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Addis NA, Abraham D, Getnet M, Bishaw A, Mengistu Z. Prevalence and associated factors of maternal birth trauma following vaginal delivery at University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia, 2022. BMC Pregnancy Childbirth 2024; 24:445. [PMID: 38937688 PMCID: PMC11210169 DOI: 10.1186/s12884-024-06635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Maternal injury with any form of perineal trauma following vaginal delivery is very common which ranges globally from 16.2 to 90.4%. The frequency of Obstetric anal sphincter Injuries and the incidence of cervical laceration increases rapidly. However, in Ethiopia, there is limited evidence on the prevalence of maternal birth trauma and its determinant factors after vaginal delivery. OBJECTIVE To assess the magnitude and associated factors of Maternal Birth Trauma after vaginal delivery at University of Gondar Comprehensive Specialized Hospital, Gondar, North-West Ethiopia, 2022. METHODS An Institution based cross-sectional study was conducted among mothers with singleton vaginal delivery at University of Gondar Comprehensive Specialized Hospital from 9th May to 9th August 2022 among 424 study participants. Pre-tested semi-structured questioner was utilized. Epi-Data version 4.6 was used for data entry and exported to SPSS version 25 for data management and analysis. To identify the determinant factors, binary logistic regression model was fitted and variables with p-value < 0.2 were considered for the multivariable binary logistic regression analysis. In the multivariable binary logistic regression analysis, Variables with P-value < 0.05 were considered to have statistical significant association with the outcome variable. The Adjusted Odds Ratio (AOR) with 95% CI was reported to declare the statistical significance and strength of association between Maternal Birth Trauma and independent variables. RESULTS A total of 424 mothers who delivered vaginally were included. The mean age of participants was 26.83 years (± 5.220 years). The proportion of birth trauma among mothers after vaginal delivery was47.4% (95%CI: 43.1, 51.7). Of different forms of perineal trauma, First degree tear in 42.8%, OASIs in 1.5% and Cervical laceration in 2.5% study participants. In the multivariable binary logistic regression analysis being primiparous (AOR = 3.00; 95%CI: 1.68, 5.38), Gestational age ≥ 39 weeks at delivery (AOR = 2.96; 95%CI: 1.57, 5.57), heavier birth weight (AOR = 12.3; 95%CI: 7.21, 40.1), bigger head circumference (AOR = 5.45; 95%CI: 2.62, 11.31), operative vaginal delivery (AOR = 6.59; 95%CI: 1.44, 30.03) and delivery without perineum and/or fetal head support (AOR = 6.30; 95%CI: 2.21, 17.94) were significantly associated with the presence of maternal birth trauma. CONCLUSION AND RECOMMENDATION Maternal birth trauma following vaginal delivery was relatively high in this study. Prim parity, gestational age beyond 39 weeks at delivery, heavier birth weight, bigger head circumference, operative vaginal delivery and delivery without perineum and/or fetal head supported were factors affecting perineal outcome. The Ministry of Health of Ethiopia should provide regular interventional training as to reduce maternal birth trauma.
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Affiliation(s)
- Nigat Amsalu Addis
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demelash Abraham
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alehegn Bishaw
- Department of Reproductive and Child Health, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mengistu
- Department of Obstetrics and Gynecology, Division for Clinical Medicine, University of Global Health Equity, Kigali, Rwanda
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Uso de cola cirúrgica no reparo de lacerações perineais intraparto: estudo série de casos. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao02724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Obstetrical Soft Tissue Trauma during Spontaneous Vaginal Birth in the Romanian Adolescent Population-Multicentric Comparative Study with Adult Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111491. [PMID: 34770005 PMCID: PMC8582859 DOI: 10.3390/ijerph182111491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18–3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13–3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.
