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Baruch Y, Gold R, Eisenberg H, Yogev Y, Groutz A. Is vaginal birth after cesarean section a risk factor for obstetric anal sphincter injury? Int J Gynaecol Obstet 2024. [PMID: 38803102 DOI: 10.1002/ijgo.15698] [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: 09/01/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To investigate whether women undergoing their first vaginal delivery after a previous cesarean section (secundiparous) are at increased risk for obstetric anal sphincter injury (OASI) compared with primiparous women. METHODS A retrospective cohort study of 85 428 women who delivered vaginally over a 10-year period in a single tertiary medical center. Incidence of OASI, risk factors, and clinical characteristics were compared between primiparous women who delivered vaginally and secundiparous women who underwent their first vaginal birth after cesarean section (VBAC). A multivariable logistic regression analysis was used to study the association between VBAC and OASI. RESULTS Overall, 36 250 primiparous and 1602 secundiparous women were enrolled, 309 of whom had OASI. The rates of OASI were similar among secundiparous women who had VBAC and primiparous women who underwent vaginal delivery (15 [0.94%] vs 294 [0.81%], P = 0.58). The proportions of third- and fourth-degree tears were also similar among secundiparous and primiparous women who experienced OASI (87% vs 91.5%, and 13% vs 8.5%, respectively, P = 0.68). Furthermore, the rates of OASI were similar in both study groups, although secundiparous women who underwent VBAC had higher rates of birth weights exceeding 3500 g (414 [25.8%] vs 8284 [22.8%], P = 0.016), and higher rates of vacuum-assisted deliveries (338 [21%] vs 6224 [17.2%], P < 0.001). A multivariate logistic regression analysis failed to establish a statistically significant association between VBAC and OASI (odds ratio 0.672, 95% confidence interval 0.281-1.61, P = 0.37). CONCLUSIONS No increased risk for OASI was found in secundiparous women who underwent VBAC compared with primiparous women at their first vaginal birth.
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Affiliation(s)
- Yoav Baruch
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Gold
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Eisenberg
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Dendini M, Aldossari SK, AlQassab HA, Aldraihem OO, Almalki A. Retrospective Case-Control Study of Extended Birth Perineal Tears and Risk Factors. Cureus 2024; 16:e57132. [PMID: 38681371 PMCID: PMC11055567 DOI: 10.7759/cureus.57132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND A perineal tear is a rupture of the skin or muscle between the vagina and anus (perineum). A third-degree tear is one type of extended perineal tear (EPT), and it involves the penetration of the anal sphincter muscle. Another type of EPT is a fourth-degree laceration, which penetrates deeper into the lining of the anus or rectum. The stretching of the perineum during childbirth may result in perineal trauma. Invasive surgical interventions are required for the treatment of EPTs. For this reason, the reduction of their incidence can be achieved by fully comprehending the risk aspects associated with them. OBJECTIVE The aim of this study is to contribute to the body of knowledge by providing insight into the various risk factors that are associated with extended perineal trauma. By following this path, this study aims to contribute to and advance Saudi Arabia's development of evidence-oriented obstetric care recommendations. STUDY DESIGN The current study is a case-control study where a review of 5000 vaginal delivery records was carried out between March 1, 2018, and March 19, 2023. For the study, cases (n = 71) were female patients who had documented greater than second-degree perineal injury. The control group (n = 238) was randomly chosen from women who had vaginal delivery but with less or equal to a second-degree perineal laceration. For each patient, we reviewed medical and obstetrics records for the following characteristics: age of diagnosis, gestational age, parity, labor induction, second-stage labor duration, mode of delivery, infant birth weight, epidural use and episiotomy indication, healthcare worker (HCW) experience, and APGAR (appearance, pulse, grimace, activity, and respiration) score. RESULTS From the 5000 births analyzed, the cases were 71 patients (1.42% of 5000 births). The mean age at diagnosis in our sample was (28.05 ± 4.66 years). The study's results showed that the following variables significantly affected the occurrence of EPTs: birth weight, labor durations, parity, HCW experience, and mode of delivery. The odds for tears were 3.69 (95% CI: 0.156-0.469) higher in nulliparous patients relative to multiparous patients. Instrumental deliveries resulted in more tears than non-instrumental deliveries with an odds ratio (OR) of 5.901 (95% CI: 2.443-14.525). This study also found that prolonged second-stage labor seems to be associated with an increased risk of perineal damage. HCW experience was looked at in relation to the increased incidence of EPTs, which showed that midwives had a lower incidence rate than physicians with an OR of 2.25 (95% CI: 1.169-4.366). Epidural usage has also been significantly associated with a lesser incidence of perineal tears, which indicates that using epidural could protect against the occurrence of EPTs. CONCLUSION In conclusion, the occurrence of perineal lacerations could be prevented during childbirth by taking preventative measures and having more precise judgments. Epidural was a protective factor in our study against the incidence of extensive perineal tearing. Furthermore, as compared to midwives, our study showed that the majority of EPTS occurred in cases of physicians (residents/consultants). Further research, proper documentation, and the development of evidence-based guidelines are needed to improve perineal care and reduce EPT incidence.
