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Kjeldsen AC, Taastrøm KA, Gommesen D, Hjorth S, Axelsen S, Nohr EA. Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow-up study. BJOG 2024. [PMID: 38800995 DOI: 10.1111/1471-0528.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To investigate how reproductive history was associated with urinary incontinence in midlife. DESIGN A follow-up study. SETTING Denmark. POPULATION A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history. METHODS How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. MAIN OUTCOME MEASURES Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. RESULTS At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. CONCLUSIONS Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
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Affiliation(s)
- Anne Cathrine Kjeldsen
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Katja Albert Taastrøm
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Gommesen
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Sarah Hjorth
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Susanne Axelsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Perslev K, Klarskov N, Bergholt T, Jangö H. The REPAIR study: oral antibiotics to prevent infection and wound dehiscence after obstetric perineal tear-a double-blinded placebo controlled randomized trial. Trials 2024; 25:221. [PMID: 38532503 DOI: 10.1186/s13063-024-08069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy. METHODS We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark. The women will be included after delivery if they have had a second-degree tear or episiotomy. After inclusion, the women will have a clinical follow-up visit after 1 week. The tear and healing will be evaluated regarding signs of infection and/or dehiscence. The women will again be invited for a 1-year clinical examination including ultrasound. Questionnaires exploring symptoms related to the obstetric tear and possible complications will be answered at both visits. Our primary outcome is wound dehiscence and/or wound infection, which will be calculated using χ2 tests to compare groups. Secondary outcomes are variables that relate to wound healing, as pain, use of painkillers and antibiotics, need for further follow-up, as well as outcomes that may be related to the birth or healing process, urinary or anal incontinence, symptoms of prolapse, female body image, and sexual problems. DISCUSSION Reducing the risk of wound dehiscence and/or infection would decrease the number of control visits, prevent the need for longer antibiotic treatment, and possibly also decrease both short-term and long-term symptoms. This would be of great importance so the mother, her partner, and the baby could establish and optimize their initial family relation. TRIAL REGISTRATION The conduction of this study is approved the 2/2-2023 with the EU-CT number: 2022-501930-49-00. CLINICALTRIALS gov Identifier: NCT05830162.
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Affiliation(s)
- Kathrine Perslev
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Nørregade 10, Copenhagen, 1165, Denmark
| | - Thomas Bergholt
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Nørregade 10, Copenhagen, 1165, Denmark
| | - Hanna Jangö
- Department of Obstetrics and Gynecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 15, Herlev, 2730, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Nørregade 10, Copenhagen, 1165, Denmark.
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Dendini M, Aldossari SK, AlQassab HA, Aldraihem OO, Almalki A. Retrospective Case-Control Study of Extended Birth Perineal Tears and Risk Factors. Cureus 2024; 16:e57132. [PMID: 38681371 PMCID: PMC11055567 DOI: 10.7759/cureus.57132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND A perineal tear is a rupture of the skin or muscle between the vagina and anus (perineum). A third-degree tear is one type of extended perineal tear (EPT), and it involves the penetration of the anal sphincter muscle. Another type of EPT is a fourth-degree laceration, which penetrates deeper into the lining of the anus or rectum. The stretching of the perineum during childbirth may result in perineal trauma. Invasive surgical interventions are required for the treatment of EPTs. For this reason, the reduction of their incidence can be achieved by fully comprehending the risk aspects associated with them. OBJECTIVE The aim of this study is to contribute to the body of knowledge by providing insight into the various risk factors that are associated with extended perineal trauma. By following this path, this study aims to contribute to and advance Saudi Arabia's development of evidence-oriented obstetric care recommendations. STUDY DESIGN The current study is a case-control study where a review of 5000 vaginal delivery records was carried out between March 1, 2018, and March 19, 2023. For the study, cases (n = 71) were female patients who had documented greater than second-degree perineal injury. The control group (n = 238) was randomly chosen from women who had vaginal delivery but with less or equal to a second-degree perineal laceration. For each patient, we reviewed medical and obstetrics records for the following characteristics: age of diagnosis, gestational age, parity, labor induction, second-stage labor duration, mode of delivery, infant birth weight, epidural use and episiotomy indication, healthcare worker (HCW) experience, and APGAR (appearance, pulse, grimace, activity, and respiration) score. RESULTS From the 5000 births analyzed, the cases were 71 patients (1.42% of 5000 births). The mean age at diagnosis in our sample was (28.05 ± 4.66 years). The study's results showed that the following variables significantly affected the occurrence of EPTs: birth weight, labor durations, parity, HCW experience, and mode of delivery. The odds for tears were 3.69 (95% CI: 0.156-0.469) higher in nulliparous patients relative to multiparous patients. Instrumental deliveries resulted in more tears than non-instrumental deliveries with an odds ratio (OR) of 5.901 (95% CI: 2.443-14.525). This study also found that prolonged second-stage labor seems to be associated with an increased risk of perineal damage. HCW experience was looked at in relation to the increased incidence of EPTs, which showed that midwives had a lower incidence rate than physicians with an OR of 2.25 (95% CI: 1.169-4.366). Epidural usage has also been significantly associated with a lesser incidence of perineal tears, which indicates that using epidural could protect against the occurrence of EPTs. CONCLUSION In conclusion, the occurrence of perineal lacerations could be prevented during childbirth by taking preventative measures and having more precise judgments. Epidural was a protective factor in our study against the incidence of extensive perineal tearing. Furthermore, as compared to midwives, our study showed that the majority of EPTS occurred in cases of physicians (residents/consultants). Further research, proper documentation, and the development of evidence-based guidelines are needed to improve perineal care and reduce EPT incidence.
