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Rygaard A, Jonsson M, Wikström AK, Brismar-Wendel S, Hesselman S. Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study. BJOG 2024; 131:1378-1384. [PMID: 38628047 DOI: 10.1111/1471-0528.17830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVE To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth. DESIGN Nationwide population-based cohort study. SETTING Sweden. POPULATION Women (n = 411 317) with first and second singleton vaginal births in Sweden, 2001-2019. METHODS Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth. MAIN OUTCOME MEASURES Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). RESULTS In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11-3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53-15.24) of recurrent OASI. CONCLUSIONS Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth.
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Affiliation(s)
- Agnes Rygaard
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Falun, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sophia Brismar-Wendel
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Danderyd Hospital, Stockholm, Sweden
| | - Susanne Hesselman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Falun, Sweden
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Bergendahl S, Jonsson M, Hesselman S, Ankarcrona V, Leijonhufvud Å, Wihlbäck AC, Wallström T, Rydström E, Friberg H, Kopp Kallner H, Brismar Wendel S. Lateral episiotomy or no episiotomy in vacuum assisted delivery in nulliparous women (EVA): multicentre, open label, randomised controlled trial. BMJ 2024; 385:e079014. [PMID: 38886011 PMCID: PMC11307825 DOI: 10.1136/bmj-2023-079014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To assess the effect of lateral episiotomy, compared with no episiotomy, on obstetric anal sphincter injury in nulliparous women requiring vacuum extraction. DESIGN A multicentre, open label, randomised controlled trial. SETTING Eight hospitals in Sweden, 2017-23. PARTICIPANTS 717 nulliparous women with a single live fetus of 34 gestational weeks or more, requiring vacuum extraction were randomly assigned (1:1) to lateral episiotomy or no episiotomy using sealed opaque envelopes. Randomisation was stratified by study site. INTERVENTION A standardised lateral episiotomy was performed during the vacuum extraction, at crowning of the fetal head, starting 1-3 cm from the posterior fourchette, at a 60° (45-80°) angle from the midline, and 4 cm (3-5 cm) long. The comparison was no episiotomy unless considered indispensable. MAIN OUTCOME MEASURES The primary outcome of the episiotomy in vacuum assisted delivery (EVA) trial was obstetric anal sphincter injury, clinically diagnosed by combined visual inspection and digital rectal and vaginal examination. The primary analysis used a modified intention-to-treat population that included all consenting women with attempted or successful vacuum extraction. As a result of an interim analysis at significance level P<0.01, the primary endpoint was tested at 4% significance level with accompanying 96% confidence interval (CI). RESULTS From 1 July 2017 to 15 February 2023, 717 women were randomly assigned: 354 (49%) to lateral episiotomy and 363 (51%) to no episiotomy. Before vacuum extraction attempt, one woman withdrew consent and 14 had a spontaneous birth, leaving 702 for the primary analysis. In the intervention group, 21 (6%) of 344 women sustained obstetric anal sphincter injury, compared with 47 (13%) of 358 women in the comparison group (P=0.002). The risk difference was -7.0% (96% CI -11.7% to -2.5%). The risk ratio adjusted for site was 0.47 (96% CI 0.23 to 0.97) and unadjusted risk ratio was 0.46 (0.28 to 0.78). No significant differences were noted between groups in postpartum pain, blood loss, neonatal outcomes, or total adverse events, but the intervention group had more wound infections and dehiscence. CONCLUSIONS Lateral episiotomy can be recommended for nulliparous women requiring vacuum extraction to significantly reduce the risk of obstetric anal sphincter injury. TRIAL REGISTRATION ClinicalTrials.gov NCT02643108.