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Affiliation(s)
- Mohammad Dendini
- Urogynecology and Reconstructive Pelvic Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Sara K Aldossari
- Medicine, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Amwaj Almalki
- Biostatistics and Epidemiology, King Abdullah International Medical Research Center, Riyadh, SAU
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Martín-Vázquez C, Goás-Gómez N, Calvo-Ayuso N, Rosón-Matilla L, Quiroga-Sánchez E, García-Fernández R. Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives. Healthcare (Basel) 2024; 12:441. [PMID: 38391816 PMCID: PMC10888027 DOI: 10.3390/healthcare12040441] [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: 12/23/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences.
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Affiliation(s)
- Cristian Martín-Vázquez
- Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Noelia Goás-Gómez
- Centro de Salud Vilalba, Servizo Galego de Saúde (SERGAS), 27800 Lugo, Spain
| | - Natalia Calvo-Ayuso
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | | | - Enedina Quiroga-Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal
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Mohd Raihan FS, Kusuma J, Nasution AA. Neonatal head circumference as a risk factor for obstetric anal sphincter injuries: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101047. [PMID: 37277090 DOI: 10.1016/j.ajogmf.2023.101047] [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: 03/13/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Between 53% and 79% of women will sustain some degree of perineal laceration during vaginal delivery. Third- and fourth-degree perineal lacerations are known as obstetric anal sphincter injuries. Timely diagnosis and prompt treatment of obstetric anal sphincter injuries can help to prevent the development of severe consequences like fecal incontinence, urinary incontinence, and rectovaginal fistula. Neonatal head circumference is routinely measured postpartum but is often not mentioned as a risk factor for obstetric anal sphincter injuries in clinical guidelines. Thus far, no review article on the risk factors for obstetric anal sphincter injuries has discussed the role of neonatal head circumference. This study aimed to review and analyze the relationship between head circumference and the occurrence of obstetric anal sphincter injuries among previous studies to conclude whether head circumference should be recognized as an important risk factor. DATA SOURCES Through study screening on Google Scholar, PubMed, Scopus, and Science Direct for articles published between 2013 to 2023, followed by assessment of eligibility, this study ended up reviewing 25 studies, 17 of which were included in the meta-analysis. STUDY ELIGIBILITY CRITERIA Only studies that reported both the neonatal head circumference and the occurrence of obstetric anal sphincter injuries were included in this review. METHODS The included studies were appraised using the Dartmouth Library risk of bias assessment checklist. Qualitative synthesis was based on the study population, findings, adjusted confounding factors, and suggested causative links in each study. Quantitative synthesis was conducted using calculation and pooling of odds ratios and inverse variance using Review Manager 5.4.1. RESULTS A statistically significant association between head circumference and obstetric anal sphincter injuries was reported in 21 of 25 studies; 4 studies reported that head circumference was a true independent risk factor. A meta-analysis of the studies that reported neonatal head circumference as a dichotomous categorical variable with a cutoff point of 35±1 cm yielded statistically significant pooled results (odds ratio, 1.92; 95% confidence interval, 1.80-2.04). CONCLUSION The risk for obstetric anal sphincter injuries increased as the neonatal head circumference increased-this should be considered in decision-making during labor and postpartum management to attain the best outcome.
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Affiliation(s)
| | - Julianty Kusuma
- Department of Obstetrics and Gynecology, Dr M. Yunus Regional General Hospital, Bengkulu, Indonesia (Dr Kusuma); Department of Medical Doctor Profession Education, Faculty of Medicine and Health Sciences, Universitas Bengkulu, Bengkulu, Indonesia (Dr Kusuma)
| | - Ahmad Azmi Nasution
- Department of Anatomy, Faculty of Medicine and Health Sciences, Universitas Bengkulu, Bengkulu, Indonesia (Dr Nasution)..
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Winkelman J, Murphy K, Booth C. Delayed presentation of a non-resorbing postpartum vulvar hematoma: A case report. Case Rep Womens Health 2023; 38:e00518. [PMID: 37440765 PMCID: PMC10334312 DOI: 10.1016/j.crwh.2023.e00518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Vulvar hematomas are more common in the obstetric population, and usually present within 24 h of delivery. Small, nonexpanding vulvar hematomas will often resolve with conservative management. In a rural setting in the USA, a 35-year-old woman, G3P3, presented to clinic 26 days after a home vaginal delivery attended by a midwife, which was complicated by postpartum hemorrhage secondary to retained placenta. Ten days after her delivery she developed intense pressure in her inferior right vulva. On examination a 4-5 cm well defined right vulvar mass was observed. Incision and drainage were performed and the mass was determined to be a hematoma that had not resorbed. Four days later, the patient returned to clinic as the mass had reformed. Computerized tomography did not show extravasation of contrast. As examination showed the mass was now 1 cm smaller, no intervention was undertaken and after one month the hematoma had completely resolved. This case provides a rare example of the delayed development of a vulvar hematoma. In the literature, the vast majority are reported to present within 24 h of delivery. Smaller hematomas, such as this one, which was 4-5 cm, are treated conservatively, as they typically absorb. This hematoma was present for approximately two weeks without resorbing.
