Abstract Background Perineal trauma refers to damage to the genitalia during the birthing process and can occur spontaneously or as a result of an episiotomy or female genital mutilation (FGM). Objective To perform a systematic review and network meta-analysis investigating the effectiveness of different PFMT relevant strategies in the prevention of perineal trauma. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG DATABASE, and ClinicalTrials.gov were searched for citations published in any language from inception to 1 July 2021. Selection criteria Randomised controlled trials (RCTs) of PFMT relevant prevention strategy to prevent perineal trauma in pregnant women. Data collection and analysis Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA). Main results Of 12632 citations screened, 21 RCTs were included. Comparing with usual care, “PFMT combine with perineal massage” and PFMT alone showed more superiority in intact perineum (RR=5.37, 95%CI: 3.79 to 7.60, moderate certainty; RR=2.58, 95%CI: 1.34 to 4.97, moderate certainty), episiotomy (RR=0.26, 95%CI: 0.14 to 0.49, very low certainty; RR=0.63, 95%CI: 0.45 to 0.90, very low certainty), and OASIS (RR=0.35, 95%CI: 0.16 to 0.78, moderate certainty; RR=0.49, 95%CI: 0.28 to 0.85, high certainty). “PFMT combine with perineal massage” show superiority in reducing perineal tear (RR=0.41, 95%CI: 0.20 to 0.85, moderate certainty). Conclusion In this systematic review, the finding on the perineal trauma indicated that “PFMT combine with perineal massage” and PFMT showed more superiority to prevent perineal trauma.

Background Hyperemesis gravidarum (HG) is a severe complication of pregnancy affecting around 1% of pregnancies globally. Objective To investigate whether ondansetron use during pregnancy is associated with increased rates of abnormal pregnancy outcomes. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG, and ClinicalTrials.gov were searched for citations published in any language from inception to 15 December 2021. Selection criteria Eligible studies included any observational study. Data collection and analysis We used odds ratios (ORs) and 95% confidence intervals (CIs) as a measure of the association between ondansetron and abnormal pregnancy outcomes. Main results Of 1,558 citations screened, 19 articles were included. No significant increased risk for overall congenital malformations (OR=1.10,95% CI:0.94–1.29, Low certainty), cleft palate (OR=0.78,95% CI:0.37–1.64, Very Low certainty), stillbirth (OR=0.60,95% CI:0.40–0.91, Low certainty) or preterm birth (OR=0.78,95% CI:0.37–1.64, Low certainty) were identified in our primary analysis. However, the results of our primary analysis indicated that ondansetron use during pregnancy was associated with significantly increased rates of heart defects (OR=1.06,95% CI:1.02–1.11, Moderate certainty) and other organ malformations (OR=1.09,95% CI:1.03–1.16, Moderate certainty) when exposed infants were compared with healthy or disease-matched controls. Conclusion Ondansetron use during pregnancy was associated with a significant increase in rate of some abnormal pregnancy outcomes in our primary analysis. In conclusion, our review found that ondansetron should not use as first-line treatment for NVP. But for sever and incurable NVP, clinician can consider use moderate amount ondansetron to treat NVP with close monitoring.