Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation

Kleín, Michael C.; Gauthier, Robert; Robbins, James M.; Kaczorowski, Janusz; Jorgensen, S H; Franco, Eliane; Johnson, Barbara; Waghorn, Kathy; Gelfand, Morrie M.; Guralnick, Melvin; Luskey, Gary W.; Joshi, Anil

doi:10.1016/0002-9378(94)90070-1

Cited by 360 publications

(288 citation statements)

References 16 publications

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“…In two other studies, the authors afirmed that there were less cases of second degree laceration and more parturitions with intact perineum in black women (11)(12)(13)(14) . Age was the next variable, and studies confirmed the absence of scientific evidence to associate perineal trauma to the maternal age, and emphasized the lack of significance in association between these variables (11,(14)(15)(16) , confirming the findings of this study.…”

Section: Resultssupporting

confidence: 85%

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

2011

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Objective:To evaluate the perineal outcomes in unconventional birth positions. Methods: A randomized clinical study. Conducted in a birth centre in the city of Itapecerica da Serra, Brazil. A sample of 158 nulliparas, divided randomly into the left lateral position (81 -experimental) and upright half-sitting (77 -control). Results: Experimental group showed less vulvar edema, 13.6% vs. 29.9%, OR 2.71 (95% IC 1.22 -6.02), episiotomy, 16.0% vs. 35.1 OR 2,46 (95% IC 1, 27 -4.74), and more labial lacerations 37,0% vs. 19,5% OR 2,43 (95% IC 1,18 -5,51). The women who adopted the upright half-sitting position had a lower risk of first-degree laceration (37,7% versus 56,8%). However, they had a higher risk of second-degree laceration and frequency of episiotomy OR 2,11 (95% IC 1,02 -4,35). The presence of vulvar edema increased the risk of spontaneous trauma and episiotomy OR 3,99 (95% IC 1, 80 -8,85). Conclusions: Our data confirmed the hypothesis that the left lateral position offers less risk of serious perineal traumas. Keywords: Obstetrical nursing; Midwifery/methods; Natural childbirth/methods; Posture; Perineum/injuries RESUMO Objetivo: Avaliar se existe associação entre o resultado perineal em posições de parto não convencionais. Métodos: Estudo clínico randomizado realizado no Centro de Parto Normal da cidade de Itapecerica da Serra, São Paulo, Brasil. A amostra foi constituida por 158 nulíparas divididas aleatoriamente na posição de parto lateral esquerda (81 no grupo experimental) e vertical semi-sentada (77 no grupo controle). Resultados: As mulheres do grupo experimental apresentaram menor edema vulvar -13,6% vs 29,9%, OR 2.71 (95% IC 1,22 -6,02), episiotomia 16,0% vs 35,1 (OR 2.46 (95% IC 1,27 -4,74) e laceração de lábios 37,0% vs 19,5% OR 2,43 (95% IC 1,18 -5,01). Na posição vertical tiveram menor risco de laceração de 1º grau -37,7% vs 56,8%. Entretanto, tiveram mais risco de laceração de 2º grau e episiotomia OR 2,11 (95% 1,02 -4,35). O edema vulvar aumentou o risco de trauma espontâneo e episiotomia OR 3,99 (95% IC 1,80 -8,85. Conclusão: Esses dados confirmam a hipótese de que a posição lateral esquerda oferece menos risco de traumas perineais graves. Descritores: Enfermagem obstétrica; Tocologia/métodos; Parto normal/métodos; Postura; Períneo/lesões RESUMEN Objetivo: Evaluar si existe asociación entre el resultado perineal en posiciones de parto no convencionales. Métodos: Estudo clínico randomizado realizado en el Centro de Parto Normal de la ciudad de Itapecerica da Serra, SP, Brasil. La muestra fue de 158 nulíparas divididas aleatoriamente en la posición de parto lateral izquierdo (81 en el grupo experimental) y vertical semi-sentada (77 en el grupo control). Resultados: Las mujeres del grupo experimental presentaron menor edema vulvar -13,6% vs 29,9%, OR 2.71 (95% IC 1,22 -6,02), episiotomía 16,0% vs 35,1 (OR 2.46 (95% IC 1,27 -4,74) y laceración de labios 37,0% vs 19,5% OR 2,43 (95% IC 1,18 -5,01).En la posición vertical tuvieron menor riesgo de laceración de 1º grado -37,7% vs 56,8%. E...

