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Okeahialam NA, Thakar R, Sultan AH. Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study. Acta Obstet Gynecol Scand 2023; 102:473-479. [PMID: 36707852 PMCID: PMC10008287 DOI: 10.1111/aogs.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS). MATERIAL AND METHODS Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. RESULTS Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. CONCLUSIONS We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future.
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Affiliation(s)
| | - Ranee Thakar
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
| | - Abdul H Sultan
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
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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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Bilateral Inferiorly Based Labia Majora Flaps: A Simple Technique for Post Episiotomy Dehiscence Coverage. World J Plast Surg 2022; 11:78-83. [PMID: 36694685 PMCID: PMC9840771 DOI: 10.52547/wjps.11.3.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 12/23/2022] Open
Abstract
Episiotomy dehiscence because of infection is a cause of major physical, psychological and social problems. Management depends on the degree of injury. The loco-regional flap can be considered in recurrent dehiscence with loss of tissue. We report a case of a 26-year-old female who presented with a post episiotomy wound in the perineal region extending from the posterior fourchette to the anal opening. She gave the history of resuturing of dehiscence twice but the result was the same. On examination, there was a loss of skin and subcutaneous tissue between vaginal and anal opening with pouting of the anal and vaginal mucosa. Per rectal examination, the anal tone was normal. Her wound was covered with bilateral inferiorly based labia majora flaps with a good outcome. So, an inferiorly based labia majora flap can be a useful option in coverage of recurrent perineal dehiscence.
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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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Aboubakr A, Gottlieb ZS, Riggs AR, Johnson SO, Jimenez D, Rekawek P, Mella MT, Dubinsky MC. Peripartum Exposure to Biologic Therapy Does Not Impact Postpartum Wound Healing in Women With IBD. Inflamm Bowel Dis 2022; 28:843-849. [PMID: 34272560 DOI: 10.1093/ibd/izab165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) commonly affects women during childbearing years and often requires antepartum therapy. Data regarding effects of biologic exposure on delivery outcomes are limited. We explored whether peripartum biologic exposure impacts wound healing following cesarean section (C-section) and vaginal delivery (VD) in IBD patients. METHODS Pregnancy and IBD data from the IBD Preconception and Pregnancy Planning (I-PrePP) Clinic database were collected and analyzed. Primary outcome was frequency of postpartum wound infection in women receiving peripartum biologics, defined as exposure in the third trimester and up to 2 weeks postdelivery relative to nonexposed patients. Secondary outcomes included effect of peripartum biologic timing and IBD phenotype on wound healing. Descriptive statistics summarized data using frequency for categorical variables and median for continuous variables. Univariate analyses tested associations when appropriate. RESULTS Of 100 deliveries (interquartile range, 30-35; median, 33 years old), 58 were C-sections and 42 VDs. Peripartum biologic exposure occurred in 72% (42 of 58) and 57% (24 of 42), respectively. Median time from last dose to delivery was 6 (interquartile range, 4-8) weeks; 21 (32%) received biologics within 72 hours following delivery. Seven infections occurred following C-section among 5 unique CD patients. Peripartum biologic exposure was not associated with infection (4 of 66 [6%] exposed vs 3 of 34 [8.8%] nonexposed; P = .68), nor was disease activity (P = 1.0). Crohn's disease (P = 0.02), internal penetrating phenotype (P < .001), prior IBD surgery (P = .03), and prior postpartum infection (P = .04) were associated with infection. CONCLUSIONS Peripartum biologic exposure does not impair postpartum wound healing; however, patients with more complicated disease phenotypes require close monitoring.