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Affiliation(s)
- Mohammad Dendini
- Urogynecology and Reconstructive Pelvic Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Sara K Aldossari
- Medicine, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Amwaj Almalki
- Biostatistics and Epidemiology, King Abdullah International Medical Research Center, Riyadh, SAU
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Macedo MD, Risløkken J, Halle T, Ellström Engh M, Siafarikas F. Occurrence and risk factors for second-degree perineal tears: A prospective cohort study using a detailed classification system. Birth 2024. [PMID: 38305584 DOI: 10.1111/birt.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/17/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The amount of tissue trauma within second-degree perineal tears varies widely. Therefore, subcategorization of second-degree tears and a better understanding of their occurrence and risk factors are needed. The aim of this study was to assess the occurrence of perineal tears when second-degree tears were subcategorized. Furthermore, we aimed to assess the association between variables related to perineal anatomy and other potential risk factors, with second-degree tear subcategories. METHODS This prospective cohort study included 880 primiparous and multiparous women giving birth to one child vaginally. Perineal tears were categorized using the classification system recommended by the Royal College of Obstetricians and Gynaecologists. In addition, second-degree tears were subcategorized as 2A, 2B, or 2C according to the percentage of damage to the perineal body. Selected variables related to perineal anatomy were as follows: length of genital hiatus; perineal body length; and previous perineal trauma. Risk factors for second-degree tear subcategories were analyzed using a multinominal regression model. RESULTS Perineal tears occurred as follows: first-degree: 35.6% (n = 313), 2A: 16.3% (n = 143), 2B: 9.1% (n = 80), 2C: 6.6% (n = 58), and third- or fourth-degree: 1.6% (n = 14). In total, 169/880 participants underwent an episiotomy. When episiotomies were excluded, the risk for 2B, or 2C tears increased with smaller genital hiatus, larger perineal body, previous perineal trauma, primiparity, higher gestational age, instrumental vaginal delivery and fetal presentation other than occiput anterior. CONCLUSION The occurrence of second-degree tear subcategories was 16.3% for 2A tears, 9.1% for 2B tears, and 6.6% for 2C tears. Factors related to perineal anatomy increased the odds for experiencing a second-degree tear in a more severe subcategory.
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Affiliation(s)
- Marthe D Macedo
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Jeanette Risløkken
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Tuva Halle
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Ellström Engh
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Franziska Siafarikas
- Division Akershus University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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Otterheim M, Hjertberg L, Pihl S, Uustal E, Blomberg M. Complications 8 weeks after an obstetric second-degree perineal laceration in relation to body mass index. Int Urogynecol J 2024; 35:77-84. [PMID: 37584704 PMCID: PMC10810915 DOI: 10.1007/s00192-023-05609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/23/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS How body mass index (BMI) affects pelvic floor function after a second-degree perineal laceration is unknown. The hypothesis of this study is that pelvic floor dysfunction and complications after an obstetric second-degree perineal laceration are more common in women with a higher BMI 8 weeks postpartum. METHODS This register-based cohort study includes 10,876 primiparous women with an obstetric second-degree perineal laceration between 2014 and 2021. Data were retrieved from the Swedish Perineal Laceration Registry. Outcomes in relation to maternal BMI were urinary incontinence (UI), anal incontinence (AI) and common complications attributable to the laceration. Uni- and multivariate logistic regressions were used for comparison between normal weight (BMI < 24.9, reference), overweight (25.0-29.9) and obese (≥ 30) women. RESULTS Multivariate analyses showed an increased risk for UI in both overweight and obese women compared to normal-weight women 8 weeks after a second-degree perineal laceration with an adjusted odds ratio (aOR) of 1.21 (CI 1.02-1.44) and 1.27 (CI 1.13-1.58) respectively. Overweight and obese women had a decreased risk for AI (aOR 0.81, CI 0.68-0.96; aOR 0.72, CI 0.57-0.90 respectively) compared with normal-weight women. No significant differences were found in the univariate analyses over BMI strata concerning complications after perineal laceration. CONCLUSIONS Primiparous overweight and obese women report less AI and more UI than normal-weight women 8 weeks after a second-degree perineal laceration. No differences were found regarding complications. These findings are new and merit further study to find potential preventive factors and interventions after a second-degree perineal laceration.