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Nóbrega MA, Pereira GMV, Brito LGO, Luz AG, Lajos GJ. Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study. Female Pelvic Med Reconstr Surg 2021; 27:e301-e305. [PMID: 32576733 DOI: 10.1097/spv.0000000000000910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of severe perineal trauma (obstetric and anal sphincter injury [OASIS]) in a tertiary high-risk pregnancy facility and the associated factors. METHODS A retrospective electronic chart review on perineal lacerations was performed from the period of April 2017 to February 2019. Obstetric and anal sphincter injury was diagnosed by a rectal examination. Primary outcome was the prevalence of OASIS (third- and fourth-degree perineal tear). Independent variables were maternal, intrapartum, and neonatal characteristics. Univariate and multivariate analyses with logistic regression models were performed. A P value lower than 0.05 was considered significant. RESULTS The prevalence of OASIS (third/fourth-degree laceration) was 1.51% (43/2846) in our population. Our population was mostly white (66.3%) and mostly primiparous (52.1%). By comparison, the prevalence of first/second-degree laceration was 43% (1223/2846). Selective episiotomy occurred in 18.73% (517/2761) of patients, and it was not associated with OASIS (P = 0.211). Advanced maternal age (P = 0.196), higher number of vaginal examinations (P = 0.169), fetal presentation (P = 0.533), and duration of second stage (P = 0.757) were not associated with OASIS. Univariate analysis has found that forceps delivery (odds ratio [OR], 3.68 [1.74-7.79]; P = 0.001), neonatal macrossomy (OR, 3.42 [1.02-11.43]; P = 0.045), and larger head circumference (OR, 1.15 [1.02-1.32]; P = 0.026) were risk factors for OASIS, whereas higher gravidity reduced the risk (OR, 0.61 [0.42-0.91] for OASIS. However, after multivariate analysis, only head circumference (OR, 1.86 [1.10-3.14]; P = 0.020) remained as a risk factor. CONCLUSIONS Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.
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Affiliation(s)
- Marina Augusto Nóbrega
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Pereira GMV, Hosoume RS, de Castro Monteiro MV, Juliato CRT, Brito LGO. Selective episiotomy versus no episiotomy for severe perineal trauma: a systematic review with meta-analysis. Int Urogynecol J 2020; 31:2291-2299. [PMID: 32333062 DOI: 10.1007/s00192-020-04308-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/07/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized whether a non-episiotomy protocol or administration of selective episiotomy as an intrapartum intervention would modify the incidence of obstetric anal sphincter injuries (OASIS). METHODS We registered this systematic review with the PROSPERO database (CRD42018111018). Prospective randomized controlled trials (RCTs) were included from databases until February 2019. The primary outcome was OASIS, and the secondary outcomes were any perineal trauma, duration of the second stage of labor, instrumental delivery, and post-partum hemorrhage. The risk of bias (Cochrane Handbook) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the RCTs. RESULTS A total of 1,833 results (PubMed 650, SCOPUS 1,144, Cochrane Library 33, LILACS 6) were obtained. However, only 2 studies fulfilled the criteria for quantitative analysis and meta-analysis (n = 574). The non-episiotomy arm included two episiotomies (1.7% of deliveries), whereas the selective episiotomy included 33 episiotomies (21.4%). Performance of selective episiotomy demonstrated no difference compared with that of the non-episiotomy group with regard to OASIS (OR = 0.46 [0.15-1.39]; n = 543; I2 = 0%,p = 0.17), any perineal trauma (OR = 0.90 [0.61-1.33]; I2 = 0%, n = 546, p = 0.59), instrumental delivery (OR = 1.40 [0.80-2.45]; I2 = 0%, n = 545, p = 0.24), duration of the second stage of labor (MD = -3.71 [-21.56, 14.14]; I2 = 72%,n = 546, p = 0.68), perineal pain (MD = 0.59 [0.01-1.17]; I2 = 0%,p = 0.05), and post-partum hemorrhage (OR = 1.75 [0.87-3.54]; I2 = 0%,n = 546,p = 0.12). The evaluated studies displayed a low risk of bias in at least four of the seven categories analyzed. GRADE demonstrated a low certainty for severe perineal tears, postpartum hemorrhage, duration of the second stage of labor, and a moderate certainty for any perineal tear. CONCLUSIONS There was no significant difference between non-episiotomy and selective episiotomy regarding OASIS. No RCT was able to confirm a benefit of the non-performance of episiotomies in the non-episiotomy arm.
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Affiliation(s)
- Gláucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, 13148-254, Brazil
| | | | | | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, 13148-254, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, 13148-254, Brazil.