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Affiliation(s)
- Aiya Aboubakr
- Department of Medicine, New York Presbyterian/Weill Cornell, New York, NY, USA
| | - Zoë S Gottlieb
- Departments of Pediatrics and Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Alexa Rae Riggs
- Departments of Pediatrics and Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Shaelyn O'Hara Johnson
- Department of Obstetrics, Gynecology & Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Darwin Jimenez
- Departments of Pediatrics and Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Patricia Rekawek
- Department of Obstetrics, Gynecology & Reproductive Science, NYU Langone Hospital Long Island, NYU Langone Health, Mineola, NY, USA
| | - Maria Teresa Mella
- Department of Obstetrics, Gynecology & Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Marla C Dubinsky
- Departments of Pediatrics and Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine, Mount Sinai, New York, NY, USA
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Okeahialam NA, Wong KW, Thakar R, Sultan AH. The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:182-191. [PMID: 35550375 DOI: 10.1016/j.ajog.2022.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to systematically determine the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair. DATA SOURCES MEDLINE, Embase, CINAHL, EmCare, the Cochrane Library, and Trip Pro databases were searched from inception to February 2021. STUDY ELIGIBILITY CRITERIA We included observational clinical studies reporting the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair. Case series and reports were excluded. Conference articles and observational study abstracts were included if they contained enough information regarding study design and outcome data. METHODS Data were analyzed as incidence (percentage) with 95% confidence intervals. Moreover, the prediction intervals were calculated to provide a predicted range for the potential incidence of wound complications when applied to an individual study setting. Study quality and risk of bias were assessed using the relevant tool from the Joanna Briggs Institute. RESULTS Of 956 studies found, 39 were selected for full-text review. Moreover, 10 studies (n=4767 women) were eligible and included in the meta-analysis. All 10 studies were conducted in high-income countries (Denmark [n=1], the United Kingdom [n=3], and the United States [n=6]). The incidences of wound infection (n=4593 women) and wound dehiscence (n=3866 women) after primary obstetric anal sphincter injury repair ranged between 0.1% to 19.8% and 1.9% to 24.6%, respectively. The overall incidences were 4.4% (95% confidence interval, 0.4-8.4) for wound infection and 6.9% (95% confidence interval, 1.6-12.2) for wound dehiscence. The prediction intervals were wide and suggested that the true incidences of wound infection and dehiscence in future studies could lie between 0.0% to 11.7% and 0.0% to 16.4%, respectively. Overall, 8 studies had a high or unclear risk of bias across ≥1 assessed element. None of the studies used the same set of clinical parameters to define wound infection or dehiscence. Furthermore, microbiological confirmation with wound swabs was never used as a diagnostic measure. CONCLUSION This was a systematic review and meta-analysis of wound infection and dehiscence incidences after primary obstetric anal sphincter injury repair. The incidence estimates from this review will be useful for clinicians when counseling women with obstetric anal sphincter injury and when consenting them for primary surgical repair.
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Affiliation(s)
| | - Ka Woon Wong
- Croydon University Hospital, Thornton Heath, England
| | - Ranee Thakar
- Croydon University Hospital, Thornton Heath, England; St George's University of London, London, United Kingdom
| | - Abdul H Sultan
- Croydon University Hospital, Thornton Heath, England; St George's University of London, London, United Kingdom.
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Laine K, Yli BM, Cole V, Schwarz C, Kwee A, Ayres-de-Campos D, Vayssiere C, Roth E, Gliozheni E, Savochkina Y, Ivanisevic M, Kalis V, Timonen S, Verspyck E, Anstaklis P, Beke A, Eriksen BH, Santo S, Kavsek G, Duvekot H, Dadak C. European guidelines on perinatal care- Peripartum care Episiotomy. J Matern Fetal Neonatal Med 2021; 35:8797-8802. [PMID: 34895000 DOI: 10.1080/14767058.2021.2005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OF RECOMMENDATIONS1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++-; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation)2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation).3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++-; Strong recommendation).4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation).
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Affiliation(s)
- Katariina Laine
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.,Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | - Vanessa Cole
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | | | | | | | | | | | | | | | | | - Vladimir Kalis
- Czech Society of Perinatology and Feto-Maternal Medicine
| | | | | | | | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology
| | | | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine
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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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Taheri M, Amiri-Farahani L. Anti-Inflammatory and Restorative Effects of Olives in Topical Application. Dermatol Res Pract 2021; 2021:9927976. [PMID: 34257643 PMCID: PMC8257351 DOI: 10.1155/2021/9927976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/21/2021] [Indexed: 01/01/2023] Open
Abstract
METHODS A literature search was conducted (1990-2021) in Medline, Embase, CINAHL, Google Scholar, Science Direct, SID, IranDoc, and Magiran databases. From the 102 reviewed articles, 17 articles were selected to be included in the current article. RESULTS Various forms of olive have long been used to accelerate the healing of various wounds and skin damage such as diabetic foot ulcers, atopic dermatitis, diaper dermatitis, episiotomy wound, and nipple ulcer but there are still no credible documents or articles that provide reliable evidence of topical use. CONCLUSION According to the information obtained from the articles reviewed, olive oil appears to be an effective, safe, and available treatment. This study suggests that olive oil is an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of olive oil in similar or different injuries in different populations.
