Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study

Meriwether, Kate V.; Rogers, Rebecca G.; Dunivan, Gena C.; Alldredge, Jill; Qualls, Clifford; Migliaccio, Laura; Leeman, Lawrence

doi:10.1007/s00192-016-2959-y

Cited by 21 publications

(11 citation statements)

References 28 publications

(43 reference statements)

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“…However, the clinical significance of sexual dimorphism in perineal body muscle attachment is unclear. For example, stretching of the perineal body during pregnancy does not substantially impact defecatory, urinary or reproductive muscle function (Meriwether et al, ). Similarly, surgical dissection through the perineal body does not adversely affect the functions of superficial perineal muscles in either males or females (Kraima et al, ).…”

Section: Discussionmentioning

confidence: 99%

A functional and clinical reinterpretation of human perineal neuromuscular anatomy: Application to sexual function and continence

et al. 2016

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Modern anatomical and surgical references illustrate perineal muscles all innervated by branches of the pudendal nerve but still organized into anatomically distinct urogenital and anal triangles with muscles inserting onto a central perineal body. However, these conflict with the anatomy commonly encountered during dissection. We used dissections of 43 human cadavers to characterize the anatomical organization of the human perineum and compare our findings to standard references. We found bulbospongiosus and the superficial portion of the external anal sphincter (EAS) were continuous anatomically with a common innervation in 92.3% of specimens. The superficial transverse perineal muscle inserted anterior and lateral to the midline, interdigitating with bulbospongiosus. The three EAS subdivisions were anatomically discontinuous. Additionally, in 89.2% of our sample the inferior rectal nerve emerged as a branch of S3 and S4 distinct from the pudendal nerve and innervated only the subcutaneous EAS. Branches of the perineal nerve innervated bulbospongiosus and the superficial EAS and nerve to levator ani innervated the deep EAS. In conclusion, we empirically demonstrate important and clinically relevant differences with perineal anatomy commonly described in standard texts. First, independent innervation to the three portions of EAS suggests the potential for functional independence. Second, neuromuscular continuity between bulbospongiosus and superficial EAS suggests the possibility of shared or overlapping function of the urogenital and anal triangles. Clin. Anat. 29:1053-1058, 2016. © 2016 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

A functional and clinical reinterpretation of human perineal neuromuscular anatomy: Application to sexual function and continence

et al. 2016

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“…However, in ‘worst case’ simulations in which the air cuff was not deflated, the BD Odon Device did generate greater distention at the posterior fourchette compared with either forceps or Kiwi. Previous studies have not demonstrated a link between perineal distention in labour and anal sphincter injury . However, these findings suggest that incorrect use of the BD Odon Device, by not deflating the air cuff prior to crowning, may generate similar or higher rates of perineal tears compared with forceps and Kiwi ventouse, whereas correct use of the BD Odon Device produced similar perineal distention to the Kiwi.…”

Section: Discussionmentioning

confidence: 68%

“…Previous studies have not demonstrated a link between perineal distention in labour and anal sphincter injury. 4 However, these findings suggest that incorrect use of the BD Odon Device, by not deflating the air cuff prior to crowning, may generate similar or higher rates of perineal tears compared with forceps and Kiwi ventouse, whereas correct use of the BD Odon Device produced similar perineal distention to the Kiwi. This finding highlights the importance of training accouchers to use the BD Odon Device correctly.…”

Section: Main Findingsmentioning

confidence: 88%

Fetal head position and perineal distension associated with the use of the BD Odon Device™ in operative vaginal birth: a simulation study

O’Brien

Winter

Burden

et al. 2017

BJOG

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Objective To investigate (1) the placement of the BD Odon Device on the model fetal head and (2) perineal distention during simulated operative vaginal births conducted with the BD Odon Device.Design Observational simulation study.Setting North Bristol NHS Trust, UK.Population or sample Four hundred and forty simulated operative vaginal births.Methods Three bespoke fetal mannequins were developed to represent (1) bi-parietal diameter of the 50th centile at term, (2) bi-parietal diameter at the 5th centile at term, and (3) 50th centile head with 2 cm of caput. Siting of the BD Odon Device on model heads was determined before and after 400 simulated operative vaginal births. Variables were analysed to determine their effect on device siting and movement during birth. The fetal mannequins were placed inside a maternal mannequin and the BD Odon Device was placed around the fetal head as per the instructions for use. The location of the air cuff was determined before and after the head was delivered. Perineal distension was determined by recording maximum perineal distention during a simulated operative vaginal birth using the same procedure, as well as scenarios employing an inappropriately non-deflated air cuff (for the BD Odon Device), the Kiwi ventouse and non-rotational forceps.Main outcome measures Site and displacement during birth of the BD Odon Device on a model head. Maximal perineal distension during birth.Results The BD Odon Device was reliably sited in a standard over the fetal head position (approximately 40 mm above the fetal chin) for all stations, head sizes and positions with no significant displacement. In occipito-posterior births, compared with occipito-anterior or transverse, the BD Odon Device routinely sited further down the fetal head (toward the chin). The BD Odon Device was not associated with more perineal distension compared with forceps or Kiwi ventouse (respectively 21, 26 and 21 mm at posterior fourchette).Conclusions The BD Odon Device reliably sited over a safe area of the fetal head in 400 simulated births representative of clinical practice. The BD Odon Device generates similar levels of perineal distension compared with Kiwi ventouse when used correctly.

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“…The Pelvic Organ Prolapse Quantification System (POP-Q) method has been used to establish the perineal skin length in term pregnancy, during second stage of labor, and postpartum [ 16 , 17 ]. The main result was that the perineal body measured with the POP-Q system increased during labor but the length during labor did not correlate with the degree of vaginal laceration.…”

Section: Discussionmentioning

confidence: 99%

Maternal Body Mass Index and Anovaginal Distance in Active Phase of Term Labor

Hjertberg

Uustal

Pihl

et al. 2018

BioMed Research International

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Introduction To evaluate if there was a difference in the anovaginal distance (AVD) measured by transperineal ultrasound between obese and normal weight women. Material and Methods A prospective observational study including 207 primiparous women at term in first stage of labor. Transperineal ultrasound with a vaginal probe was used to measure the AVD. Maternal, pregnancy, and delivery characteristics potentially associated with perineal thickness were extracted from woman's medical records. The participants were divided into three BMI groups based on maternal weight in early pregnancy: normal weight (BMI < 25), overweight (BMI 25–29.9), and obesity (BMI ≥ 30). Obese and overweight women were compared with normal weight women regarding the AVD. Results The mean AVD was 24.3, 24.9, and 27.0 mm in the normal weight, overweight, and obesity group, respectively. There were no group differences in background characteristics. The AVD was significantly longer in obese women compared with normal weight women (p = 0.018). Conclusions The observed longer AVD in obese women might be protective of the anal sphincter complex, explaining lower rates of anal sphincter injuries in this group. Further studies are indicated to evaluate whether the length of the AVD plays a role in the risk assessment of obstetric anal sphincter injury. The trial is registered in ClinicalTrials.gov and the trial registration ID is NCT03149965.

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Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study

Cited by 21 publications

References 28 publications

A functional and clinical reinterpretation of human perineal neuromuscular anatomy: Application to sexual function and continence

A functional and clinical reinterpretation of human perineal neuromuscular anatomy: Application to sexual function and continence

Fetal head position and perineal distension associated with the use of the BD Odon Device™ in operative vaginal birth: a simulation study

Maternal Body Mass Index and Anovaginal Distance in Active Phase of Term Labor

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