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Chang SD, Hsieh WC, Chiu SYH, Ng KL, Liang CC. Factors determining the persistence of prenatal stress urinary incontinence 12 months postpartum. Taiwan J Obstet Gynecol 2023; 62:40-44. [PMID: 36720548 DOI: 10.1016/j.tjog.2022.10.003] [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] [Accepted: 10/25/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Whilst many studies have explored the mechanisms of stress urinary incontinence (SUI) following various modes of delivery, few have examined outcomes of postpartum SUI in women who experienced new-onset SUI during their pregnancy. Our primary objective was to investigate the risk factors for persistent postpartum SUI in women with new-onset SUI during pregnancy at 1-year follow-up following vaginal delivery. MATERIALS AND METHODS 303 women with new-onset SUI during pregnancy who underwent vaginal delivery in a university hospital between 2014 and 2015 were included. In-person interviews were conducted for all participants on the second postpartum day, followed by phone interviews at 12 months postpartum, with completion of structured questionnaires, including Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7). Demographic, obstetrics and questionnaire scores were analyzed and compared between the group of women who experienced persistent postpartum SUI and the group who did not. RESULTS At 12 months postpartum, 16.5% (n = 50) of women had persistent postpartum SUI, with 83.5% (n = 253) experiencing resolution of SUI symptoms. Maternal age ≥35 years (aOR = 2.62; 95% CI, 1.40-4.87, P = 0.002), gestational age at birth ≥40 weeks (aOR = 2.21; 95% CI, 1.12-4.37, P = 0.022), and severe perineal lacerations (aOR = 2.32; 95% CI, 1.27-4.45, P = 0.013) were independent risk factors for persistent postpartum SUI for women following vaginal delivery at 1-year follow-up. CONCLUSION The prevalence of persistent postpartum SUI at 1-year following vaginal delivery is 16.5%, with advanced maternal age, gestational age at birth ≥40 weeks and severe perineal lacerations being independent risk factors.
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Affiliation(s)
- Shuenn-Dhy Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kai-Lyn Ng
- Department of Obstetrics and Gynecology, Mount Elizabeth Novena Hospital, Singapore; Division of Urogynaecology, National University Hospital, Singapore
| | - Ching-Chung Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Hu Y, Lu H, Huang Q, Ren L, Wang N, Huang J, Yang M, Cao L. Risk factors for severe perineal lacerations during childbirth: A systematic review and meta‐analysis of cohort studies. J Clin Nurs 2022. [PMID: 35791260 DOI: 10.1111/jocn.16438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/24/2022] [Accepted: 06/20/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Yinchu Hu
- School of Nursing Peking University Beijing China
| | - Hong Lu
- School of Nursing Peking University Beijing China
| | - Qifang Huang
- School of Nursing Peking University Beijing China
| | - Lihua Ren
- School of Nursing Peking University Beijing China
| | - Na Wang
- School of Nursing Capital Medical University Beijing China
| | - Jing Huang
- School of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London London UK
| | - Minghui Yang
- Department of Obstetrics and Gynecology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Linlin Cao
- Department of Obstetrics and Gynecology Peking University Third Hospital Beijing China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Beijing China
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Woldegeorgis BZ, Obsa MS, Tolu LB, Bogino EA, Boda TI, Alemu HB. Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:905174. [PMID: 35865171 PMCID: PMC9295659 DOI: 10.3389/fmed.2022.905174] [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] [Received: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Episiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice. Methods Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI). Result A total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I2: 95.1%] were factors associated with episiotomy practice. Conclusion In this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- Department of Internal Medicine, Wolaita Sodo University, Sodo, Ethiopia
- *Correspondence: Beshada Zerfu Woldegeorgis
| | | | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Efa Ambaw Bogino
- Dermatovenereology Department, Wolaita Sodo University, Sodo, Ethiopia
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Chikazawa K, Imai K, Ko H, Ichi N, Misawa M, Kuwata T. Risk factors associated with perineal and vaginal lacerations and vaginal removal in total laparoscopic hysterectomy. Gynecol Minim Invasive Ther 2022; 11:150-154. [PMID: 36158298 PMCID: PMC9491053 DOI: 10.4103/gmit.gmit_118_21] [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] [Received: 11/02/2021] [Revised: 02/10/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives: This study aimed to identify risk factors associated with perineal and vaginal lacerations related to vaginal removal during total laparoscopic hysterectomy (TLH). Materials and Methods: We retrospectively assessed 134 patients who underwent TLH, of whom 44 (32.8%) had vaginal lacerations. Results: Univariate analysis revealed that for patients with myomas and adenomyosis, gonadotropin-releasing hormone agonist use and myomas with a transverse diameter of ≥5 cm were significant risk factors, while multiparity (vaginal delivery) was a protective factor for perineal and vaginal lacerations. Moreover, multivariate analysis indicated that multiparity was the only statistically significant protective factor. For cervical intraepithelial neoplasia, endometrial cancer, and endometrial hyperplasia, only a uterine transverse diameter of ≥5 cm was a significant risk factor for perineal or vaginal lacerations. Conclusion: For patients with large myomas, multiple vaginal delivery was a protective factor, and in patients with normal-sized uteri, a uterine transverse diameter of ≥5 cm was a risk factor for perineal or vaginal lacerations.