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Section: Resultssupporting

confidence: 85%

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

2011

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“…As Tabela 2 -Relação entre a pressão muscular perineal e o retorno à atividade sexual, no pós-parto tardio. 21 . Em estudo sobre o treinamento da musculatura do assoalho pélvico como tratamento de mulheres com incontinência urinária foi avaliado o efeito do trabalho de parto e parto com disfunções urinárias, intestinais e sexuais e conclui-se que há necessidade de estudos epidemiológicos populacionais, com metodologia apropriada 22 .…”

Section: Discussionunclassified

Relação entre a pressão muscular perineal no puerpério e o tipo de parto

Menta¹,

Schirmer²

2006

Rev. Bras. Ginecol. Obstet.

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ResumoObjetivo: relacionar o tipo de parto e as características do períneo com valores da pressão muscular perineal (PMP) mensurada em primíparas nas posições deitada e sentada com a musculatura perineal em repouso e em contração máxima. Métodos: estudo quantitativo do tipo transversal, realizado em maternidade conveniada ao Sistema Único de Saúde (SUS) do município de São Paulo. A casuística, obtida por conveniência, foi de 95 primíparas de termo. A avaliação ocorreu entre o 40º e o 45º dia. Realizaram-se entrevista, exame físico e mensuração da PMP por meio do perineômetro de Kegel. A mensuração foi realizada nas posições deitada e sentada, com a musculatura em repouso e em contração máxima, sendo considerada a média de três aferições para cada posição e estado muscular. Resultados: 76,8% (73) das primíparas tiveram parto vaginal e 23,2% (22) cesárea. No pós-parto vaginal, observou-se períneo íntegro em 18,9% (18), com rotura perineal em 24,2% (23) e com episiotomia em 33,7% (32). Os valores obtidos da PMP foram em: posição deitada/musculatura em repouso, 18,9 mmHg; deitada/musculatura em contração máxima, 30,7 mmHg; sentada/musculatura em repouso, 34,5 mmHg; sentada/musculatura em contração máxima, 46,5 mmHg. Conclusão: não houve associação entre o tipo de parto e as condições perineais e a pressão muscular perineal. , day with an interview, physical examination and measurement of PMF using a perineometer of the Kegel type. The measurement was carried out in the lying and seated positions, muscular status (at rest and in maximum contraction), and the average of three measures for each position and muscular state were considered. Results: 76.8% (73) of the women had vaginal delivery and 23.2% (22) cesarean section. After vaginal delivery, intact perineum in 18.9%, (18), perineal rupture in 24.2% (23), and episiotomy in 33.7% (32) were observed. Obtained values of the PMF were: lying position muscular rest 18. 9 mmHg, lying position maximum contraction: 30,7 mmHg, seated position muscular rest: 34.5 mmHg, seated positions maximum muscular contraction: 46.5 mmHg. Conclusion: there was association between the type and the characteristics of the delivery and PMF. PALAVRAS-CHAVE:

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“…Additional health issues, like blood loss, bowel and urinary dysfunction, sexual problems, fatigue and depression have been also reported [3] [4]. The severity of postnatal perineal pain is directly related to the degree and complexity of the genital tract injury sustained [5]. Episiotomy is usually performed for the sake of protection against these complications.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Role of Measuring the Perineal Length as a Predictor of Progress of Labor and Obstetrical Trauma

Farghaly¹,

Shaaban²,

Amen³

et al. 2017

OJOG

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Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of <4 cm (36.7 ± 13.05 vs. 26.9 ± 10.4 minutes; respectively). Regression analysis of possible risk factors showed that circumcised primigravida with long perineum (≥ 4 cm) are more liable to have episiotomy (OR (95%CI) 1.96 (1.1 -3.5); 20.9 (11.1 -39.5); 4.8 (2.5 -9.2); respectively). Tears needed to repair are however, more common in circumcised women with short perineum (<4 cm) who delivered without episiotomy (OR (95%CI) 14.16 (8.1 -24.9); 4.54 (1.5 -14) respectively. Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.

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Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation

Cited by 360 publications

References 16 publications

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

Relação entre a pressão muscular perineal no puerpério e o tipo de parto

Evaluating the Role of Measuring the Perineal Length as a Predictor of Progress of Labor and Obstetrical Trauma

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