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Affiliation(s)
- Mahdiyeh Taheri
- Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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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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Jummaat F, Yahya EB, Khalil H.P.S. A, Adnan AS, Alqadhi AM, Abdullah CK, A.K. AS, Olaiya NG, Abdat M. The Role of Biopolymer-Based Materials in Obstetrics and Gynecology Applications: A Review. Polymers (Basel) 2021; 13:633. [PMID: 33672526 PMCID: PMC7923797 DOI: 10.3390/polym13040633] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
Biopolymers have gained tremendous attention in many daily life applications, including medical applications, in the past few years. Obstetrics and gynecology are two fields dealing with sensitive parts of the woman's body and her newborn baby, which are normally associated with many issues such as toxicity, infections, and even gene alterations. Medical professions that use screening, examination, pre, and post-operation materials should benefit from a better understanding of each type of material's characteristics, health, and even environmental effects. The underlying principles of biopolymer-based materials for different obstetric and gynecologic applications may discover various advantages and benefits of using such materials. This review presents the health impact of conventional polymer-based materials on pregnant women's health and highlights the potential use of biopolymers as a safer option. The recent works on utilizing different biopolymer-based materials in obstetric and gynecologic are presented in this review, which includes suture materials in obstetric and gynecologic surgeries, cosmetic and personal care products, vaginal health, and drug delivery; as well as a wound dressing and healing materials. This review highlights the main issues and challenges of biopolymers in obstetric and gynecologic applications.
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Affiliation(s)
- Fauziah Jummaat
- Management & Science University Medical Centre, University Drive, Off Persiaran Olahraga, Section 13, Shah Alam 40100, Malaysia
| | - Esam Bashir Yahya
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - Abdul Khalil H.P.S.
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - A. S. Adnan
- Management & Science University Medical Centre, University Drive, Off Persiaran Olahraga, Section 13, Shah Alam 40100, Malaysia
| | | | - C. K. Abdullah
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - Atty Sofea A.K.
- Hospital Seberang Jaya, Jalan Tun Hussein Onn, Seberang Jaya, Permatang Pauh 13700, Malaysia;
| | - N. G. Olaiya
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - Munifah Abdat
- Department of Preventive and Public Health Dentistry, Faculty of Dentistry, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
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Arendsen LP, Thakar R, Bassett P, Sultan AH. A double blind randomized controlled trial using copper impregnated maternity sanitary towels to reduce perineal wound infection. Midwifery 2020; 92:102858. [PMID: 33157498 DOI: 10.1016/j.midw.2020.102858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effect of copper impregnated sanitary towels on the infection rate following vaginal delivery (VD). DESIGN Single center double blind randomized controlled trial. PARTICIPANTS Women aged 18 or over who had a sutured second-degree tear or episiotomy following VD. INTERVENTIONS All women were randomized to receive either a copper-oxide impregnated sanitary towel (study group) or a non-copper sanitary towel (control group). MAIN OUTCOME MEASURES The primary study outcome was the incidence of wound infection within a 30-day period from VD, assessed via telephone questionnaire. Secondary outcomes were length of hospital stay and risk factors of infection. RESULTS 450 women were enrolled in the study of whom 225 were randomized to the copper impregnated sanitary towel (study group) and 225 to the non-copper sanitary towel (control group) group. Follow-up rate was 98.2%. A total of 102 women (23.1%) developed an infection within 30 days following VD, 19 in the study group (8.6%) and 83 (37.4%) in the control group (P = <0.001, absolute risk reduction (ARR) of 28.8%). The incidence of superficial/deep and organ/space infections was significantly lower in the study group (7.7% vs. 30.2%, P = <0.001 and 4.6% vs. 31.5%, P = <0.001 respectively) with an ARR of 22.5% and 27.0% respectively. Multivariable analysis reported Asian ethnicity and prolonged rupture of membranes as significant risk factors; for the development of infection (OR 1.91, P = 0.03 and OR = 1.97, P = 0.04 respectively). CONCLUSIONS This is the first study to demonstrate a significant reduction in infection rate following VD with the use of copper impregnated sanitary towels.
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Affiliation(s)
- Linda Petra Arendsen
- Obstetrics and Gynaecology Department, Croydon University Hospital, 530 London Road, CR7 7YE, United Kingdom
| | - Ranee Thakar
- Obstetrics and Gynaecology Department, Croydon University Hospital, 530 London Road, CR7 7YE, United Kingdom
| | - Paul Bassett
- Statsconsultancy Ltd, 40 Longwood Lane, Amersham, Bucks, HP7 9EN, United Kingdom
| | - Abdul Hameed Sultan
- Obstetrics and Gynaecology Department, Croydon University Hospital, 530 London Road, CR7 7YE, United Kingdom; Honorary Reader, St George's University of London, Cranmer Terrace, SW17 0RE, United Kingdom.