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Affiliation(s)
- Sandra Bergendahl
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susanne Hesselman
- Department of Women's and Children's Health, Centre for Clinical Research Dalarna, Falun, Sweden
| | - Victoria Ankarcrona
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Leijonhufvud
- Department of Clinical Science Helsingborg, Lund University, Helsingborg, Sweden
| | - Anna-Carin Wihlbäck
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Tove Wallström
- Department of Clinical Science and Education, South General Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Emmie Rydström
- Department of Obstetrics and Gynecology, Växjö Central Hospital, Växjö, Sweden
| | - Hanna Friberg
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Laderas Díaz E, Rodríguez‐Almagro J, Picón Rodríguez R, Martínez Galiano JM, Martínez Rodríguez S, Hernández‐Martínez A. Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain. Nurs Open 2024; 11:e2160. [PMID: 38660722 PMCID: PMC11043828 DOI: 10.1002/nop2.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
AIM Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN Observational cross-sectional study. METHODS Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Estíbaliz Laderas Díaz
- Department of Obstetrics & GynecologyLa Mancha Centro General HospitalAlcázar de San Juan, Ciudad RealSpain
| | - Julián Rodríguez‐Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Rafael Picón Rodríguez
- Department of General and Digestive SurgerySanta Bárbara HospitalPuertollano, Ciudad RealSpain
| | - Juan Miguel Martínez Galiano
- Department of NursingJaen UniversityJaenSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Sandra Martínez Rodríguez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Antonio Hernández‐Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
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Perslev K, Klarskov N, Bergholt T, Jangö H. The REPAIR study: oral antibiotics to prevent infection and wound dehiscence after obstetric perineal tear-a double-blinded placebo controlled randomized trial. Trials 2024; 25:221. [PMID: 38532503 DOI: 10.1186/s13063-024-08069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy. METHODS We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark. The women will be included after delivery if they have had a second-degree tear or episiotomy. After inclusion, the women will have a clinical follow-up visit after 1 week. The tear and healing will be evaluated regarding signs of infection and/or dehiscence. The women will again be invited for a 1-year clinical examination including ultrasound. Questionnaires exploring symptoms related to the obstetric tear and possible complications will be answered at both visits. Our primary outcome is wound dehiscence and/or wound infection, which will be calculated using χ2 tests to compare groups. Secondary outcomes are variables that relate to wound healing, as pain, use of painkillers and antibiotics, need for further follow-up, as well as outcomes that may be related to the birth or healing process, urinary or anal incontinence, symptoms of prolapse, female body image, and sexual problems. DISCUSSION Reducing the risk of wound dehiscence and/or infection would decrease the number of control visits, prevent the need for longer antibiotic treatment, and possibly also decrease both short-term and long-term symptoms. This would be of great importance so the mother, her partner, and the baby could establish and optimize their initial family relation. TRIAL REGISTRATION The conduction of this study is approved the 2/2-2023 with the EU-CT number: 2022-501930-49-00. CLINICALTRIALS gov Identifier: NCT05830162.
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Affiliation(s)
- Kathrine Perslev
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Nørregade 10, Copenhagen, 1165, Denmark
| | - Thomas Bergholt
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Nørregade 10, Copenhagen, 1165, Denmark
| | - Hanna Jangö
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Nørregade 10, Copenhagen, 1165, Denmark.
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Maghalian M, Alikamali M, Nabighadim M, Mirghafourvand M. The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis. Arch Gynecol Obstet 2024; 309:843-869. [PMID: 37632600 DOI: 10.1007/s00404-023-07195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND In order to reduce the complications of perineal damage and the pain caused by it for the mother, this study was conducted to determine the effect of warm perineal compress on perineal trauma (1st-, 2nd-, 3rd-, and 4th-degree perineal tears), postpartum pain, intact perineum (primary outcomes), episiotomy, length of the second stage, and APGAR score at 1 and 5 min after childbirth (secondary outcome). METHODS PubMed, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, SID, Magiran, and ClinicalTrials.gov were searched to identify the relevant articles from inception to November 1, 2022, with language restriction (only English and Persian). A manual search was also performed. Risk of bias 2 (RoB2) and ROBIN-I were employed to evaluate the quality of the included papers. Meta-analysis was conducted using RevMan 5.3. Heterogeneity was assessed using I2. In cases with high heterogeneity, subgroup analysis was utilized based on the parity and ethnicity, and time of pain measurement after delivery also a random-effects model was used instead of a fixed-effects model. Trial sequential analysis (TSA) was performed for the primary outcomes. The certainty of evidence was assessed using the GRADE approach. RESULTS A total number of 228 articles were found in databases. Of these articles, eighty-six were screened by title, 27 by abstract, and 21 by full text. Finally, 14 articles were included, of which ten were RCT and four were non-RCT. Meta-analysis results revealed that warm perineal compress significantly reduced perineal pain (RR 0.23, 95% CI 0.08-0.66; P = 0.0006), average pain (SMD - 0.73, 95% CI 1.23 to - 0.23; P = 0.004), second-degree perineal tear (RR 0.65, 95% CI 0.54-0.79; P˂0.00001), third-degree perineal tear (RR 0.32, 95% CI 0.15-0.67; P = 0.003), fourth-degree perineal tear (RR 0.11, 95% CI 0.01-0.87; P = 0.04), episiotomy (RR 0.63, 95% CI 0.46-0.86; P = 0.004), and intact perineum significantly increased (RR 3.06, 95% CI 1.79-5.22; P < 0.0001) compared to the control group. However, there was no statistically significant difference in terms of first-degree tear (RR 1.04, 95% CI 0.86-1.25; P = 0.72), length of the second stage of labor (MD - 0.60, 95% CI - 2.43 to 1.22; P = 0.52), the first minute (MD - 0.03, 95% CI - 0.07 to 0.02; P = 0.24) and the fifth minute Apgar score (MD - 0.02, 95% CI - 0.07 to 0.03; P = 0.46) between the two groups. CONCLUSION Warm perineal compress administered during the second stage of labor reduce postpartum pain, second and third-degree perineal tears, and episiotomy rate while it increases the incidence of intact perineum compared to the control group.
