Background & Objective: Perineal rupture is the most frequent complication of vaginal
delivery and significantly contributes to maternal morbidity, particularly through postpartum hemorrhage. Hands-on perineal support and Ritgen maneuver are commonly applied techniques to minimize perineal trauma; however, there is limited evidence comparing their effects on rupture severity. This study was conducted with aim to compare the degree of perineal rupture between Hands-on and Ritgen maneuver and to identify maternal and neonatal factors associated with increased severity. Materials & Methods: This cross-sectional analytic observational study was conducted on women undergoing spontaneous vaginal
delivery at two hospitals in Makassar. Eligible participants were women with singleton term pregnancies in cephalic presentation who delivered without episiotomy or instrumental assistance. Participants were categorized according to the perineal support technique. Maternal demographic factors, neonatal anthropometrics, and perineal rupture degree were recorded and analyzed using bivariate and multivariate testing. P<۰.۰۵ was considered significant. Results: A total of ۱۰۵ participants were included, with ۴۴ undergoing Ritgen maneuver and ۶۱ receiving Hands-on support. Second-degree rupture was the most common finding in both groups, with no significant difference in distribution (۴۴.۲% vs ۵۵.۸%; P=۰.۱۱۳). Neonatal birth weight, length, and head circumference were also comparable. Multivariate analysis identified parity as the strongest predictor of rupture severity, with primiparous women exhibiting a markedly higher risk of moderate-to-severe rupture (OR ۱۲.۱۶; ۹۵% CI ۳.۳۳-۴۴.۳۵; P<۰.۰۰۱). Conclusion: Hands-on and Ritgen maneuver yield similar perineal outcomes.
Parity is the predominant determinant of rupture severity, suggesting that maternal obstetric factors play a more substantial role than the perineal support technique selected.