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Kim KW, Lee S. Childbirth outcomes and perineal damage in women with natural childbirth : a review of medical records in a natural birth center in Korea. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:379-387. [PMID: 36311447 PMCID: PMC9328644 DOI: 10.4069/kjwhn.2021.08.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
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Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial. J Clin Med 2021; 10:jcm10225250. [PMID: 34830530 PMCID: PMC8621123 DOI: 10.3390/jcm10225250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ2 (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ2 (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women.
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Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study. J Pers Med 2021; 11:jpm11080685. [PMID: 34442329 PMCID: PMC8398826 DOI: 10.3390/jpm11080685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period from January 2010 to April 2017. Results: During the study period, a total of 33,026 patients were included in the study. For maternal variables, the associated increased risk of severe perineal tearing in nulliparous women is OR = 3.48, for induced labor OR = 1.29, and for instrumental delivery by forceps OR = 4.52 or spatulas OR = 4.35; for the obstetric variable of episiotomy, it is OR = 3.41. For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears, and for birth weights of 3000 g (OR = 2.41), 3500 g (OR = 1.97), and 4000 g (OR = 2.17), statistically significant differences were found in each of the groups (p < 0.05). Conclusion: Primiparity, induction of labor, episiotomy, instrumental delivery with forceps or spatula, and a birth weight of 3000 g or more are significantly associated with an increased risk of third and fourth degree perineal tears.
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Tseng JY, Lin IC, Lin JH, Chang CM, Chao WT, Wang PH. Optimal approach for management of postpartum vulva hematoma: Report of three cases. Taiwan J Obstet Gynecol 2021; 59:780-783. [PMID: 32917338 DOI: 10.1016/j.tjog.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Vulvar hematomas though common in obstetrical practice can rapidly evolve into a life-threatening condition if not managed appropriately. Depending on clinical status and medical facility, conservative management, surgical debridement, or vessel-occlusion strategy can be considered. CASE REPORT Case 1 was a 28 year-old pregnant woman. Increasing hematoma over 12 cm in size was noted on postpartum Day 2. Debridement and arterial embolization were done. Case 2 was a referred woman at age of 30 who delivered at a local obstetric clinic. Debridement was performed successfully. Case 3 was a 23 year-old woman with postpartum bilateral hematoma. Drop in hemoglobin level prompted the medical team to transfer and airlift the patient for arterial embolization and subsequent vulva debridement. CONCLUSION Optimal management of hematoma is dependent on maternal hemodynamic condition, bleeding status, and availability of interventional radiology.
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Affiliation(s)
- Jen-Yu Tseng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - I-Chia Lin
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Jun-Hung Lin
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Chia-Ming Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Female Cancer Foundation, Taipei, Taiwan.
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Schrot-Sanyan S, Kolanska K, Haimeur Y, Varlas V, Parisot-Liance L, Daraï E, Bornes M. Language barrier as a risk factor for obstetric anal sphincter injury - A case-control study. J Gynecol Obstet Hum Reprod 2021; 50:102138. [PMID: 33831603 DOI: 10.1016/j.jogoh.2021.102138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The incidence of grade 3-4 perineal tears, also known as obstetric anal sphincter injury (OASI), is reported to be between 0.5 and 2.5%. Beyond the medico-economic burden, the consequences of OASI on a woman's emotional, psychological, sexual, and physical wellbeing are considerable. Among the various risk factors of OASI, few data are available about the impact of a language barrier on its incidence. MATERIAL AND METHODS We conducted a case-control study to evaluate the effect of language barriers on the risk of OASI comparing 171 women with OASI and 163 matched controls. The matched criteria included ethnicity, age, previous vaginal delivery, delivery mode, prophylactic episiotomy and birthweight. Patients' characteristics were compared and crude ORs and 95% CIs estimated using unadjusted logistic models. Multivariate analysis was performed with recognized potential confounders. RESULTS All of the cases had grade 3 tears. Language barrier was a determinant factor of OASI with an OR of 3.32 [1.36-8.90], p = 0.01. Other risk factors were occipito-posterior delivery, African origin and prolonged labor duration (OR 6.33, 95% CI: 2.04-27.78, p = 0.004, OR 1.85, 95% CI: 1.08-3.19, p = 0.03 and OR 1.03, 95% CI: 1.01-1.05, p = 0.004, respectively). CONCLUSION Our data suggest that language barrier is an independent risk factor of OASI. Physicians and midwives should attempt to identify patients with a language barrier during prenatal visits. Education about simple terms used during delivery could decrease the incidence of this complication.