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Affiliation(s)
| | | | - Mahsan Nabighadim
- Medical School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Schmidt PC, Fenner DE. Repair of episiotomy and obstetrical perineal lacerations (first-fourth). Am J Obstet Gynecol 2024; 230:S1005-S1013. [PMID: 37427859 DOI: 10.1016/j.ajog.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 07/11/2023]
Abstract
Perineal injury after vaginal delivery is common, affecting up to 90% of women. Perineal trauma is associated with both short- and long-term morbidity, including persistent pain, dyspareunia, pelvic floor disorders, and depression, and may negatively affect a new mother's ability to care for her newborn. The morbidity experienced after perineal injury is dependent on the type of laceration incurred, the technique and materials used for repair, and the skill and knowledge of the birth attendant. After all vaginal deliveries, a systematic evaluation including visual inspection and vaginal, perineal, and rectal exams is recommended to accurately diagnose perineal lacerations. Optimal management of perineal trauma after vaginal birth includes accurate diagnosis, appropriate technique and materials used for repair, providers experienced in perineal laceration repair, and close follow-up. In this article, we review the prevalence, classification, diagnosis, and evidence supporting different closure methods for first- through fourth-degree perineal lacerations and episiotomies. Recommended surgical techniques and materials for different perineal laceration repairs are provided. Finally, best practices for perioperative and postoperative care after advanced perineal trauma are reviewed.
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Affiliation(s)
- Payton C Schmidt
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Chen YQ, Wang ZW, Liu HC, Wu J, Qin JZ, Li JH, Wu DQ, Jiang HY. Effects of pelvic floor myofascial manipulation intervention on primiparas and neonates during the second stage of vaginal delivery. Exp Ther Med 2024; 27:5. [PMID: 38223324 PMCID: PMC10785011 DOI: 10.3892/etm.2023.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/20/2023] [Indexed: 01/16/2024] Open
Abstract
A prolonged second stage of vaginal delivery increases the risk of shoulder dystocia, unnecessary episiotomies and cesarean sections. However, no standardized method has been proposed to tackle this issue. The effects of pelvic floor myofascial manipulation intervention during the second stage of labor in primiparas and its prognostic value in neonatal postpartum outcomes remain unknown. In the present study, a total of 60 primiparas who were expecting a vaginal delivery in the Second Affiliated Hospital of Hainan Medical College (Haikou, China) between October 2021 and January 2022 were selected. These women were randomly assigned to a control group (standard intrapartum care) or an experimental group (pelvic floor myofascial manipulation for 15-20 min during the second stage of labor along with standard intrapartum care) using a random number table, with 28 patients in each group. There was no significant difference in age, gestational time or body mass index between the two groups before delivery, indicating that the baseline data were comparable. The second stage of labor duration, forced breath-holding time and postpartum hemorrhage volume in the experimental group were significantly lower than those in the control group. The pain visual analog scale scores, fatigue scores and neonatal Apgar scores in the experimental group were also significantly lower than those in the control group. The rate of episiotomy in the experimental group was lower than that in the control group, but the difference was not statistically significant. In conclusion, pelvic floor myofascial manipulation intervention during the second stage of labor for primiparas with vaginal delivery can reduce the duration of the second stage of labor, the amount of bleeding during labor and the pain during labor. Meanwhile, it has the potential to improve neonatal outcomes.
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Affiliation(s)
- Yan-Qing Chen
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Zhao-Wei Wang
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Hai-Chao Liu
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Jiao Wu
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Jun-Zhong Qin
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Ju-Hui Li
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Dong-Qing Wu
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
| | - Hui-Yu Jiang
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570216, P.R. China
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Urasaki MBM, Lima MOP, Gonçalves R, Araújo NM, Pereira CGS. Measurement of perineal tears as an additional tool for laceration assessment during vaginal birth. Eur J Midwifery 2023; 7:43. [PMID: 38125555 PMCID: PMC10731751 DOI: 10.18332/ejm/174310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/14/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Spontaneous lacerations at vaginal birth are everyday events, but their classification and management still challenge midwifery care. This study aims to measure and describe first-degree and second-degree perineal lacerations resulting from vaginal birth, describe their repair, and the education provided for care. METHODS A descriptive study was conducted in a public maternity hospital in São Paulo, Brazil, with 87 parturients. Data were collected between October 2017 and June 2018 using a structured instrument containing obstetric variables and a description of lacerations. The obstetricians and nurse midwives assisted with births, determining the degree of laceration and intervention, and the researchers measured and reported them. RESULTS The majority of parturients (82.7%) had lacerations only in the anterior region, 8% had them in the posterior region, and 9.2% in both regions. The lacerations were classified as first-degree (78.1%) or second-degree (21.8%). Among the 32 nulliparous parturients, 27.6% had first-degree lacerations, and 9.2% had second-degree. Of the 55 multiparous parturients, 50.6% had first-degree, and 12.6% had second-degree. Among the lacerations assessed as first-degree, 25% had deeper tissue layers compromised in addition to the skin and mucosa. There were 180 lacerations, with an average length of 33.1 mm, depth of 19.8 mm, and width of 23.8 mm. Half of the parturients did not receive guidance on laceration care. There was no association between parity and size, number, location, or degree classification of lacerations. CONCLUSIONS This study provides a broad description of the characteristics of perineal lacerations and presents measurement techniques as a complementary resource for evaluating lacerations.
