The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women

Abstract

Objective Determine the effect of perineal lacerations on pelvic floor outcomes including urinary and anal incontinence, sexual function and perineal pain in a nulliparous cohort with low incidence of episiotomy. Methods Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with 2nd, 3rd or 4th degree lacerations. Results 448 women had vaginal deliveries. 151 sustained second degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. 336 (74.8%) presented for 6-month follow-up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity however they had slightly lower sexual function scores (27.3 vs. 29.1, p=0.01). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2cm) perineal trauma demonstrated increased likelihood of perineal pain (15.5 vs. 6.2 %) and weaker pelvic floor muscle strength (61.0 vs. 44.3%); p=0.03 compared to women with more superficial trauma Conclusion: Women having second degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.

Urinary incontinence after uncomplicated spontaneous vaginal birth in primiparous women during the first year after birth

“…Our results are in line with the findings from a number of previous studies; the obstetric variables prolonged the second stage of labour [23,24], and perineal injury [25,26], birth weight [15,23,24], and head circumference [25] seem to be of no or minor importance for the incidence of UI postpartum. Although Wesnes et al reported that neonatal parameters such as birth weight > 3,540 g and head circumference > 36 cm may act in synergy to increase the risk of UI at 6 months postpartum in women undergoing spontaneous, noninstrumental vaginal birth [27].…”

Does midwife experience affect the rate of severe perineal tears?

“…Although much less attention is given to mild perineal tears, they are much more prevalent than severe tears, and may be associated with significant pain and psychological distress at the time of suturing . Moreover, the majority of women experience some short‐term discomfort or pain after perineal repair, and up to 17.8% of women will have sustained perineal pain 6 months after delivery . Short‐ and long‐term maternal morbidity associated with perineal repair may also lead to major physical, psychological, and social problems, affecting the woman's ability to care for her new baby …”

Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study

“…Women were eligible for enrollment until 36 completed weeks of gestation (14). Prior publications from this cohort compared the pelvic floor outcomes of women who did and did not enter the second stage of labor (14), specific sexual function changes during pregnancy (15), the effect of perineal lacerations on pelvic floor function at 6 months postpartum (16), as well as perineal anatomy (17). The investigators have also studied differences in translabial ultrasonographic measurements of the anal sphincter complex (ASC) in those who delivered vaginally versus by cesarean delivery (18), if these measurements relate to postpartum anal and fecal incontinence based on delivery mode (19), and if ASC measurements differ by method: translabially versus endoanally (20).…”