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Okeahialam NA, Thakar R, Kleprlikova H, Taithongchai A, Sultan AH. Early re-suturing of dehisced obstetric perineal wounds: A 13-year experience. Eur J Obstet Gynecol Reprod Biol 2020; 254:69-73. [PMID: 32942078 DOI: 10.1016/j.ejogrb.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe post-operative outcomes following early re-suturing of obstetric perineal wound dehiscence. STUDY DESIGN This was a retrospective series of 72 women who underwent re- suturing of a dehisced perineal wound at a tertiary urogynaecology department during a 13-year period (December 2006 - December 2019). RESULTS Seventy-two women with complete perineal wound dehiscence opted for secondary re-suturing. Other accompanying symptoms included purulent discharge from the wound (22.2 %), perineal pain (23.6 %) and both purulent discharge and pain (26.4 %). The median time taken for the wound to heal completely following re-suturing was 28 days (IQR 14.0-52.0); 49.2 % had healed completely by four weeks, 63.5 % by six weeks and 76.2 % by eight weeks. The median number of out-patient follow-up appointments required was 2 (IQR 1.0-3.0). No post-operative complications were experienced in 63.6 % of women, one complication occurred in 25.8 % and two complications in 10.6 %. Complications included skin dehiscence (33.3 %), granuloma (33.3 %), scar tissue (17.6 %), perineal pain (5.9 %) and sinus formation (5.9 %). Of the women who developed two complications, four developed skin dehiscence with granulation tissue and one had skin sinus formation. One developed granulation tissue with perineal pain. All complications were managed conservatively in an outpatient setting or surgically under local anaesthetic, without further complication. There was no significant difference (p = 0.443) in complication rates between the group (n = 10) with dehisced wounds with signs of wound infection (purulent discharge or the presence of both purulent discharge and pain) pre-operatively versus the group (n = 14) without signs of infection. CONCLUSIONS This study demonstrates the positive outcomes of early re-suturing of perineal wound dehiscence with faster healing, reduced follow-up requirements and few major complications. It provides information to clinicians who are uncertain about the effects of early re-suturing of perineal wounds which can be used to help counsel mothers with wound dehiscence on their management options.
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Affiliation(s)
| | - R Thakar
- Croydon University Hospital, London UK; Honorary Senior Lecturer St George's University of London, UK
| | - H Kleprlikova
- Croydon University Hospital, London UK; Department of General Anthropology, Faculty of Humanities, Charles University in Prague, Czech Republic
| | | | - A H Sultan
- Croydon University Hospital, London UK; Honorary Reader St. George's University of London, UK.
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The Anti-Inflammatory Properties of the Topical Application of Human Milk in Dermal and Optical Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4578153. [PMID: 32774417 PMCID: PMC7396075 DOI: 10.1155/2020/4578153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 12/16/2022]
Abstract
Methods The various datasets including Ovid, PubMed, Google Scholar, Science Direct, Magiran, Irandoc, SID, and IranMedex were searched from 1990 to 2018. From the 119 reviewed articles, 20 articles were selected to be included in the current article. Results There is a consensus among the literature and ancient texts regarding the effectiveness of THM in curing the various types of skin damages, such as cord separation, atopic dermatitis, diaper dermatitis, conjunctivitis, scratches, insect bite, perineal ulcer, and nipple ulcer. However, the importance of its application has not been given much attention. Conclusion According to the information obtained from the articles reviewed, the THM appears to be an effective, safe, and available treatment compared to conventional chemical treatments. This study suggests THM as an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of THM in similar or different injuries in different populations.