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Affiliation(s)
- Maristela B. M. Urasaki
- Midwifery Program, School of Arts, Science and Humanities, Sao Paulo University, Sao Paulo, Brazil
| | - Marlise O. P. Lima
- Midwifery Program, School of Arts, Science and Humanities, Sao Paulo University, Sao Paulo, Brazil
| | - Roselane Gonçalves
- Midwifery Program, School of Arts, Science and Humanities, Sao Paulo University, Sao Paulo, Brazil
| | - Natalucia M. Araújo
- Midwifery Program, School of Arts, Science and Humanities, Sao Paulo University, Sao Paulo, Brazil
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Saad J, Painter C. Management of postpartum perineal wound complications. Curr Opin Obstet Gynecol 2023; 35:505-509. [PMID: 37560791 DOI: 10.1097/gco.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Perineal wound complications occur in up to 25% of postpartum patients. Wound complications are most common after obstetric anal sphincter injuries (OASIS) but can occur after any laceration. It is imperative that any provider caring for postpartum patients understand the best evidence-based practices to recognize and manage these complications. We present a review of the available literature on the management of postpartum perineal wound complications. RECENT FINDINGS There is a paucity of new publications on the management of postpartum perineal wound complications, despite an increased emphasis on postpartum recovery in women's health. The role of topical estrogen in healing of perineal wounds was investigated in a pilot study, demonstrating that granulation tissue does express estrogen receptors, and the use of estrogen increases cell proliferation. Progression of perineal wound healing by secondary intention was evaluated in an observational study. Wound healing was delayed in 30% of women, with the initial wound area, perimeter, bacterial colonization, and OASIS being associated with delayed healing. SUMMARY Evidence based practices on timing of follow-up, addressing wound care and analgesia, administrating antibiotics, timing secondary repair, and surgical technique all play a role in optimizing recovery and reducing morbidity in patients with postpartum perineal wound complications.
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Affiliation(s)
- Jaber Saad
- Kaiser Permanente East Bay and University of California San Francisco
| | - Caitlyn Painter
- University of California San Francisco, Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Science, San Francisco, California, USA
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Puissegur A, Accoceberry M, Rouzaire M, Pereira B, Herault M, Bruhat C, Delabaere A, Gallot D. Risk Factors for Perineal Wound Breakdown in Early Postpartum: A Retrospective Case-Control Study. J Clin Med 2023; 12:jcm12083036. [PMID: 37109371 PMCID: PMC10146046 DOI: 10.3390/jcm12083036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
We conducted a retrospective case-control study in patients presenting a perineal tear (second degree or higher) or episiotomy complicated by wound breakdown during maternity stay to identify risk factors associated with wound breakdown in early postpartum with a view to improving the quality of care. We collected ante- and intrapartum characteristics and outcomes at the postpartum visit. In all, 84 cases and 249 control subjects were included. In univariate analysis, primiparity, absence of history of vaginal delivery, a longer second phase of labour, instrumental delivery, and a higher degree of laceration emerged as risk factors for early perineal suture breakdown postpartum. Gestational diabetes, peripartum fever, streptococcus B, and suture technique did not emerge as risk factors for perineal breakdown. Multivariate analysis confirmed that instrumental delivery (OR = 2.18 [1.07; 4.41], p = 0.03) and a longer second phase of labour (OR = 1.72 [1.23; 2.42], p = 0.001) were risk factors for early perineal suture breakdown.
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Affiliation(s)
- Amandine Puissegur
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie Accoceberry
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marion Rouzaire
- CIC 1405 CRECHE Unit, INSERM, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie Herault
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Clément Bruhat
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Amélie Delabaere
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Denis Gallot
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- Translational Approach to Epithelial Injury and Repair Team, GReD, CNRS, INSERM, Auvergne University, 63000 Clermont-Ferrand, France
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11
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Okeahialam NA, Thakar R, Sultan AH. Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study. Acta Obstet Gynecol Scand 2023; 102:473-479. [PMID: 36707852 PMCID: PMC10008287 DOI: 10.1111/aogs.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS). MATERIAL AND METHODS Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. RESULTS Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. CONCLUSIONS We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future.