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Affiliation(s)
- Stephanie Schrot-Sanyan
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Kamila Kolanska
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France.
| | - Yousra Haimeur
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Valentin Varlas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Laure Parisot-Liance
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Emile Daraï
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Marie Bornes
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France
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Risk factors for obstetric anal sphincter injury among parous women. Arch Gynecol Obstet 2020; 303:709-714. [PMID: 32975606 DOI: 10.1007/s00404-020-05806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Nulliparity and operative vaginal delivery are established risk factor for obstetric anal sphincter injury (OASI). However, risk factors for OASIS occurrence among parous women delivering vaginally are not well-established. We aimed to study the risk factors for OASI occurrence among parous women. METHODS A retrospective study including all parous women who delivered vaginally at term during 2011-2019 at a university hospital. Deliveries of parous women with OASI were compared to deliveries without OASI. The risk factors associated with OASI were investigated. RESULTS Overall, 35,397 women were included in the study with an OASI rate of 0.4% (n = 144). A higher rate of only one previous vaginal delivery was noted in the OASI group (78.5% vs. 46.4%, OR [95% CI] 4.20, 2.82-6.25, p < 0.001). The rate of vacuum-assisted deliveries was comparable between the study groups. The median birth weight was higher among the OASI group (3566 vs. 3300 g, p < 0.001), as was the rate of macrosomic neonates (19.4% vs. 5.5%, OR [95% CI] 4.15, 2.74-6.29, p < 0.001). On multivariate logistic regression analysis, only two factors were independently positively associated with the occurrence of OASI: a history of only one previous vaginal delivery (adjusted OR [95% CI] 4.34, 2.90-6.49, p = 0.001), and neonatal birth-weight (for each 500 g increment) (adjusted OR [95% CI] 2.51, 1.84-3.44, p < 0.001). CONCLUSIONS Among parous women, the only factors found to be independently positively associated with OASI were the order of parity and neonatal birth-weight. Vacuum-assisted delivery was not associated with an increased risk of OASI among parous women.
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Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study. J Pregnancy 2020; 2020:8395142. [PMID: 32953178 PMCID: PMC7481952 DOI: 10.1155/2020/8395142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background Episiotomy is the most common obstetric procedure, performed when the clinical circumstances place the patient at a high risk of high-degree laceration. However, episiotomy should be done with judicious indication to lower perineal laceration with fewer complications. Despite its adverse effects, the magnitude of episiotomy is increasing due to different factors. Therefore, this study is aimed at determining the recent magnitude of episiotomy and at identifying associated factors among women who gave delivery in Arba Minch General Hospital, Southern Ethiopia. Methods An institution-based cross-sectional study was conducted from December 15, 2018, to January 30, 2019. A systematic random sampling technique was used to select study participants. A semistructured questionnaire was used to collect data. This was supplemented with a review of the labor and delivery records. Binary and multivariable logistic regression analyses were performed to identify factors associated with the magnitude of episiotomy. P value ≤ 0.05 was used to determine the level of statistically significant variables. Results The magnitude of episiotomy was found to be 272 (68.0%) with 95%CI = 64.0‐72.5. Women who attended secondary education [AOR = 10.24, 95%CI = 2.81‐37.34], women who attended college and above [AOR = 4.61, 95%CI = 1.27‐16.71], birth weight ≥ 3000 g [AOR = 4.84, 95%CI = 2.66‐8.82], primipara [AOR = 4.13, 95%CI = 2.40‐7.12], being housewife occupants [AOR = 3.43, 95%CI = 1.20‐9.98], married women [AOR = 2.86, 95%CI = 1.40‐5.84], and body mass index < 25 kg/m2 [AOR = 2.85, 95%CI = 1.50‐5.44] were independent variables found to have significant association with episiotomy. Conclusion The magnitude of episiotomy was 68.0% which is higher than the recommended practice by WHO (10%). The study participants' occupational status, marital status, educational status, parity, birth weight, and BMI were significantly associated with the magnitude of episiotomy in the study area. Therefore, to reduce the rate of episiotomy, it is better to have periodic training for birth attendants regarding the indication of episiotomy.
