1
|
Wu JC, Yu XL, Ji HJ, Lou HQ, Gao HJ, Huang GQ, Zhu XL. Pelvic floor dysfunction and electrophysiology in postpartum women at 6-8 weeks. Front Physiol 2023; 14:1165583. [PMID: 37288437 PMCID: PMC10242003 DOI: 10.3389/fphys.2023.1165583] [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: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Objective: To investigate the incidence of pelvic floor dysfunction (PFD) and electrophysiological indicators in postpartum women at 6-8 weeks and explore the influence of demographic characteristics and obstetric factors. Methods: A survey questionnaire collected information about the conditions of women during their pregnancy and puerperal period and their demographic characteristics; pelvic organ prolapse quantitation (POP-Q) and pelvic floor muscle electrophysiology (EP) examination were conducted in postpartum women at 6-8 weeks. Results: Vaginal delivery was a risk factor for anterior pelvic organ prolapse (POP) (OR 7.850, 95% confidence interval (CI) 5.804-10.617), posterior POP (OR 5.990, 95% CI 3.953-9.077), anterior and posterior stage II POP (OR 6.636, 95% CI 3.662-15.919), and postpartum urinary incontinence (UI) (OR 6.046, 95% CI 3.894-9.387); parity was a risk factor for anterior POP (OR 1.397,95% CI 0.889-2.198) and anterior and posterior stage II POP (OR 4.162, 95% CI 2.125-8.152); age was a risk factor for anterior POP (OR 1.056, 95% CI 1.007-1.108) and postpartum UI (OR 1.066, 95% CI 1.014-1.120); body mass index (BMI) was a risk factor for postpartum UI (OR 1.117, 95% CI 1.060-1.177); fetal birth weight was a risk factor for posterior POP (OR 1.465, 95% CI 1.041-2.062); and the frequency of pregnancy loss was a risk factor for apical POP (OR 1.853, 95% CI 1.060-3.237). Conclusion: Pelvic floor muscle EP is a sensitive index of early pelvic floor injury. The changes in muscle strength and fatigue degree coexist in different types of postpartum PFD, and each has its own characteristics.
Collapse
Affiliation(s)
- Jia-Cong Wu
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, China
| | - Xiao-Li Yu
- Department of Outpatient, Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Hui-Jing Ji
- Nantong University Xinglin College, Nantong, China
| | - Hai-Qin Lou
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, China
| | - Hong-Ju Gao
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, China
| | - Guo-Qin Huang
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, China
| | - Xiao-Li Zhu
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, China
| |
Collapse
|
2
|
Okeahialam NA, Thakar R, Sultan AH. Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study. Acta Obstet Gynecol Scand 2023; 102:473-479. [PMID: 36707852 PMCID: PMC10008287 DOI: 10.1111/aogs.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS). MATERIAL AND METHODS Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. RESULTS Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. CONCLUSIONS We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future.
Collapse
Affiliation(s)
| | - Ranee Thakar
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
| | - Abdul H Sultan
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
| |
Collapse
|
3
|
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]
|
4
|
Bălălău OD, Bacalbașa N, Olaru OG, Pleș L, Stănescu DA. Vaginal birth after cesarean section – literature review and modern guidelines. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.1/13.17] [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
|
5
|
Filippini M, Farinelli M, Lopez S, Ettore C, Gulino FA, Capriglione S. Postpartum perineal pain: may the vaginal treatment with CO 2 laser play a key-role in this challenging issue? J Matern Fetal Neonatal Med 2019; 34:1190-1197. [PMID: 31164016 DOI: 10.1080/14767058.2019.1628208] [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] [Indexed: 10/26/2022]
Abstract
PURPOSE Pregnancy and childbirth, despite being physiological events, represent a very delicate period in a woman's life, because they expose to important vulvo-perineal traumas. The pelvic pain that follows each delivery, whether spontaneous or surgical (caesarean section), does not end in the first days after birth but, depending on the studies, becomes persistent in a very variable percentage of cases. Therefore, in the present pilot study, we aimed, for the first time in literature, to assess the efficacy of CO2 laser in women affected by perineal postpartum symptoms. MATERIALS AND METHODS Between February 2013 and June 2018, all women with late postpartum pelvic pain referred to the Department of Obstetrics and Gynecology of San Marino Hospital, were recruited and treated using the CO2 laser for three applications every 4-6 weeks. RESULTS Between February 2013 and June 2018, according to the inclusion and exclusion criteria, 32 women with late postpartum pelvic pain were recruited in our protocol study. Mean age of patients was 34.1 years. At latest follow-up, our data demonstrated an improvement in symptoms (dyspareunia, pain at introitus, vaginal dryness, itching and vaginal burning) with a mean reduction of this symptom of 70% from baseline. CONCLUSIONS This study has shown the effectiveness of CO2 laser treatment in postpartum perineal pain. Nevertheless, our results should be considered promising but preliminary. In fact, they need to be tested in larger cohort of patients to confirm its application in clinical practice and to evaluate the long-term duration of this treatment.