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Affiliation(s)
| | - Ranee Thakar
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
| | - Abdul H Sultan
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
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12
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Okeahialam NA, Thakar R, Sultan AH. Bacterial autofluorescence in infected perineal wounds: A prospective cohort study. Diagn Microbiol Infect Dis 2023; 105:115831. [DOI: 10.1016/j.diagmicrobio.2022.115831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
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13
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A blended learning perineal suturing programme for midwifery students: An evaluative descriptive study. Nurse Educ Pract 2022; 64:103453. [DOI: 10.1016/j.nepr.2022.103453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
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14
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TUĞRUL ERSAK D, ERSAK B, ZORLU U, KOKANALI MK, MORALOĞLU TEKİN Ö, DOĞANAY M. Düşük riskli kadınlarda enfekte epizyotomi riskini öngören bir model. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Infected episiotomy (IE) is a rare complication of vaginal delivery. However, the practical use of the risk factors involved in the development of IE is unclear. The aim of this study is to create a risk scoring model to be applied in clinical practice with the risk factors we will determine so as to predict the development of IE.
Materials and Methods: All women who were delivered vaginally with mediolateral episiotomy within a 1-year period were included in this retrospective study. While 42 women (cases) with the diagnosis of IE were eligible for inclusion in the study and formed the case group, randomly selected 168 women in whom IE was not detected formed the control group. Possible risk factors for the development of IE were evaluated by multivariate regression analysis.
Results: The analysis revealed 5 significant independent factors related to IE. Among these factors, 5 points were given to current smoking presence, 4 points to weight gain during pregnancy ≥11.5 kg, 3 points to postpartum neutrophil to lymphocyte ratio ≥10.4, 2 points to presence of diabetes mellitus, and 1 point to presence of hospitalization before active phase of labor. And a cut-off value of 5.5 was found to be moderately effective in predicting IE.
Conclusion: Consequently, this five-variable model can predict the presence of IE with significant efficiency. In the presence of these variables, the clinician can identificate the patients at risk of IE. In this way, individualized patient risk assessment and situation-specific counseling can be made.
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Affiliation(s)
- Duygu TUĞRUL ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Burak ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Uğurcan ZORLU
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Mahmut Kuntay KOKANALI
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Özlem MORALOĞLU TEKİN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Melike DOĞANAY
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
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15
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Bilateral Inferiorly Based Labia Majora Flaps: A Simple Technique for Post Episiotomy Dehiscence Coverage. World J Plast Surg 2022; 11:78-83. [PMID: 36694685 PMCID: PMC9840771 DOI: 10.52547/wjps.11.3.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 12/23/2022] Open
Abstract
Episiotomy dehiscence because of infection is a cause of major physical, psychological and social problems. Management depends on the degree of injury. The loco-regional flap can be considered in recurrent dehiscence with loss of tissue. We report a case of a 26-year-old female who presented with a post episiotomy wound in the perineal region extending from the posterior fourchette to the anal opening. She gave the history of resuturing of dehiscence twice but the result was the same. On examination, there was a loss of skin and subcutaneous tissue between vaginal and anal opening with pouting of the anal and vaginal mucosa. Per rectal examination, the anal tone was normal. Her wound was covered with bilateral inferiorly based labia majora flaps with a good outcome. So, an inferiorly based labia majora flap can be a useful option in coverage of recurrent perineal dehiscence.
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16
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Adanna Okeahialam N, Thakar R, Sultan AH. The clinical progression and wound healing rate of dehisced perineal tears healing by secondary intention: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2022; 274:191-196. [PMID: 35667174 DOI: 10.1016/j.ejogrb.2022.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish the clinical progression of dehisced perineal wounds healing by secondary intention and to investigate the incidence and factors associated with delayed healing. METHODS Secondary analysis of women with perineal wound dehiscence recruited into the PERINEAL study between August 2020- August 2021 (NCT04480684). Three-dimensional wound measurements were taken with the Silhouette® camera. Significant bacterial colonisation was diagnosed using the MolecuLight i:X camera. As it is agreed that acute wounds should heal sufficiently within four weeks, diagnosis of delayed wound healing was made if a wound took longer than four weeks to heal. A wound was deemed to have healed if there was complete wound closure, with no evidence of granulation tissue or signs of infection on clinical examination. RESULTS 55 women with perineal wound dehiscence participated. Wounds took an average of 3 weeks to heal (range 1-16) and 38 (69.1%) wounds healed in ≤ 4 weeks from the first clinical review. 17 (30.9%) wounds had significant bacterial colonisation, identified on bacterial fluorescence imaging. Women with a wound area of < 1.60 cm2 or wound perimeter of < 5.57 cm had a 70% probability of wound healing in ≤ 4 weeks. 47.1% of wounds with significant bacteria colonisation healed within 4 weeks, in comparison to 78.9% of wounds not colonised (p = 0.03). 25.0 % (n = 2) of wounds with OASI healed within 4 weeks, in comparison to 76.5% (n = 36) of wounds with no OASI (p = 0.02). Bacterial fluorescence (OR 0.21 (0.05-0.87)) and OASIs (OR 0.09 (0.01-0.66)) were independent risk factors associated with delayed wound healing. The model including wound area, fluorescence and OASIs had the greatest AUC (0.81, 95% CI 0.67-0.94) indicating the best predictive model. CONCLUSIONS This is the first study to describe healing outcomes of dehisced perineal wounds and factors associated with delayed healing. The study findings will help clinicians counsel women effectively and tailor follow-up care at the first assessment, based on individual risk factors.