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Pergialiotis V, Bellos I, Fanaki M, Vrachnis N, Doumouchtsis SK. Risk factors for severe perineal trauma during childbirth: An updated meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247:94-100. [PMID: 32087423 DOI: 10.1016/j.ejogrb.2020.02.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
Several studies have investigated the importance of maternal, fetal factors and intrapartum characteristics in predicting severe perineal lacerations. The purpose of the present systematic review is to accumulate current evidence and provide estimated effect sizes for the various risk factors described. We reviewed Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar for published studies in the field for observational studies as well as randomized controlled trials. Two researchers independently assessed the included studies and documented outcomes. Data extraction was performed using a modified data form that was based in Cochrane`s data collection form for intervention reviews for RCTs and non-RCTs. Forty-three articles were selected for inclusion in the present systematic review. The analyzed population reached 716,031 parturient of whom 22,280 (3,1%) sustained third- and fourth-degree perineal lacerations. Several risk factors were identified. Instrumental delivery [RR 3.38 (2.21, 5.18)], midline episiotomy [RR 2.88 (1.79, 4.65)] and a persistent occiput posterior position [RR 2.73 (2.08, 3.58)] were associated with the higher risk of developing severe perineal lacerations. Mediolateral episiotomy did not increase, but was also not protective against perineal lacerations [RR 1.55 (0.95, 2.53)]. Several factors contribute to the development of severe perineal lacerations. The present meta-analysis presents accumulated data that may help physicians estimate risks and provide appropriate patient counseling.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece; Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Maria Fanaki
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Vrachnis
- Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Stergios K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece; Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom; St George's University of London, London, United Kingdom
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Košec V, Djaković I, Čukelj M, Ejubović E, Sumpor B, Djaković Ž. INCREASED OASIS INCIDENCE - INDICATOR OF THE QUALITY OF OBSTETRIC CARE? Acta Clin Croat 2019; 58:365-370. [PMID: 31819335 PMCID: PMC6884390 DOI: 10.20471/acc.2019.58.02.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/15/2018] [Indexed: 11/24/2022] Open
Abstract
In the era of new molecular, epigenetic and proteomic discoveries, birth canal injuries seem like outdated discussion. A vast increase in the incidence of obstetric anal sphincter injuries (OASIS) has been recorded in the last two decades despite advantages in modern medicine and new obstetric methods. This increase might be attributed to the new classification of perineal injury but also to the new imaging methods, including endoanal sonography, which earlier identifies injuries that previously were considered to be occult and actually underwent unrecognized, and which should have been recognized immediately postpartum. OASIS are third and fourth degree perineal injuries that occur during delivery. The reported incidence of OASIS varies from 0.1% to 10.9%. It is well known that third and fourth degree perineal injuries occur more often in primiparae, and in cases of macrosomic newborn, dorsoposterior position of fetal head and shoulder dystocia. The protective role of episiotomy is controversial. Birth canal injury during delivery can happen to any parturient woman. It is important for obstetricians to have this in mind at every delivery. Repercussions of OASIS are serious and can persist for life. They include emotional, psychological, social, physical and sexual disturbances. Therefore, it is very important to recognize the risk factors, diagnose the injury on time and treat it properly by a multidisciplinary team. Accordingly, it can be concluded that the increased incidence of OASIS is a result of better recognition of the risk factors, reduced rates of unrecognized sphincter injuries, adoption of the new classification and better postpartum imagining methods for detection of occult injuries.
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Khresheh R, Barclay L. Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives in Jordan. Women Birth 2019; 33:e176-e181. [PMID: 30910398 DOI: 10.1016/j.wombi.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Episiotomy is still performed routinely by clinicians in many countries. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy practice among clinicians working in public hospitals in Jordan. METHODS A cross-sectional study, using a self-administered survey questionnaire, was conducted among midwives and obstetricians in three public hospitals in Jordan. RESULTS 112 (87.5%) clinicians responded to the questionnaire. Low knowledge level of evidence about overuse and risk of episiotomy was identified among participants with a significant difference among obstetricians and midwives (P<0.05). Results revealed that both obstetricians and midwives have limited access to evidence which is not emphasised in their learning, practice, or hospital policy. The majority of obstetricians (80%) and midwives (79%) thought an episiotomy rate of 81% is about right. The most common reason for performing episiotomy identified by both obstetricians (83.1%) and midwives (75.5%) was to reduce the risk of 3rd and 4th degree perineal laceration. The most common obstacle to reducing episiotomy rate reported by obstetricians (78.0%) was lack of training on preventing perineal tears, while the most common obstacles reported by midwives were insufficient time to wait for the perineum to stretch (56.6%) and difficulty changing the conventional practices in the labour ward (52.8%). CONCLUSION This study identifies that obstetricians and midwives in Jordan rely on non evidence-based beliefs to guide their practice on performing an episiotomy. Training, continuing education, and developing evidence based clinical policies and guidelines for surgical procedures, such as in an episiotomy, are needed.
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Affiliation(s)
| | - Lesley Barclay
- School of Medicine, University Centre for Rural Health, The University of Sydney, NSW Australia.
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Garcia-Lausin L, Perez-Botella M, Duran X, Rodríguez-Pradera S, Gutierrez-Martí MJ, Escuriet R. Relation between Epidural Analgesia and severe perineal laceration in childbearing women in Catalonia. Midwifery 2018; 70:76-83. [PMID: 30594059 DOI: 10.1016/j.midw.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objectives were to study the association between epidural analgesia and risk of severe perineal laceration (SPL), and identify additional risk factors for SPL. This multicentre study consisted of an analysis of data from the MidconBirth Phase I Database, on the use of EA and perineal results during childbirth. (World Health Organization, International Clinical Trials Registry Platform, 2016: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN17833269). METHODS We conducted a prospective study of pregnant women at term between July 2016 and July 2017 in 30 public maternity hospitals in Catalonia, Spain. Inclusion criteria were an uncomplicated singleton pregnancy, in cephalic presentation and vaginal birth. Data was analysed separately for instrumental births and spontaneous vaginal births, as the former is more frequently associated with episiotomy and more perineal lacerations. Risk factors as well as protective factors in each cohort of women (instrumental and spontaneous vaginal birth), were identified. Multivariate logistic regression model was performed to study the association between epidural analgesia and SPL to identify potential confounders. Odds ratios (OR), using 95% confidence intervals (CI) were constructed. FINDINGS During the study period, 5497 eligible women gave birth, 77.46% of them received epidural analgesia. SPL occurred in 1.63% of births. The univariate analysis showed births with epidural analgesia had significantly higher rates of inductions, augmentation of labour, lithotomy position for birth and episiotomy. However, this association disappeared when the variable "type of vaginal birth" was introduced. In multivariate logistic regression, nulliparity was the major predictor for SPL (OR: 0.17; CI 95%: 0.08-0.34, p: 0.000). KEY CONCLUSIONS Epidural analgesia was not associated with SPL once confounding factors were included. Other interesting factors associated with SPL were identified. IMPLICATIONS FOR PRACTICE This paper identifies important practice areas which contribute to SPL and which have the potential to be rectified. It offers evidence on the role that EA plays on pelvic floor injuries and it adds to existing evidence about the disadvantages of using the lithotomy position for birth, especially in relation to SPL. It highlights the need for practice change in Catalonia from what can be considered a medical model of care to one more aligned with the midwifery philosophy of care through the development of clinical guidelines. It also signals the need to provide women with evidence base upon which to make informed choices on the use of EA, specifically in relation to SPL.
