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.