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Affiliation(s)
| | - Ranee Thakar
- Consultant Obstetrician and Urogynaecologist, Croydon University Hospital. Honorary Senior Lecturer, St George's University of London, UK.
| | - Abdul H Sultan
- Consultant Obstetrician and Urogynaecologist, Croydon University Hospital. Honorary Reader, St. George's University of London, UK.
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17
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Spontaneous Perineal Trauma during Non-Operative Childbirth—Retrospective Analysis of Perineal Laceration Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137653. [PMID: 35805312 PMCID: PMC9266119 DOI: 10.3390/ijerph19137653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
Childbirth-related perineal trauma (CRPT) is defined as damage to the skin, muscles of the perineum, as well as to the anal sphincter complex and anal epithelium. The aim of the study was to analyze the risk factors for spontaneous injuries to the soft tissues of the birth canal during non-operative delivery. This was a single-center retrospective case-control study. The study included the analysis of two groups, the study group featured 7238 patients with spontaneous perineal laceration (any degree of perineal laceration) and the control group featured patients without perineal laceration with 7879 cases. The analysis of single-factor logistic regression showed that the factors related to perineal laceration during childbirth are the age of the patients giving birth (p = 0.000), the BMI before delivery (p = 0.000), the number of pregnancies (p = 0.000) and deliveries (p = 0.000), diagnosed gestational diabetes (p = 0.046), home birth (p = 0.000), vaginal birth after cesarean (VBAC) (p = 0.001), the use of oxytocin in the second stage of childbirth (p = 0.041), the duration of the second stage of childbirth (p = 0.000), body weight (p = 0.000), and the circumference of the newborn head (p = 0.000). Independent factors that increase the risk of perineal laceration during childbirth are an older age of the woman giving birth, a history of cesarean section, a higher birth weight of the newborn, and factors that reduce the risk of spontaneous perineal trauma are a higher number of deliveries and home birth.
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18
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Brophy C, Corbett GA, O Brien L. Shining a light on postnatal perineal granulation tissue. Int J Gynaecol Obstet 2022; 159:315-316. [PMID: 35656745 PMCID: PMC9542055 DOI: 10.1002/ijgo.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Caroline Brophy
- Postnatal Morbidity Service (POPPY Clinic), National Maternity Hospital, Dublin, Ireland.,Department of Midwifery, National Maternity Hospital, Dublin, Ireland
| | - Gillian A Corbett
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Laoise O Brien
- Postnatal Morbidity Service (POPPY Clinic), National Maternity Hospital, Dublin, Ireland.,Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
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19
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White C, Atchan DM. POSTPARTUM MANAGEMENT OF PERINEAL INJURY - A CRITICAL NARRATIVE REVIEW OF LEVEL 1 EVIDENCE. Midwifery 2022; 112:103410. [DOI: 10.1016/j.midw.2022.103410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
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20
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Okeahialam NA, Wong KW, Thakar R, Sultan AH. The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:182-191. [PMID: 35550375 DOI: 10.1016/j.ajog.2022.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to systematically determine the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair. DATA SOURCES MEDLINE, Embase, CINAHL, EmCare, the Cochrane Library, and Trip Pro databases were searched from inception to February 2021. STUDY ELIGIBILITY CRITERIA We included observational clinical studies reporting the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair. Case series and reports were excluded. Conference articles and observational study abstracts were included if they contained enough information regarding study design and outcome data. METHODS Data were analyzed as incidence (percentage) with 95% confidence intervals. Moreover, the prediction intervals were calculated to provide a predicted range for the potential incidence of wound complications when applied to an individual study setting. Study quality and risk of bias were assessed using the relevant tool from the Joanna Briggs Institute. RESULTS Of 956 studies found, 39 were selected for full-text review. Moreover, 10 studies (n=4767 women) were eligible and included in the meta-analysis. All 10 studies were conducted in high-income countries (Denmark [n=1], the United Kingdom [n=3], and the United States [n=6]). The incidences of wound infection (n=4593 women) and wound dehiscence (n=3866 women) after primary obstetric anal sphincter injury repair ranged between 0.1% to 19.8% and 1.9% to 24.6%, respectively. The overall incidences were 4.4% (95% confidence interval, 0.4-8.4) for wound infection and 6.9% (95% confidence interval, 1.6-12.2) for wound dehiscence. The prediction intervals were wide and suggested that the true incidences of wound infection and dehiscence in future studies could lie between 0.0% to 11.7% and 0.0% to 16.4%, respectively. Overall, 8 studies had a high or unclear risk of bias across ≥1 assessed element. None of the studies used the same set of clinical parameters to define wound infection or dehiscence. Furthermore, microbiological confirmation with wound swabs was never used as a diagnostic measure. CONCLUSION This was a systematic review and meta-analysis of wound infection and dehiscence incidences after primary obstetric anal sphincter injury repair. The incidence estimates from this review will be useful for clinicians when counseling women with obstetric anal sphincter injury and when consenting them for primary surgical repair.