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Souza MRTD, Farias LMVC, Ribeiro GL, Coelho TDS, Costa CCD, Damasceno AKDC. Factors related to perineal outcome after vaginal delivery in primiparas: a cross-sectional study. Rev Esc Enferm USP 2020; 54:e03549. [PMID: 32187311 DOI: 10.1590/s1980-220x2018043503549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/30/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Identify the associations between perineal outcome in primiparas and interventions during labor and delivery, newborn weight and APGAR score. METHOD Document-based, correlational, retrospective, quantitative study conducted in a tertiary maternity hospital in the state of Ceará, between July 2017 and January 2018. The independent variables were labor induction, amniotomy, non-pharmaceutical methods for relieving pain, forceps, episiotomy, Kristeller maneuver, position in the expulsion stage, shoulder dystocia, and newborn weight and APGAR score, and the dependent variable was perineal outcome. Pearson's chi-square test and Fisher's exact test were used. RESULTS A total of 226 normal-risk primiparas who had a vaginal delivery. An association was found between horizontal position in the expulsion stage and episiotomy, and between not performing an episiotomy and perineal tearing. The other variables (labor, delivery and neonatal) did not have any effect on perineal tearing. CONCLUSION Interventions, with the exception of episiotomies, did not have an influence on the occurrence of perineal trauma, but they do need to be carefully assessed. Deliveries in a horizontal position were associated with a higher likelihood of performing an episiotomy.
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Affiliation(s)
| | | | - Gabriela Lima Ribeiro
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Tatiane da Silva Coelho
- Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Camila Chaves da Costa
- Universidade da Integração Internacional da Lusofonia Afro-Brasileira, Redenção, CE, Brazil
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Aguiar M, Farley A, Hope L, Amin A, Shah P, Manaseki-Holland S. Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. Matern Child Health J 2019; 23:1048-1070. [PMID: 30915627 PMCID: PMC6606670 DOI: 10.1007/s10995-019-02732-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36–55%), 24% (95% CI 17–32%), and 1.4% (95% CI 1.2–1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings.
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Affiliation(s)
- Magda Aguiar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Hope
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Nursing and Midwifery, Institute of Health & Society, University of Worcester, Worcester, UK
| | - Adeela Amin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pooja Shah
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Analysis of non-obstetric vaginal and vulvar trauma: risk factors for operative intervention. Updates Surg 2019; 71:735-740. [PMID: 31538318 DOI: 10.1007/s13304-019-00679-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
Vaginal and vulvar trauma may occur accidentally or because of an act of violence. Due to its rarity, little is known about risk factors effecting need for operative intervention. We sought to perform a large descriptive analysis of adult non-obstetric vulvovaginal trauma (VVT) and elucidate risk factors for requiring operative intervention. A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. Patients ≥ 16 years old with vaginal or vulvar trauma were identified. Risk factors for surgical intervention were identified using a multivariable logistic regression analysis. From 2,040,235 female patients, 2445 (< 0.2%) were identified to have VVT with the majority being injury to the vagina (68.6%). In patients with injury to the vagina, age > 65 (OR = 0.41, CI 0.26-0.62, p < 0.001), Injury Severity Score > 25 (OR = 0.66, CI 0.50-0.86, p = 0.01) and victims of rape (OR = 0.39, 95% CI 0.26-0.57, p < 0.001) were less likely to require operative intervention. In patients with injury to the vulva, age > 65 (OR = 0.45, CI 0.21-0.94, p = 0.02), victims of rape (OR = 0.26, CI 0.08-0.87, p = 0.01) and gunshot violence (OR = 0.10, CI 0.02-0.59, p = 0.02) were less likely to require operative intervention, but those with a concomitant injury to the vagina were more likely to require operative intervention (OR = 2.56, CI 1.63-4.03, p < 0.001). Injuries to the vagina or vulva occur in < 0.2% of traumas. Interestingly, in both vulvar and vaginal trauma, older age, and involvement in rape were associated with lower risk for operative intervention. A combined injury to the vagina and vulva increases the need for operative intervention.