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Knight M, Chiocchia V, Partlett C, Rivero-Arias O, Hua X, Bowler U, Gray J, Gray S, Hinshaw K, Khunda A, Moore P, Mottram L, Owino N, Pasupathy D, Sanders J, Sultan AH, Thakar R, Tuffnell D, Linsell L, Juszczak E. Intravenous co-amoxiclav to prevent infection after operative vaginal delivery: the ANODE RCT. Health Technol Assess 2019; 23:1-54. [PMID: 31590702 DOI: 10.3310/hta23540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sepsis is a leading cause of direct and indirect maternal death in both the UK and globally. All forms of operative delivery are associated with an increased risk of sepsis, and the National Institute for Health and Care Excellence's guidance recommends the use of prophylactic antibiotics at all caesarean deliveries, based on substantial randomised controlled trial evidence of clinical effectiveness. A Cochrane review, updated in 2017 (Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev 2017;8:CD004455), identified only one small previous trial of prophylactic antibiotics following operative vaginal birth (forceps or ventouse/vacuum extraction) and, given the small study size and extreme result, suggested that further robust evidence is needed. OBJECTIVES To investigate whether or not a single dose of prophylactic antibiotic following operative vaginal birth is clinically effective for preventing confirmed or presumed maternal infection, and to investigate the associated impact on health-care costs. DESIGN A multicentre, randomised, blinded, placebo-controlled trial. SETTING Twenty-seven maternity units in the UK. PARTICIPANTS Women who had an operative vaginal birth at ≥ 36 weeks' gestation, who were not known to be allergic to penicillin or constituents of co-amoxiclav and who had no indication for ongoing antibiotics. INTERVENTIONS A single dose of intravenous co-amoxiclav (1 g of amoxicillin/200 mg of clavulanic acid) or placebo (sterile saline) allocated through sealed, sequentially numbered, indistinguishable packs. MAIN OUTCOME MEASURES Primary outcome - confirmed or suspected infection within 6 weeks of giving birth. Secondary outcomes - severe sepsis, perineal wound infection, perineal pain, use of pain relief, hospital bed stay, hospital/general practitioner visits, need for additional perineal care, dyspareunia, ability to sit comfortably to feed the baby, maternal general health, breastfeeding, wound breakdown, occurrence of anaphylaxis and health-care costs. RESULTS Between March 2016 and June 2018, 3427 women were randomised: 1719 to the antibiotic arm and 1708 to the placebo arm. Seven women withdrew, leaving 1715 women in the antibiotic arm and 1705 in the placebo arm for analysis. Primary outcome data were available for 3225 out of 3420 women (94.3%). Women randomised to the antibiotic arm were significantly less likely to have confirmed or suspected infection within 6 weeks of giving birth (180/1619, 11%) than women randomised to the placebo arm (306/1606, 19%) (relative risk 0.58, 95% confidence interval 0.49 to 0.69). Three serious adverse events were reported: one in the placebo arm and two in the antibiotic arm (one was thought to be causally related to the intervention). LIMITATIONS The follow-up rate achieved for most secondary outcomes was 76%. CONCLUSIONS This trial has shown clear evidence of benefit of a single intravenous dose of prophylactic co-amoxiclav after operative vaginal birth. These results may lead to reconsideration of official policy/guidance. Further analysis of the mechanism of action of this single dose of antibiotic is needed to investigate whether earlier, pre-delivery or repeated administration could be more effective. Until these analyses are completed, there is no indication for administration of more than a single dose of prophylactic antibiotic, or for pre-delivery administration. TRIAL REGISTRATION Current Controlled Trials ISRCTN11166984. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 54. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Virginia Chiocchia
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christopher Partlett
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xinyang Hua
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ursula Bowler
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James Gray
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Shan Gray
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kim Hinshaw
- Department of Obstetrics and Gynaecology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.,Faculty of Health Sciences, University of Sunderland, Sunderland, UK
| | - Aethele Khunda
- Department of Women's Health, James Cook University Hospital, Middlesbrough, UK
| | - Philip Moore
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Linda Mottram
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nelly Owino
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, King's Health Partners, London, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.,Department of Women's Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - Derek Tuffnell
- Department of Women's Health, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology. Clin Microbiol Rev 2019; 32:32/4/e00125-18. [PMID: 31413046 DOI: 10.1128/cmr.00125-18] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Health care-associated infections (HAIs) are a global problem associated with significant morbidity and mortality. Controlling the spread of antimicrobial-resistant bacteria is a major public health challenge, and antimicrobial resistance has become one of the most important global problems in current times. The antimicrobial effect of copper has been known for centuries, and ongoing research is being conducted on the use of copper-coated hard and soft surfaces for reduction of microbial contamination and, subsequently, reduction of HAIs. This review provides an overview of the historical and current evidence of the antimicrobial and wound-healing properties of copper and explores its possible utility in obstetrics and gynecology.
