初産婦における妊娠期会陰部自己マッサージの効果に関する無作為化比較試験

A Randomized Controlled Trial on Evaluating Effectiveness of Perineal Massage during Pregnancy in Primiparous Women

要旨

　現在, 分娩時の会陰損傷を防止するための方策として, 妊娠末期に妊婦が会陰部自己マッサージを行うことが注目されている. このような状況を受け, 初産婦に対して, マッサージの効果に関する無作為化比較試験を行った. 対象の条件を満たした90名のうち, 協力の得られた63名を介入群 (30名) と対照群 (33名) に割り付け, 介入群には自己マッサージ法を週4回以上, 分娩まで (3週間以上) 実施してもらった. 第一義的なエンドポイントである会陰切開施行率の減少については, 介入により21％減少がみられたが, 統計的に有意な減少には至らなかった. 第2のエンドポイントである会陰損傷の程度の比較でも, 介入群をマッサージ続行者に限定した比較においてのみ, 対照群よりも介入群のほうが, 損傷の程度が軽度であった. これらの結果から, 妊娠末期における会陰部自己マッサージは, 初産婦の経腟分娩において会陰切開施行率を低下させ, 会陰損傷を軽度にする効果があるとは認められなかった．しかし, 今回の結果は, 検出力の不足が関係している可能性もあり, 今後必要対象数を満たした追試を行う必要がある．

Abstract

　Self-massage on the perineum given by the pregnant woman in late gestation has been a focus of constant attention as a measure of preventing the perineal injury at delivery.

　In view of the current circumstances, a randomized controlled trial was conducted to evaluate the effectiveness of self-massage in primiparous women.

　Among 90 women who met the conditions of this trial, 63 women participated in the study and they were assigned to an intervention group (30 women) and a contrast group (33 women). The intervention group was given an instruction of how to give self-massage. The massage was given at least four times a week until at the time of delivery (more than three weeks).

　There were two primary factors to be evaluated: reduction of episiotomy rates and comparison of the degree of perineal injury. The episiotomy rates in the intervention group were reduced by 21%, which cannot be said as a statistically significant decrease. As for the comparison of the degree of perineal injury, those who continued the massage in the intervention group had slighter injury than those in the contrast group.

　It was suggested that perineal massage during late gestation could not reduce episiotomy rates and make the perineal injury slighter.

　The results were thought to have been affected by insufficient power of test. More examination on the effectiveness of self-massage should be conducted, securing the number of required subjects.