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Affiliation(s)
- L Garcia-Lausin
- Department of Experimental and Health Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Mar Health Park, Spain.
| | - M Perez-Botella
- Research in Childbirth and Health unit (ReaRH), University of Central Lancashire, United Kingdom
| | - X Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d´Investigacions Mèdiques (IMIM), Spain
| | | | | | - R Escuriet
- Innovation and Health Division, Catalan Health Service, Spain; Mar School of Nursing, Universitat Pompeu Fabra (UPF), Spain
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Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwan J Obstet Gynecol 2018; 57:340-345. [DOI: 10.1016/j.tjog.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
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Gebuza G, Kaźmierczak M, Gdaniec A, Mieczkowska E, Gierszewska M, Dombrowska-Pali A, Banaszkiewicz M, Maleńczyk M. Episiotomy and perineal tear risk factors in a group of 4493 women. Health Care Women Int 2018; 39:663-683. [PMID: 29648935 DOI: 10.1080/07399332.2018.1464004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Episiotomy belongs to the most frequent procedures carried out during delivery. Performing episiotomy should be reduced as there is scientific evidence indicating that it can cause pain, sexual problems, and serious, long-term health consequences. The aim of the researchers is to identify factors associated with episiotomy and the perineal tear. Analyses were performed using a model of a logistic regression. The study involved 4493 women. The episiotomy risk was related to: a birth weight exceeding 3500 grams, an instrumental delivery by means of forceps or vacuum extraction. The decrease of episiotomy rate increased the rate of perineal tear of first and second degree. The study has shown that episiotomy protects women from third- and fourth-degree perineal tear.
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Affiliation(s)
- Grażyna Gebuza
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Marzena Kaźmierczak
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Alicja Gdaniec
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Estera Mieczkowska
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | | | | | | | - Marek Maleńczyk
- b Obstetrics, Feminine Health, and Oncologic Gynecology Unit, District Hospital , Torun , Poland
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Horng HC, Huang BS, Lu YF, Chang WH, Chiou JS, Chang PL, Lee WL, Wang PH. Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan. Medicine (Baltimore) 2018; 97:e9711. [PMID: 29369201 PMCID: PMC5794385 DOI: 10.1097/md.0000000000009711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pregnancy weight gain may be associated with adverse pregnancy outcomes. The article aims to explore the relationship between weight change and pregnancy outcome in the Taiwanese pregnant women.The retrospective cohort study enrolled women with vertex singleton pregnancy at University-associated Hospital between 2011 and 2014. Pregnancy weight change was separated into 3 groups, based on the Institute of Medicine (IOM) guidelines: below (n = 221); within (n = 544); and above (n = 382). Analysis of variance, χ tests, generalized linear models, and logistic regression models were used for statistical comparisons.Pregnant women with weight change above IOM guidelines had a significant increase in both maternal and perinatal complications compared with normal controls (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.03-1.98; P = .043; OR 1.45, 95% CI 1.01-1.87; P = .049, respectively). This finding was not found in pregnant women with weight gain below IOM guidelines. Moreover, age (OR 1.08, 95% CI 1.02-1.15; P = .0011), pre-pregnancy weight (OR 1.04, 95% CI 1.01-1.09; P = .0008), pre-pregnancy body mass index (BMI; OR 1.15, 95% CI 1.06-1.30; P < .0001), weight at the time of delivery (OR 1.05, 95% CI 1.02-1.13; P < .0001) and BMI at the time of delivery (OR 1.15, 95% CI 1.06-1.39; P < .0001), all contributed to increased maternal complications but not perinatal complications, whereas parity (OR 0.23, 95% CI 0.12-0.41; P < .0001) and gestational age (OR 0.50, 95% CI 0.35-0.62; P < .001) were associated with fewer maternal complications.Our study reconfirmed that for Taiwanese pregnant women, the approximate pregnancy weight gain recommended by IOM in 2009 was associated with the fewest maternal and perinatal complications. If approximate pregnancy weight gain cannot be attained, even less weight gain during pregnancy is still reasonable without significantly and adversely affecting maternal and perinatal outcomes in Taiwan.
