Repair of episiotomy and obstetrical perineal lacerations (first–fourth)

Schmidt, Payton; Fenner, Dee E.

doi:10.1016/j.ajog.2022.07.005

Cited by 6 publications

(10 citation statements)

References 42 publications

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“…The prevalence of obstetric perineal lacerations varies in the literature. A recent study published by Schmidt et al reports that 50-90% of women giving vaginal births are affected by a perineal laceration 30 . The prevalences of second degree perineal lacerations varies in the literature between 35-78% [31][32][33] .…”

Section: Obstetric Perineal Lacerationsmentioning

confidence: 99%

“…The prevalences of second degree perineal lacerations varies in the literature between 35-78% [31][32][33] . Whilst the prevalence of OASI varies in the literature between 1.5% and 16% 30,34,35 . The differences in reported prevalence might depend on different methods of examination, definitions of perineal lacerations, and on different reporting systems.…”

Section: Obstetric Perineal Lacerationsmentioning

confidence: 99%

“…After giving birth vaginally, all women should undergo a thorough examination of the pelvic floor to diagnose any potential perineal laceration 12,30,41,42 . However, it is essential that the examination and repair are preceded by information about what is to take place and why, and that the woman provides her consent for these procedures 30,43 . A structured examination of the pelvic floor requires optimal conditions, optimal anesthesia, good lighting, and knowledge of the pelvic floor anatomy.…”

Section: Diagnostics Of Perineal Lacerationsmentioning

confidence: 99%

“…Furthermore, the examination of the perineal laceration includes inspection, bidigital palpation with a finger in the rectum to examine the sphincter complex, but also to lift the posterior vaginal wall, thereby optimizing the visualization of vaginal structures, is recommended 12,30 . Transperineal ultrasound with assessment of internal sphincters provides added information about whether the internal sphincter is intact or ruptured 44 .…”

Section: Diagnostics Of Perineal Lacerationsmentioning

confidence: 99%

“…The bidigital palpation is emphasized since it facilitates the visualisation of the tissues in the pelvic floor by lifting the posterior vaginal wall. Furthermore the bidigital palpation of the perineal body allowing an estimation of its length has been shown useful in predicting the risk for an OASI 30 . Quantitative evaluation of palpation has previously been lacking.…”

Section: Diagnostics Of Perineal Lacerationsmentioning

confidence: 99%

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The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

Hjertberg

2024

Linköping University Medical Dissertations

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ObjectivesThis thesis aimed to assess the impact of maternal body mass index (BMI) on pelvic floor during labor and focusing on pelvic floor function following an anal sphincter injury (OASI). Additionally, the objective was to design a study protocol for a randomized controlled trial (RCT) with the objective to evaluate the impact of supplementary anesthesia during the examination and repair of obstetric perineal lacerations. Material and MethodsStudy I was an observational prospective cohort study, conducted at the maternity ward Linköping University Hospital, including 207 primiparous women in the active phase of labor. Transperineal ultrasound was used for measurement of the anovaginal distance (AVD) during active phase of labor. AVD were analyzed in relation to the women´s BMI groups. Study II and III were nationwide Swedish register studies, including 6595 women with a first time vaginal birth complicated by an OASI. Data was sourced from the Swedish Perineal Laceration Register (PLR), based on medical records and patient reported outcome measurements (PROM). Women were categorized by BMI, and analyses were performed on PROM data at the 8 week follow-up (Study II), and at the 12 month follow-up (Study III), after an OASI. Study IV, is a study protocol for a RCT, with parallel groups. Women who undergo examination and repair of obstetric perineal lacerations (grade I and II) are randomized into two arms (1:1); analgesia with pudendal nerve block (PNB) with Ropivacaine®-the PNB group or analgesia with PNB in combination with patient-controlled sedation (PCS) with propofol, the PCS group. ResultsObese women exhibited a higher AVD compared to normal weight women. The mean AVD was 25 mm for primiparous women in the active phase of labor. Overweight and obese women reported fewer wound complications than normal weight women at 8 weeks postpartum. Additionally, overweight and obese women had a lower risk of anal incontinence (AI) at 8 weeks after an OASI compared to normal weight counterparts. However, at 12 months after an OASI, the risk of AI was comparable across BMI groups. Urinary incontinence (UI) was more prevalent among overweight and obese women, with a higher risk of UI both at 8 weeks and 12 months after an OASI compared to normal weight women. Overweight and obese women had a lower risk of reporting dyspareunia at 12 months after an OASI compared to normal weight women. Results from the ongoing RCT are pending. ConclusionsDifferences in the AVD during active phase of labor were observed between women with normal weight and those who were overweight or obese. The higher AVD in obese women compared to normal weight women may indicate a valuable anatomical distinction that could be protective for pelvic floor muscles vulnerable during labor. Furthermore, women sustaining an OASI after their first vaginal birth reported distinct complications at 8 weeks and 12 months postpartum based on BMI. Various explanations may underlie these differences in reported complications, including the hypothesis that women w...

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