Indications
1. Rigid perineum or thick perineum (inelastic perineum).
2. Big baby; due to gestational mellitus
3. Breech delivery
4. Shoulder dystocia; anterior shoulder stuck in pelvic area.
5. Pre-term delivery
6. Unable to response to the given instruction, mother not responding.
7. Forcep delivery
8. Previous perineal injury
9. Anticipating perineal tear
10. Threaten perineal injury in primigrivida
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