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17
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Gommesen D, Nohr EA, Drue HC, Qvist N, Rasch V. Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study. Arch Gynecol Obstet 2019; 300:67-77. [PMID: 31004221 DOI: 10.1007/s00404-019-05165-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women. METHODS A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11-21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case-control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm). RESULTS Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95% confidence interval [CI] 5.48-34.1 and aOR 3.27, 95% CI 1.52-7.04, respectively). BMI > 35 kg/m2 increased the risk of wound infection and dehiscence (aOR 7.66, 95% CI 2.13-27.5 and aOR 3.46, 95% CI 1.10-10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95% CI 1.05-8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95% CI 0.15-0.70). CONCLUSIONS Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.
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Affiliation(s)
- Ditte Gommesen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Gynaecology and Obstetrics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Ellen Aagaard Nohr
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Henrik Christian Drue
- Department of Radiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Niels Qvist
- Department of Gastroenterological Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Vibeke Rasch
- Department of Gynaecology and Obstetrics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
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Wiseman O, Rafferty AM, Stockley J, Murrells T, Bick D. Infection and wound breakdown in spontaneous second-degree perineal tears: An exploratory mixed methods study. Birth 2019; 46:80-89. [PMID: 30136338 DOI: 10.1111/birt.12389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Perineal trauma affects large numbers of women who have a vaginal birth. This study explores the incidence, etiology and women's experiences of wound infection/breakdown associated with spontaneous second degree tears. METHODS This was an exploratory mixed methods study set in an urban tertiary National Health Service hospital in 2014-2015. The study included a prospective observational study of second-degree tears using electronic patient records. Infection was defined using criteria adapted from Public Health England's Surgical Site Infection Surveillance Service. We also did a case-control study of maternity records to explore factors associated with perineal infection/wound breakdown, and semi-structured interviews with a purposeful sample of women who experienced wound infection/breakdown. RESULTS Of 2892 vaginal births during the study period, 76.8% sustained perineal trauma, with second-degree tears most commonly recorded (n = 828/28.6%). Sixteen (1.9%) had a documented infection/wound breakdown which were associated with "compromised wound status" (increased severity of wound/poor suturing; P = 0.033) Women complained of a lack of information about their perineum and poor postnatal surveillance by midwives and physicians. Diagnosis and treatment were often delayed by clinicians' reliance on external signs of wound infection. Although the sample size was small, there were no differences in rates of infection between sutured and unsutured second-degree tears. CONCLUSIONS Although second-degree tears were common after vaginal birth, wound infection/breakdown was relatively uncommon. Women who report feeling unwell or develop pyrexia postnatally should be assessed urgently. A prospective longitudinal study exploring the long-term sequelae of second-degree tears is needed.
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Affiliation(s)
- Octavia Wiseman
- Centre for Maternal and Child Health, City, University of London, London, UK
| | - Anne M Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Jane Stockley
- Department of Medical Microbiology, Worcestershire Royal Hospital, Worcester, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Debra Bick
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Male infants and birth complications are associated with increased incidence of postnatal depression. Soc Sci Med 2019; 220:56-64. [DOI: 10.1016/j.socscimed.2018.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/18/2018] [Accepted: 10/14/2018] [Indexed: 12/13/2022]
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Mohamed-Ahmed O, Hinshaw K, Knight M. Operative vaginal delivery and post-partum infection. Best Pract Res Clin Obstet Gynaecol 2018; 56:93-106. [PMID: 30992125 DOI: 10.1016/j.bpobgyn.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
During the past decade, there has been an increase in the awareness of infections associated with pregnancy and delivery. The most significant cause of post-partum infection is caesarean section; 20-25% of operations are followed by wound infections, endometritis or urinary tract infections. Approximately 13% of women in the UK undergo operative vaginal delivery (OVD) with forceps or vacuum, which is also associated with an increased risk of infection, estimated at 0.7%-16% of these deliveries. Despite this, previous reviews have identified only one small trial of antibiotic prophylaxis in 393 women and concluded that there was insufficient evidence to support the routine use of prophylactic antibiotics after OVD. The ANODE trial, a multicentre, blinded, placebo-controlled trial from the UK, is due to report findings from more than 3400 women in 2019 and will be the largest study to date of antibiotic prophylaxis following OVD.
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Affiliation(s)
- Olaa Mohamed-Ahmed
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kim Hinshaw
- City Hospitals Sunderland NHS Foundation Trust, Faculty of Health Sciences, University of Sunderland, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.