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Casteleiro A, Santibanez M, Paras-Bravo P, Pellico-Lopez A, Paz-Zulueta M. Clinical practice outcomes and differential results in maternal and neonatal morbidity among pregnant women in Spain who are candidates for a normal birth: a cross-sectional study. BMJ Open 2019; 9:e026899. [PMID: 31420385 PMCID: PMC6701598 DOI: 10.1136/bmjopen-2018-026899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/22/2019] [Accepted: 07/30/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the percentage of pregnant women who are potential candidates for a normal birth in the region of Cantabria, Spain. Also, to compare the main clinical practice outcome indicators and the rates of maternal and neonatal morbidity among the group of candidate women versus non-candidates. DESIGN A cross-sectional study. SETTING A tertiary Hospital in Cantabria (Northern region of Spain). PARTICIPANTS The study population comprised the total number of hospital births that took place between 1 January 2014 and 31 December 2014 (n=3315). RESULTS Secondary registers were accessed to review the main indicators of care and the outcome of births. The χ2 test or the Student's t-test were used to compare both groups for the categorical and continuous variables, respectively. In total, 1863 births (56.20%) were candidates for applying the strategy of care for a normal birth. In 50.86% of these candidate births, an episiotomy was performed, compared with 60.96% in the group of non-candidates (p<0.001). Regarding caesarean sections, these were carried out in 19.32% of the candidate births, compared with 26.79% of non-candidate births (p<0.001). Furthermore, there were statistically significant differences between the groups according to the type of birth, the need for instrumental birthing methods, the existence of perineal tears, Apgar scores and the requirement for the infant to be admitted to the neonatal intensive care unit. CONCLUSIONS Our results suggest a differential clinical practice, in line with the recommendations of the Clinical Practice Guidelines for Care of Normal Birth. Nonetheless, improvements are necessary regarding the care provided to women and infants, as the percentages of episiotomies and caesarean sections are still high when compared with current standards and compared with other reports.
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Affiliation(s)
- Ana Casteleiro
- Servicio de Obstetricia y Ginecología, Hospital Universitario de Basurto, Bilbao, Spain
| | - M Santibanez
- Global Health Research Group, Universidad de Cantabria, Santander, Spain
- Faculty of Nursing, University of Cantabria, Santander, Spain
- Nursing Research Group, IDIVAL, Santander, Spain
| | - Paula Paras-Bravo
- Faculty of Nursing, University of Cantabria, Santander, Spain
- Nursing Research Group, IDIVAL, Santander, Spain
| | | | - María Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Santander, Spain
- GRIDES, IDIVAL, Santander, Spain
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Magnani PS, Bettiol H, da Silva AAM, Barbieri MA, de Carvalho Cavalli R, Brito LGO. Urinary incontinence between 12 and 24 months postpartum: a cross-sectional study nested in a Brazilian cohort from two cities with different socioeconomic characteristics. Int Urogynecol J 2019; 30:1003-1011. [DOI: 10.1007/s00192-019-03907-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/07/2019] [Indexed: 01/21/2023]
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Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study. Int Urogynecol J 2018; 30:951-957. [PMID: 30343376 DOI: 10.1007/s00192-018-3793-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Perineal preparation techniques for childbirth have been used with the aim of reducing perineal tears during the expulsive phase of labor. However, no studies were found to investigate the effects of instrument-assisted stretching versus perineal massage on pelvic floor muscle (PFM) variables. Therefore, the aim of this study was to evaluate the effect of instrument-assisted stretching versus perineal massage on the extensibility and strength of the PFMs. METHODS Primiparous women were randomized to the instrument-assisted stretching (IStr) group (n = 13) and perineal massage (PnM) group (n = 14). The groups participated in eight sessions, twice weekly, beginning at the 34th gestational week. The IStr group underwent the intervention for 15 min using EPI-NO®. The PnM group underwent a perineal massage protocol for 10 min. Each woman was evaluated by a blinded physiotherapist before, after four and after eight sessions for primary (PFM extensibility using the EPI-NO® circumference) and secondary (PFM strength using a manometer) outcomes. Covariate analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate. RESULTS Both groups showed an increase in PFM extensibility compared with the evaluations before and after four and eight sessions (PnM group from 17.6 ± 1.8 to 20.2 ± 1.9 cm; IStr group from 19.9 ± 1.6 to 22.9 ± 1.6 cm;p < 0.001). There was no difference between groups. Regarding muscle strength, no statistical differences were observed between evaluations or between groups. CONCLUSIONS Instrument-assisted stretching and perineal massage increase extensibility and do not alter the strength of PFMs in pregnant women.
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Drusany Starič K, Bukovec P, Jakopič K, Zdravevski E, Trajkovik V, Lukanović A. Can we predict obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol 2017; 210:196-200. [DOI: 10.1016/j.ejogrb.2016.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/02/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
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Ballesteros-Meseguer C, Carrillo-García C, Meseguer-de-Pedro M, Canteras-Jordana M, Martínez-Roche ME. Episiotomy and its relationship to various clinical variables that influence its performance. Rev Lat Am Enfermagem 2016. [PMID: 27224064 DOI: 10.1590/1518-8345.0334.2686.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand the episiotomy rate and its relationship with various clinical variables. METHOD a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. VARIABLES Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. RESULTS the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. CONCLUSIONS episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.