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Affiliation(s)
| | - Ka Woon Wong
- Croydon University Hospital, Thornton Heath, England
| | - Ranee Thakar
- Croydon University Hospital, Thornton Heath, England; St George's University of London, London, United Kingdom
| | - Abdul H Sultan
- Croydon University Hospital, Thornton Heath, England; St George's University of London, London, United Kingdom.
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21
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Yan W, Machowska A, Sihavong A, Sychareun V, Chaleunvong K, Keohavong B, Eriksen J, Hanson C, Vongsouvath M, Brauner A, Mayxay M, Kounnavong S, Stålsby Lundborg C. Antibiotic Prescribing in Connection to Childbirth: An Observational Study in Two Districts in Lao PDR. Antibiotics (Basel) 2022; 11:antibiotics11040448. [PMID: 35453200 PMCID: PMC9029038 DOI: 10.3390/antibiotics11040448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Overuse and misuse of antibiotics has frequently been reported for obstetric conditions and procedures, which may impact both the mother and the unborn baby and increase antibiotic resistance. This study aimed to investigate the antibiotic prescribing pattern in connection to childbirth in two districts in Lao PDR. It is a cross-sectional observational study. Antibiotic prescription data related to childbirth was collected via reviews of medical records in two district hospitals and five health centers in Lao PDR from September 2019 to November 2020. In total, antibiotic prescription data for 1777 women were extracted from their medical records. It was found that all women received antibiotics during in-patient care irrespective of delivery mode. When in hospital, 85.5% of the women who underwent a caesarean section got antibiotic treatment for 5 days and women who had a vaginal delivery usually had antibiotic treatment for one day or less. All the women got oral antibiotics for an additional 4–5 days upon discharge. Antibiotic prescription rate in connection to childbirth was very high in comparison with the WHO guidelines, and antibiotics were used extensively in the participating health facilities. Interventions to guide appropriate prescribing behavior in relation to childbirth are urgently needed in Lao PDR.
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Affiliation(s)
- Weirong Yan
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
- Correspondence:
| | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane 01030, Laos;
| | - Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane 7444, Laos;
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
| | - Bounxou Keohavong
- Food and Drug Department, Ministry of Health, Vientiane 01030, Laos;
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
- Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital,118 83 Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Division of Clinical Microbiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos;
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
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22
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Relação entre vulvovaginite pré-natal e laceração perineal relacionada ao parto. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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23
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Okeahialam NA, Thakar R, Sultan AH. Healing of disrupted perineal wounds after vaginal delivery: a poorly understood condition. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S8-S16. [PMID: 34781764 DOI: 10.12968/bjon.2021.30.sup20.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perineal injury following childbirth can result in complications such as wound infection and dehiscence. The reported incidence of these complications in the literature range between 0.1-23.6% and 0.2-24.6%, respectively. However, the healing of disrupted perineal wounds is poorly understood. In addition, it is a neglected area in maternity services. In this review, the authors explore the process of wound healing in the context of infected perineal wounds following childbirth. In addition, the authors describe the management of complications including hypergranulation, perineal pain and dyspareunia.
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Affiliation(s)
| | - Ranee Thakar
- Consultant Obstetrician and Urogynaecologist, Croydon University Hospital, London, and Honorary Senior Lecturer, St George's University of London
| | - Abdul H Sultan
- Consultant Obstetrician and Urogynaecologist, Croydon University Hospital, London, and Honorary Reader, St George's University of London
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24
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Childs C, Sandy-Hodgetts K, Broad C, Cooper R, Manresa M, Verdú-Soriano J. Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. J Wound Care 2021; 29:S1-S48. [PMID: 33170077 DOI: 10.12968/jowc.2020.29.sup11a.s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Charmaine Childs
- Professor of Clinical Science, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow/Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia; Director, Skin Integrity Research Unit, University of Western Australia, Perth, Australia
| | - Carole Broad
- Clinical Specialist Physiotherapist in Pelvic Health, Department of Physiotherapy, Cardiff and Vale UHB, Cardiff, Wales, UK
| | - Rose Cooper
- Former Professor of Microbiology at Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Margarita Manresa
- Maternal and Fetal Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Verdú-Soriano
- Professor of Community Nursing and Wound Care, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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25