Collapse
Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Carla Ettore
- Dipartimento Materno-Infantile, ARNAS Garibaldi-Nesima, Catania, Italy
| | | | - Stella Capriglione
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino
| |
Collapse
|
6
|
Contributing factors of pregnant women's beliefs towards mode of delivery: a cross-sectional study from Iran. Matern Health Neonatol Perinatol 2018; 4:9. [PMID: 29744129 PMCID: PMC5930689 DOI: 10.1186/s40748-018-0077-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Delivery is a critical event in every woman's life. Under some medical conditions, women sometimes undergo a cesarean section to save the life of themselves and their infant. Understanding the factors associated with choosing the type of delivery leads to more effective health interventions and the promotion of maternal and newborn health. The aim of this study is to determine contributing factors in pregnant women's beliefs toward the mode of delivery in a sample of women referring to Hojatieh Hospital in Isfahan, Iran. Methods This cross-sectional study was conducted in September 2016 on 200 pregnant women (gestational age 30-37 weeks) referred to Hojatieh Hospital in Isfahan, Iran. The inclusion criteria of this study included healthy pregnancy and having no known cases (heart, pulmonary, and renal disease) and pregnancy complications (spotting, bleeding, headache, blurred vision), and willingness of pregnant women to complete the questionnaire. Data were collected through an eight-part questionnaire consisting of demographic factors, delivery intention, knowledge, perceived self-efficacy, attitude, perceived social, and private support in the presence of the researcher and the outcome of delivery were asked 2 weeks after the due date of delivery during a telephone call. Data were analyzed using SPSS16 software, independent t-test, chi-square, and logistic regression. Results There was no significant differences between the mean scores of knowledge and private social support among individuals with two types of delivery (P > 0.05), but the mean scores of perceived self-efficacy and public social support in women who gave birth normal were significantly higher than those of women who gave birth by cesarean section (P < 0.05). Conclusion The findings of this study showed that attitude and perceived self-efficacy were the most important predictors of delivery mode. Therefore, education based on the items included in these factors might be useful for choosing the delivery mode. The results might be used in evidence based midwifery practices in low and middle income countries to promote normal delivery and perhaps maternal health index.
Collapse
|
7
|
Dudley L, Kettle C, Waterfield J, Ismail KMK. Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study. BMJ Open 2017; 7:e013008. [PMID: 28188152 PMCID: PMC5306502 DOI: 10.1136/bmjopen-2016-013008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore women's lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT). DESIGN A nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology. PARTICIPANTS AND SETTING A purposive sample of six women at 6-9 months postnatal who participated in the RCT were interviewed in their own homes. RESULTS Following Giorgi's analytical framework the verbatim transcripts were analysed for key themes. Women's lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme 'participating in the RCT' was 'a priori' with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options. CONCLUSIONS To the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option. TRIAL REGISTRATION NUMBER ISRCTN05754020; results.