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Ballesteros-Meseguer C, Carrillo-García C, Meseguer-de-Pedro M, Canteras-Jordana M, Martínez-Roche ME. Episiotomy and its relationship to various clinical variables that influence its performance. Rev Lat Am Enfermagem 2016; 24:e2793. [PMID: 27224064 PMCID: PMC4877173 DOI: 10.1590/1518-8345.0334.2686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/04/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: to understand the episiotomy rate and its relationship with various clinical
variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary
hospital. Variables: Parity, gestational age, start of labor, use of epidural
analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and
completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that
presented a significant association were primiparity (RR=2.98), gestational age
>41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia
use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion
(RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years
(RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower
incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we
wish to reduce the episiotomy rate, it will be necessary to bear in mind these
risk factors when establishing policies for reducing this procedure.
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15
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Xing JJ, Liu XF, Xiong XM, Huang L, Lao CY, Yang M, Gao S, Huang QY, Yang W, Zhu YF, Zhang DH. Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle: A Randomized Controlled Trial. PLoS One 2015; 10:e0137267. [PMID: 26340002 PMCID: PMC4560435 DOI: 10.1371/journal.pone.0137267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/13/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Combined spinal-epidural analgesia (CSEA) is sometimes used for difficult births, but whether it contributes to postpartum pelvic muscle disorder is unclear. This randomized controlled trial examined whether CSEA given during labor affects the electrophysiological index of postpartum pelvic floor muscle function. Methods A consecutive sample of primiparous women who delivered vaginally at term were randomly assigned to a CSEA group (n = 143) and control group (n = 142) between June 2013 and June 2014. All were assessed 6–8 weeks later for electrophysiological function of pelvic floor muscle. Results The two groups were similar in the degree of muscle strength, muscle fatigue, and pelvic dynamic pressure of pelvic floor muscle. The CSEA and control groups showed similar proportions of women with normal muscle strength (score ≥4) in type I pelvic fibers (23.1% vs. 14.1%, P = 0.051) and type II pelvic fibers (28.0% vs. 24.6%, P = 0.524). The groups also contained similar proportions of women who showed no fatigue in type I fibers (54.5% vs. 48.6%, P = 0.315) or type II fibers (88.8% vs. 87.3%, P = 0.699). Similarly low proportions of women in the CSEA group and control group showed normal pelvic dynamic pressure (11.2% vs. 7.7%, P = 0.321). However, women in the CSEA group spent significantly less time in labor than those in the control group (7.25 vs. 9.52 h, P <0.001). Conclusions CSEA did not affect the risk of postpartum pelvic muscle disorder in this cohort of primiparous women who gave birth vaginally. A significant shorter duration of labour was observed in the CSEA-group. Trial Registration ClinicalTrials.gov NCT02334150
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Affiliation(s)
- Ji-Juan Xing
- Anesthesia Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
| | - Xiu-Fen Liu
- Pain Management Department, First Affiliated Hospital of Peking University, Beijing 100034, China
| | - Xiao-Ming Xiong
- Obstetrics and Gynecology Department, Maternal and Child Health Hospital of Nandan County, Hechi 547200, China
| | - Li Huang
- Pain Management Department, First Affiliated Hospital of Peking University, Beijing 100034, China
| | - Cheng-Yi Lao
- Anesthesia Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
| | - Mei Yang
- Maternity Care Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
| | - Shan Gao
- Maternity Care Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
| | - Qiong-Yan Huang
- Anesthesia Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
| | - Wei Yang
- Anesthesia Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
| | - Yun-Feng Zhu
- Anesthesia Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
- * E-mail: (DHZ); (YFZ)
| | - Di-Hua Zhang
- Child Care Department, Maternal and Child Health Hospital of Nanning City, Nanning 530011, China
- * E-mail: (DHZ); (YFZ)
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16
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Brito LGO, Ferreira CHJ, Duarte G, Nogueira AA, Marcolin AC. Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review. Int Urogynecol J 2015; 26:1429-36. [DOI: 10.1007/s00192-015-2687-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/11/2015] [Indexed: 01/20/2023]
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