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Objective To study the effects of antenatal perineal massage on subsequent perineal outcomes at delivery.

Design A randomised, single-blind prospective study.

Setting Department of Obstetrics and Gynaecology, Watford General Hospital.

Participants Eight hundred and sixty-one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995.

Results Comparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no-massage group and 69.0% in the massage group (P= 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P= 0.094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P= 0.024 and P= 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30.

Conclusion Antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.