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Knight M, Mottram L, Gray S, Partlett C, Juszczak E. Prophylactic antibiotics for the prevention of infection following operative vaginal delivery (ANODE): study protocol for a randomised controlled trial. Trials 2018; 19:395. [PMID: 30041702 PMCID: PMC6056933 DOI: 10.1186/s13063-018-2787-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/04/2018] [Indexed: 02/08/2023] Open
Abstract
Background Sepsis is one of the most important causes of maternal death and severe morbidity worldwide. Studies conducted both in the UK and US have documented an additional risk associated with operative vaginal delivery. However, a Cochrane review, updated in 2017, identified only one small trial of prophylactic antibiotics following operative vaginal delivery, which included a total of 393 women. Given the small size of that trial, it recommended that further robust evidence is needed. Operative vaginal delivery rates vary worldwide, but typically 5–10% of women have operative vaginal births. A conservative estimated incidence of maternal infection following operative vaginal delivery is 4%, based on the one previous trial. There is, therefore, considerable scope for direct patient benefit from an effective preventive strategy. Methods/Design This protocol describes a multicentre, randomised, blinded, placebo-controlled trial aiming to recruit 3424 participants from over 20 hospital sites in the UK. Women who have undergone an operative vaginal delivery at 36+0 weeks or greater gestation with no indication for ongoing antibiotics in the postpartum period and no contra-indications to prophylactic co-amoxiclav, will be randomised to receive a single intravenous dose of co-amoxiclav or placebo. The primary outcome will be confirmed or suspected maternal infection within 6 weeks of delivery, as defined by one of (a) a new prescription of antibiotics for presumed perineal wound-related infection, endometritis or uterine infection, urinary tract infection with systemic features or other systemic infection, (b) systemic infection confirmed with a culture or (c) endometritis as defined by the US Centers for Disease Control and Prevention. Outcome information will be collected by a single telephone interview and questionnaire, with clinical data collected from medical records or the hospital laboratory if necessary, at 6 weeks post-delivery. Discussion This randomised trial will investigate whether a prophylactic dose of antibiotic following operative vaginal delivery can reduce the incidence of infection and sepsis. If shown to be effective, this could lead to a change in recommended practice and the prevention of infection. Conversely, if there is no significant difference between the two arms, then this could contribute to a reduction in antibiotic use and improved antimicrobial stewardship. Trial registration ISRCTN11166984. Registered on 23 September 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2787-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Linda Mottram
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Shan Gray
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Christopher Partlett
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
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de Jesús-García A, Paredes-Solís S, Valtierra-Gil G, Los Santos FRSD, Sánchez-Gervacio BM, Ledogar RJ, Andersson N, Cockcroft A. Associations with perineal trauma during childbirth at home and in health facilities in indigenous municipalities in southern Mexico: a cross-sectional cluster survey. BMC Pregnancy Childbirth 2018; 18:198. [PMID: 29855266 PMCID: PMC5984371 DOI: 10.1186/s12884-018-1836-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Episiotomy and perineal tears remain common in vaginal deliveries. This study estimated the frequency of and factors associated with perineal tears, episiotomies, and postnatal infections among women in two predominantly indigenous municipalities in southern Mexico, where traditional midwives play an important role in women's health. METHODS A cross-sectional study contacted women who gave birth in the previous three years. An administered questionnaire asked about place of delivery, birthing position, birth attendant, episiotomy, perineal tears, and wound infection after delivery. Cluster adjusted bivariate and then multivariate analysis examined factors potentially associated with self-reported perineal trauma (episiotomy and/or perineal tear). Key informant interviews sought insights into some of the findings. RESULTS Among women with a vaginal delivery, 71% (876/1238) of indigenous women and 18% (36/197) of non-indigenous women delivered at home. Some 17% (247/1416) of women overall, and 33% (171/525) of those delivering in a health facility, reported an episiotomy during delivery. Among 171 women reporting an episiotomy in a health facility, 30% (52) also reported a perineal tear. Overall, 13% (190/1412) of women reported they had a perineal tear during delivery, 17% (86/515) of those delivering in a health facility and 12% (104/897) of those delivering at home. A quarter of the women had self-reported perineal trauma during their last delivery, 38% (196/511) of those delivering in a health facility and 18% (160/893) of those delivering at home. In bivariate analysis, indigenous ethnicity, home delivery, upright posture in labour, and delivery by a traditional midwife were associated with a lower risk of perineal trauma, while primiparas had a higher risk. In the final multivariate model, delivery by a traditional midwife was protective (ORa 0.41, 95%CIca 0.32-0.54) and primiparity was a risk factor (ORa 2.01, 95%CIca 1.5-2.68) for perineal trauma. Women suggested that fear of bad treatment and being cut made them unwilling to deliver in health facilities. CONCLUSIONS The rate of perineal trauma among women giving birth in indigenous communities could be reduced by efforts to decrease the use of episiotomies in health facilities, and by opening a dialogue with traditional midwives to increase their interaction with formal health services.
