendez O, Zuleta JJ. Selective vs routine midline episiotomy for the prevention of third or fourth-degree lacerations in nulliparous women. American Journal of Obstetrics and Gynecology 2008;198(258):e1-4.
Samarasekera 2009
Sanders 2005
  • Sanders J, Peters T, Campbell R. Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice. Midwifery 2005;21(2):154-60.
Schaub 2008
  • Schaub AF, Litschgi M, Hoesli I, Holzgreve W, Bleul U, Geissbuhler V. Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation. Journal of Perinatal Medicine 2008;36(2):129-35.
Soong 2005
Spallicci 2007
  • Spallicci MD, Chiea MA, Singer JM, Albuquerque PB, Bittar RE, Zugaib M. Use of hyaluronidase for cervical ripening: a randomized trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2007;130(1):46-50.
Sultan 2002
Thies-Lagergren 2011
  • Thies-Lagergren L, Kvist LJ, Christensson K, Hildingsson I. Maternal outcomes in nulliparous women who gave vaginal birth on a birth seat or in any other position: Results of a randomised controlled trial in Sweden. Journal of Paediatrics and Child Health 2011;47 (Suppl 1):36-7.
Voldner 2009
Weerasekera 2002
  • Weerasekera DS, Premaratne S. A randomised prospective trial of the obstetric forceps versus vacuum extraction using defined criteria. Journal of Obstetrics and Gynaecology 2002;22:344-5.
Williams 2007
Williams 2011
  • Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. The McGraw-Hill Companies, 2011.