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Macedo MD, Risløkken J, Halle T, Ellström Engh M, Siafarikas F. Occurrence and risk factors for second-degree perineal tears: A prospective cohort study using a detailed classification system. Birth 2024. [PMID: 38305584 DOI: 10.1111/birt.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/17/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The amount of tissue trauma within second-degree perineal tears varies widely. Therefore, subcategorization of second-degree tears and a better understanding of their occurrence and risk factors are needed. The aim of this study was to assess the occurrence of perineal tears when second-degree tears were subcategorized. Furthermore, we aimed to assess the association between variables related to perineal anatomy and other potential risk factors, with second-degree tear subcategories. METHODS This prospective cohort study included 880 primiparous and multiparous women giving birth to one child vaginally. Perineal tears were categorized using the classification system recommended by the Royal College of Obstetricians and Gynaecologists. In addition, second-degree tears were subcategorized as 2A, 2B, or 2C according to the percentage of damage to the perineal body. Selected variables related to perineal anatomy were as follows: length of genital hiatus; perineal body length; and previous perineal trauma. Risk factors for second-degree tear subcategories were analyzed using a multinominal regression model. RESULTS Perineal tears occurred as follows: first-degree: 35.6% (n = 313), 2A: 16.3% (n = 143), 2B: 9.1% (n = 80), 2C: 6.6% (n = 58), and third- or fourth-degree: 1.6% (n = 14). In total, 169/880 participants underwent an episiotomy. When episiotomies were excluded, the risk for 2B, or 2C tears increased with smaller genital hiatus, larger perineal body, previous perineal trauma, primiparity, higher gestational age, instrumental vaginal delivery and fetal presentation other than occiput anterior. CONCLUSION The occurrence of second-degree tear subcategories was 16.3% for 2A tears, 9.1% for 2B tears, and 6.6% for 2C tears. Factors related to perineal anatomy increased the odds for experiencing a second-degree tear in a more severe subcategory.
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Affiliation(s)
- Marthe D Macedo
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Jeanette Risløkken
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Tuva Halle
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Ellström Engh
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Franziska Siafarikas
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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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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Opondo C, Harrison S, Sanders J, Quigley MA, Alderdice F. The relationship between perineal trauma and postpartum psychological outcomes: a secondary analysis of a population-based survey. BMC Pregnancy Childbirth 2023; 23:639. [PMID: 37674105 PMCID: PMC10481495 DOI: 10.1186/s12884-023-05950-6] [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: 04/05/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Perineal trauma, involving either naturally occurring tears or episiotomy, is common during childbirth but little is known about its psychological impact. This study aimed to determine the associations between childbirth related perineal trauma and psychological outcomes reported by women three months after giving birth and to explore factors that could mediate relationships between perineal trauma and maternal psychological outcomes. METHODS This study was a secondary analysis of data from a cross-sectional population-based survey of maternal and infant health. A total of 4,578 women responded to the survey, of which 3,307 had a vaginal birth and were eligible for inclusion into the analysis. Symptoms of depression, anxiety, and post-traumatic stress (PTS) symptoms were assessed using validated self- report measures. Physical symptoms were derived from a checklist and combined to produce a composite physical symptoms score. Regression models were fitted to explore the associations. RESULTS Nearly three quarters of women experienced some degree of perineal trauma. Women who experienced perineal trauma reported having more postnatal physical symptoms (adjusted proportional odds ratio 1.47, 95%CI 1.38 to 1.57, p-value < 0.001), were more likely to report PTS symptoms (adjusted OR 1.19, 95%CI 1.04 to 1.36, p-value 0.010), and there was strong evidence that each unit increase in the physical symptoms score was associated with between 38 and 90% increased adjusted odds of adverse psychological symptoms. There was no evidence of association between perineal trauma and satisfaction with postnatal care, although there was strong evidence that satisfaction with labour and birth was associated with 16% reduced adjusted odds of depression and 30% reduced adjusted odds of PTS symptoms. CONCLUSIONS Women who experienced perineal trauma were more likely to experience physical symptoms, and the more physical symptoms a woman experienced the more likely she was to report having postnatal depression, anxiety and PTS symptoms. There was some evidence of a direct association between perineal trauma and PTS symptoms but no evidence of a direct association between perineal trauma and depression or anxiety. Assessment and management of physical symptoms in the postnatal period may play an important role in reducing both physical and psychological postnatal morbidity.
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Affiliation(s)
- Charles Opondo
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, OX3 7LF, Oxford, UK
| | - Siân Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, OX3 7LF, Oxford, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Ty Dewi Sant Health Park, Cardiff, CF14 4XN, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, OX3 7LF, Oxford, UK
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, OX3 7LF, Oxford, UK.
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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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Xie H, Guo Z, Cao Q, Ye Y, Chen L, Luo N. Effect of individualized comfortable nursing on prognosis of vacuum sealing drainage in patients with orthopedic trauma. Medicine (Baltimore) 2023; 102:e32903. [PMID: 36800609 PMCID: PMC9936052 DOI: 10.1097/md.0000000000032903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
To explore the effect of individualized comfortable nursing on prognosis of vacuum sealing drainage (VSD) in patients with orthopedic trauma. 110 patients with orthopedic trauma VSD were randomly divided into the control group and the observation group, with 55 patients in each group receiving routine care and comfortable care. The wound healing time, visual analog scale, quality of life score, the level of inflammatory factors, the incidence of complications, and patient satisfaction were compared between the 2 groups. The average time of wound healing in the observation group was significantly lower than that in the control group (P < .01). The satisfaction rate in the observation group was significantly higher than that in the control group (P = .029). Meanwhile, the results showed that visual analog scale and quality of life scores in the observation group was significantly improved than that of the control group after receiving intervention (P < .05). After receiving intervention, the levels of TNF-α and IL-6 of patients in both groups were decreased, and the levels of TNF-α and IL-6 in the observation group were significantly decreased than those in the control group. Moreover, the incidence rate of adverse reaction in the observation group was significantly lower than that in the control group (P < .01). Comfortable nursing can reduce the wound healing time, the postoperative pain level, the incidence of complications, and improve patient satisfaction, which is of great significance for the prognosis of VSD in patients with orthopedic trauma.
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Affiliation(s)
- Huifang Xie
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Zhaodi Guo
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Qin Cao
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Yuan Ye
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Li Chen
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Na Luo
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
- * Correspondence: Na Luo, Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei 430200, China (e-mail: )
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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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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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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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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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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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Leite JS, Caroci-Becker A, Alves Mascarenhas VH, Gonzalez Riesco ML. Perineal tears sustained during vaginal birth: a cross-sectional study. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2020.11.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Erbaba H, Ciesielski P. Vaginal Birth Related Perineal Traumas and the Importance of Experimental Trainings. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2020. [DOI: 10.5799/jcei/7589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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