Collapse
Affiliation(s)
- L Dudley
- The Maternity Centre, Royal Stoke, University Hospitals of North Midlands, Staffordshire, UK
- Faculty of Health Sciences, Staffordshire University, Stafford, UK
| | - C Kettle
- Faculty of Health Sciences, Staffordshire University, Stafford, UK
| | - J Waterfield
- School of Health and Rehabilitation and Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Khaled M K Ismail
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
8
|
Morais Í, Lemos A, Katz L, Melo LFRD, Maciel MM, Amorim MMRD. Perineal Pain Management with Cryotherapy after Vaginal Delivery: A Randomized Clinical Trial. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2016; 38:325-32. [PMID: 27427867 PMCID: PMC10374237 DOI: 10.1055/s-0036-1584941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 05/17/2016] [Indexed: 10/21/2022] Open
Abstract
Introduction Systematic reviews that evaluate the perineal cryotherapy to reduce pain in the vaginal postpartum are inconclusive. Purpose To evaluate clinical effectiveness of cryotherapy in the management of humanized postpartum perineal pain and vaginal edema. Methods A double-bind randomized controlled clinical trial (UTN number: U1111-1131-8433) was conducted in a hospital in Northeastern, Brazil. Women were included following humanized childbirth. All had vaginal deliveries of a single, full-term pregnancy with cephalic presentation. Exclusion criteria included previous perineal lesion, episiotomy during the current delivery, instrumental delivery, uterine curettage and postpartum hemorrhage. In the experimental group, an ice pack was applied six times on the perineum for 20 minutes, reducing the temperature between 10 and 15 ° C, then 60 minutes without exposure to cold. In the non-cryotherapy, a water bag unable to reduce the temperature to this extent was used, compliance with the same application protocol of the first group. Perineal temperature was monitored at zero, 10 and 20 minutes for application in both groups. Evaluations were made immediately before and after the applications and 24 hours after delivery spontaneous, to determine the association between variables. Results A total of 80 women were included in the study, 40 in each group. There was no significant difference in scores of perineal pain and edema between the groups with or without cryotherapy until 24 hours after childbirth. There was no difference between groups when accomplished repeated measures analysis over the 24 hours after delivery, considering the median perineal pain (p = 0.3) and edema (p = 0.9). Perineal cryotherapy did not influence the amount of analgesics used (p = 0.07) and no adverse effect was registered. Conclusion The use of cryotherapy following normal vaginal delivery within the concept of humanized minimally interventionist childbirth had no effect on perineal pain and edema, since it was already substantially lower, nor the need for pain medicaments.
Collapse
Affiliation(s)
- Ítalo Morais
- Post-Graduate Program in Maternal-Infant Health, Instituto de Medicina Integral Professor Fernando Figueira (IMIP); Department of Physical Therapy, Centro Universitário Maurício de Nassau (UNINASSAU), Recife, Pernambuco, Brazil
| | - Andréa Lemos
- Post-Graduate Program in Maternal-Infant Health, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Leila Katz
- Post-Graduate Program in Maternal-Infant Health, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Lorena Fernandes Rosendo de Melo
- Cientific Initiation Program, Instituto de Medicina Integral Professor Fernando Figueira (IMIP). Undergraduate course in Medicine, Faculdade Pernambucana de Saúde (FPS), Recife, Pernambuco, Brazil
| | - Mariano Maia Maciel
- Cientific Initiation Program, Instituto de Medicina Integral Professor Fernando Figueira (IMIP). Undergraduate course in Medicine, Faculdade Pernambucana de Saúde (FPS), Recife, Pernambuco, Brazil
| | - Melania Maria Ramos de Amorim
- Post-Graduate Program in Maternal-Infant Health, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
- Instituto Paraibano de Pesquisa Professor Joaquim Amorim Neto (IPESQ); Department of Medicine, Universidade Federal de Campina Grande (UFCG), Campina Grande, Paraiba, Brazil
| |
Collapse
|
9
|
Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting. Obstet Gynecol Int 2016; 2016:5798068. [PMID: 27413377 PMCID: PMC4931095 DOI: 10.1155/2016/5798068] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75–82). Women attending health centres were more likely satisfied than women attending hospitals (χ2 = 83.7, df = 12, P < 0.001). The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (χ2 = 27.4, df = 1, P < 0.001). The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75–14.1) and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44–9.06). Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09–81). Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals.
Collapse
|