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Affiliation(s)
- Huann-Cheng Horng
- Department of Obstetrics and Gynecology
- Institute of BioMedical Informatics
- Department of Obstetrics and Gynecology
| | - Ben-Shian Huang
- Department of Obstetrics and Gynecology
- Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Yen-Feng Lu
- Department of Obstetrics and Gynecology
- Department of Obstetrics and Gynecology, National Yang-Ming University Hospital, Ilan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Nursing
| | - Jyh-Shin Chiou
- Department of Obstetrics and Gynecology
- Department of Obstetrics and Gynecology, National Yang-Ming University Hospital, Ilan
| | | | - Wen-Ling Lee
- Department of Medicine, Cheng-Hsing General Hospital, Taipei
- Department of Nursing, Oriental Institute of Technology, New Taipei City
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology
- Department of Obstetrics and Gynecology
- Institute of Clinical Medicine, National Yang-Ming University, Taipei
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Wakwoya E, Fita F. Adverse maternal outcome and its association with gestational diabetes among women who gave birth in selected public hospitals in Eastern Ethiopia. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2018. [DOI: 10.4103/tjog.tjog_69_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Frigerio M, Manodoro S, Bernasconi DP, Verri D, Milani R, Vergani P. Incidence and risk factors of third- and fourth-degree perineal tears in a single Italian scenario. Eur J Obstet Gynecol Reprod Biol 2017; 221:139-143. [PMID: 29304391 DOI: 10.1016/j.ejogrb.2017.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/17/2017] [Accepted: 12/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate III and IV degree tears rates and related risk factors in a single Italian centre. The secondary goal was to build a predictive model based on identified risk factors. STUDY DESIGN This was a retrospective cohort study. All vaginal deliveries from 2011 to 2015 in a single Italian University Hospital were analysed. Univariate analysis was applied to evaluate the overall association between each factor and severe tear. Multivariate logistic regression was used to build a predictive model for the absolute risk of severe tear. We computed a resampling validated measure (AUC) of the predictive accuracy of the model and we provided a nomogram for the risk calculation in clinical practice. RESULTS 62 out of 10133 patients (0.61%) had a severe perineal tear. Univariate analysis identified gestational age >40 weeks, nulliparity, moderate/severe obesity, oxytocin use in pushing stage, sinciput presentation, instrumental delivery, shoulder dystocia, pushing stage ≥90 min, lithotomy position, birth weight >4 kg, head circumference at birth >34 cm and length at birth >50 cm as risk factors. Multivariate analysis identify moderate/severe obesity (OR = 2.8), instrumental delivery (OR = 2.6) and birth weight (OR = 1.1/hg) as independent risk factors. Using the predicted risk score from the final model (bootstrap-validated AUC 70%), we designed a nomogram for severe perineal tears absolute risk calculation. CONCLUSION Moderate/severe obesity, instrumental delivery and foetal weight resulted as independent risk factors for severe obstetrical tears.
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Affiliation(s)
| | | | - Davide P Bernasconi
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Italy
| | - Debora Verri
- ASST Monza, Ospedale San Gerardo, Monza, Italy; School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Italy
| | - Rodolfo Milani
- ASST Monza, Ospedale San Gerardo, Monza, Italy; School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Italy
| | - Patrizia Vergani
- ASST Monza, Ospedale San Gerardo, Monza, Italy; School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Italy
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Chikazawa K, Ushijima J, Takagi K, Nakamura E, Samejima K, Kadowaki K, Horiuchi I. Site and incidence of birth canal lacerations from instrumental delivery with mediolateral episiotomy. Taiwan J Obstet Gynecol 2017; 55:861-862. [PMID: 28040134 DOI: 10.1016/j.tjog.2016.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Instrument-assisted vaginal delivery is a significant risk factor for birth canal lacerations. Although many obstetricians recently are recommending restrictive rather than a routine episiotomy, reports have shown restrictive episiotomy to be associated with more extensive anterior birth canal trauma compared with routine episiotomy. MATERIALS AND METHODS We retrospectively reviewed 110 cases of forceps and vacuum deliveries and investigated the site of birth canal lacerations. Birth canal lacerations were divided into four sites according to direction-anterior, ipsilateral, contralateral, and posterior. RESULTS The frequency of lacerations were, from most to least, posterior (34%), lateral (21.7%), and anterior (1.9%). Moreover, among the lateral lacerations, they were more frequent in the contralateral side of episiotomy than the ipsilateral side (18.9% vs. 4.7%, p < 0.01). CONCLUSION Our results indicate that caution is also needed concerning not only the anterior site, but also the contralateral site of an episiotomy to prevent laceration in an instrument-assisted vaginal delivery.
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Affiliation(s)
- Kenro Chikazawa
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan
| | - Junko Ushijima
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan
| | - Kenjiro Takagi
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan.
| | - Eishin Nakamura
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan
| | - Koki Samejima
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan
| | - Kanako Kadowaki
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan
| | - Isao Horiuchi
- Saitama Medical Center, Jichi Medical University, Perinatal Center, Division of Maternal Fetal Medicine, Saitama, Japan
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