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Affiliation(s)
- Abraham de Jesús-García
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Av. Pino s / n, Colonia El Roble, C.P.38640, Acapulco, Guerrero, Mexico
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Av. Pino s / n, Colonia El Roble, C.P.38640, Acapulco, Guerrero, Mexico.
| | - Geovani Valtierra-Gil
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Av. Pino s / n, Colonia El Roble, C.P.38640, Acapulco, Guerrero, Mexico
| | - Felipe Rene Serrano-de Los Santos
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Av. Pino s / n, Colonia El Roble, C.P.38640, Acapulco, Guerrero, Mexico
| | - Belén Madeline Sánchez-Gervacio
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Av. Pino s / n, Colonia El Roble, C.P.38640, Acapulco, Guerrero, Mexico
| | - Robert J Ledogar
- CIETinternational, 511 Avenue of the Americas #132, New York, USA
| | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Av. Pino s / n, Colonia El Roble, C.P.38640, Acapulco, Guerrero, Mexico.,Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montreal, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montreal, Canada
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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.
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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
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Dudley L, Kettle C, Thomas PW, Ismail KMK. Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a pilot and feasibility randomised controlled trial. BMJ Open 2017; 7:e012766. [PMID: 28188151 PMCID: PMC5306527 DOI: 10.1136/bmjopen-2016-012766] [Citation(s) in RCA: 12] [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] [Received: 05/22/2016] [Revised: 08/01/2016] [Accepted: 09/21/2016] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To establish the feasibility of conducting a definitive randomised controlled trial (RCT) comparing the effectiveness of resuturing versus expectant management for dehisced perineal wounds. DESIGN A multicentre pilot and feasibility RCT. SETTING Ten UK maternity units from July 2011 to July 2013. POPULATION Eligible women with a dehisced perineal wound within 2 weeks of childbirth. METHODS The interventions were resuturing or expectancy. Randomisation was via web or telephone, stratified by participating centre. Blinding was not possible due to the nature of the interventions. Analysis was by intention-to-treat. OUTCOME The primary outcome measure was wound healing at 6-8 weeks. RESULTS The study revealed a number of feasibility issues, particularly strong patient and clinician preference for treatment options at recruiting centres and the timing of the primary outcome measure. Thirty-four women were randomised (17 in each arm). Data from 33 women were analysed on an intention-to-treat analysis to obtain preliminary estimates of effect size. There was a difference in wound healing at 2 weeks favouring resuturing (OR 20.00, 95% CI 2.04 to 196.37, p=0.004). However, by 6-8 weeks all but one wound in both groups had healed. CONCLUSIONS PREVIEW revealed a number of feasibility issues, which impacted on recruitment rate. These will have to be taken into account in the design of any future definitive study. In this feasibility study, resuturing was associated with quicker wound healing and women reported higher satisfaction rates with the outcome at 3 months. TRIAL REGISTRATION NUMBER ISRCTN05754020.
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Affiliation(s)
- L Dudley
- The Maternity Centre, Royal Stoke, University Hospitals of North Midlands, Staffordshire, UK
- Faculty of Health, Staffordshire University, Stafford, UK
- Faculty of Health Sciences, Professor Emerita of Women's Health, Staffordshire University, Stafford, UK
| | - C Kettle
- Faculty of Health Sciences, Professor Emerita of Women's Health, Staffordshire University, Stafford, UK
| | - P W Thomas
- Faculty of Health and Social Sciences, Professor of Health Care Statistics and Epidemiology, Bournemouth University Clinical Research Unit, Bournemouth University, Dorset, UK
| | - K M K Ismail
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Jansova M, Kalis V, Rusavy Z, Zemcik R, Lobovsky L, Laine K. Modeling manual perineal protection during vaginal delivery. Int Urogynecol J 2013; 25:65-71. [DOI: 10.1007/s00192-013-2164-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/15/2013] [Indexed: 11/30/2022]
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Dudley L, Kettle C, Ismail K. Prevalence, pathophysiology and current management of dehisced perineal wounds following childbirth. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjom.2013.21.3.160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lynn Dudley
- Lynn Dudley Midwife and Ph.D. Student University Hospital of North Staffordshire
| | - Christine Kettle
- Christine Kettle Professor in Women's Health Staffordshire University
| | - Khaled Ismail
- Khaled Ismail Professor of Obstetrics and Gynaecology University of Birmingham
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