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Goh YP, Tan PC, Hong JGS, Sulaiman S, Omar SZ. Combined massage and warm compress to the perineum during active second stage of labor in nulliparas: A randomized trial. Int J Gynaecol Obstet 2021; 155:532-538. [PMID: 33484158 DOI: 10.1002/ijgo.13613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/28/2020] [Accepted: 01/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the combined effect of massage and warm compress to the perineum (MassComp) compared with standard "hands-off" in the second stage of labor. METHODS A randomized trial was conducted in a University hospital in Malaysia. Nulliparous women at term who were about to start pushing were randomized to massage during pushing and warm compress to the perineum in between pushes or to standard "hands-off" care. Primary outcome was suturing for perineal injury (episiotomy or tear). RESULTS A total of 156 participants were analyzed based on intention to treat. Perineal repair rates were 53/79 (67%) for MassComp versus 70/77 (91%) for control (relative risk [RR] 0.72, 95% confidence interval [CI] 0.61-0.98, number needed to treat for an additional beneficial outcome [NNTb ] 5, 95% CI 2.83-8.62, P < 0.001). Of the secondary outcomes, participants' satisfaction with care (visual numerical rating scale 0-10; 8.3 ± 1.2 vs 7.8 ± 1.2, P = 0.014), major perineal injury (second degree or higher) rates 34/79 (43%) versus 51/77 (66%) (RR 0.72, 95% CI 0.58-0.97, NNTb 5, 95% CI 2.61-12.56, P = 0.004), episiotomy rates 28/79 (37%) versus 40/77 (53%) (RR 0.72, 95% CI 0.52-0.98, NNTb 8, 95% CI 3.63-36.46, P = 0.043), intervention to delivery intervals 29.5 ± 13.6 versus 27.9 ± 13.8 minutes (P = 0.472) and spontaneous vaginal delivery rates 63/79 (79.7%) versus 56/77 (72.7%) (RR 1.11, 95% CI 0.92-1.34, P = 0.306) for MassComp versus control, respectively. CONCLUSION Massage and warm compress during pushing decreased the perineal suturing, major perineal injury, and episiotomy rates and improved maternal satisfaction. CLINICAL TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN42773879.
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Affiliation(s)
- Yi Pei Goh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Jesrine Gek Shan Hong
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Okeahialam NA, Thakar R, Kleprlikova H, Taithongchai A, Sultan AH. Early re-suturing of dehisced obstetric perineal wounds: A 13-year experience. Eur J Obstet Gynecol Reprod Biol 2020; 254:69-73. [PMID: 32942078 DOI: 10.1016/j.ejogrb.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe post-operative outcomes following early re-suturing of obstetric perineal wound dehiscence. STUDY DESIGN This was a retrospective series of 72 women who underwent re- suturing of a dehisced perineal wound at a tertiary urogynaecology department during a 13-year period (December 2006 - December 2019). RESULTS Seventy-two women with complete perineal wound dehiscence opted for secondary re-suturing. Other accompanying symptoms included purulent discharge from the wound (22.2 %), perineal pain (23.6 %) and both purulent discharge and pain (26.4 %). The median time taken for the wound to heal completely following re-suturing was 28 days (IQR 14.0-52.0); 49.2 % had healed completely by four weeks, 63.5 % by six weeks and 76.2 % by eight weeks. The median number of out-patient follow-up appointments required was 2 (IQR 1.0-3.0). No post-operative complications were experienced in 63.6 % of women, one complication occurred in 25.8 % and two complications in 10.6 %. Complications included skin dehiscence (33.3 %), granuloma (33.3 %), scar tissue (17.6 %), perineal pain (5.9 %) and sinus formation (5.9 %). Of the women who developed two complications, four developed skin dehiscence with granulation tissue and one had skin sinus formation. One developed granulation tissue with perineal pain. All complications were managed conservatively in an outpatient setting or surgically under local anaesthetic, without further complication. There was no significant difference (p = 0.443) in complication rates between the group (n = 10) with dehisced wounds with signs of wound infection (purulent discharge or the presence of both purulent discharge and pain) pre-operatively versus the group (n = 14) without signs of infection. CONCLUSIONS This study demonstrates the positive outcomes of early re-suturing of perineal wound dehiscence with faster healing, reduced follow-up requirements and few major complications. It provides information to clinicians who are uncertain about the effects of early re-suturing of perineal wounds which can be used to help counsel mothers with wound dehiscence on their management options.
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Affiliation(s)
| | - R Thakar
- Croydon University Hospital, London UK; Honorary Senior Lecturer St George's University of London, UK
| | - H Kleprlikova
- Croydon University Hospital, London UK; Department of General Anthropology, Faculty of Humanities, Charles University in Prague, Czech Republic
| | | | - A H Sultan
- Croydon University Hospital, London UK; Honorary Reader St. George's University of London, UK.
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A one-stop perineal clinic: our eleven-year experience. Int Urogynecol J 2020; 31:2317-2326. [PMID: 32617635 PMCID: PMC7561568 DOI: 10.1007/s00192-020-04405-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/17/2020] [Indexed: 11/05/2022]
Abstract
Introduction and hypothesis The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period. Methods This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and anal manometry and endoanal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes. Results There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management. Conclusion We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities.
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Bovbjerg ML, Cheyney M. Current Resources for Evidence-Based Practice, July 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:391-404. [PMID: 32574584 PMCID: PMC7305877 DOI: 10.1016/j.jogn.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of whether it is ethical not to offer doula care to all women, and commentaries on reviews focused on folic acid and autism spectrum disorder, and timing of influenza vaccination during pregnancy.
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