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Affiliation(s)
- Maria Otterheim
- Department of Obstetrics and Gynaecology, Vrinnevi Hospital, Norrköping, Sweden
| | - Linda Hjertberg
- Department of Obstetrics and Gynaecology, Vrinnevi Hospital, Norrköping, Sweden
- Department of Obstetrics and Gynaecology, University Hospital, 587 50, Linköping, Sweden
| | - Sofia Pihl
- Department of Obstetrics and Gynaecology, University Hospital, 587 50, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Eva Uustal
- Department of Obstetrics and Gynaecology, University Hospital, 587 50, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology, University Hospital, 587 50, Linköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Saad J, Painter C. Management of postpartum perineal wound complications. Curr Opin Obstet Gynecol 2023; 35:505-509. [PMID: 37560791 DOI: 10.1097/gco.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Perineal wound complications occur in up to 25% of postpartum patients. Wound complications are most common after obstetric anal sphincter injuries (OASIS) but can occur after any laceration. It is imperative that any provider caring for postpartum patients understand the best evidence-based practices to recognize and manage these complications. We present a review of the available literature on the management of postpartum perineal wound complications. RECENT FINDINGS There is a paucity of new publications on the management of postpartum perineal wound complications, despite an increased emphasis on postpartum recovery in women's health. The role of topical estrogen in healing of perineal wounds was investigated in a pilot study, demonstrating that granulation tissue does express estrogen receptors, and the use of estrogen increases cell proliferation. Progression of perineal wound healing by secondary intention was evaluated in an observational study. Wound healing was delayed in 30% of women, with the initial wound area, perimeter, bacterial colonization, and OASIS being associated with delayed healing. SUMMARY Evidence based practices on timing of follow-up, addressing wound care and analgesia, administrating antibiotics, timing secondary repair, and surgical technique all play a role in optimizing recovery and reducing morbidity in patients with postpartum perineal wound complications.
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Affiliation(s)
- Jaber Saad
- Kaiser Permanente East Bay and University of California San Francisco
| | - Caitlyn Painter
- University of California San Francisco, Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Science, San Francisco, California, USA
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Li P, Li Y, Zhang Y, Zhao L, Li X, Bao J, Guo J, Yan J, Zhou K, Sun M. Incidence, temporal trends and risk factors of puerperal infection in Mainland China: a meta-analysis of epidemiological studies from recent decade (2010-2020). BMC Pregnancy Childbirth 2023; 23:815. [PMID: 37996780 PMCID: PMC10666378 DOI: 10.1186/s12884-023-06135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Puerperal infection (PI) is a severe threat to maternal health. The incidence and risk of PI should be accurately quantified and conveyed for prior decision-making. This study aims to assess the quality of the published literature on the epidemiology of PI, and synthesize them to identify the temporal trends and risk factors of PI occurring in Mainland China. METHODS This review was registered in PROSPERO (CRD42021267399). Putting a time frame on 2010 to March 2022, we searched Cochrane library, Embase, Google Scholar, MEDLINE, Web of Science, China biology medicine, China national knowledge infrastructure and Chinese medical current contents, and performed a meta-analysis and meta-regression to pool the incidence of PI and the effects of risk factors on PI. RESULTS A total of 49 eligible studies with 133,938 participants from 17 provinces were included. The pooled incidence of PI was 4.95% (95%CIs, 4.46-5.43), and there was a statistical association between the incidence of PI following caesarean section and the median year of data collection. Gestational hypertension (OR = 2.14), Gestational diabetes mellitus (OR = 1.82), primipara (OR = 0.81), genital tract inflammation (OR = 2.51), anemia during pregnancy (OR = 2.28), caesarean section (OR = 2.03), episiotomy (OR = 2.64), premature rupture of membrane (OR = 2.54), prolonged labor (OR = 1.32), placenta remnant (OR = 2.59) and postpartum hemorrhage (OR = 2.43) have significant association with PI. CONCLUSIONS Maternal infection remains a crucial complication during puerperium in Mainland China, which showed a nationwide temporal rising following caesarean section in the past decade. The opportunity to prevent unnecessary PI exists in several simple but necessary measures and it's urgent for clinicians and policymakers to focus joint efforts on promoting the bundle of evidence-based practices.
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Affiliation(s)
- Peng Li
- Department of Hospital Infection Control, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Li
- Department of Hospital Infection Control, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Youjian Zhang
- Department of Hospital Infection Control, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lina Zhao
- Department of Obstetrics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaohong Li
- Department of Obstetrics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jianing Guo
- Department of Hospital Infection Control, Henan Province Women and Children's Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Yan
- Department of Obstetrics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke Zhou
- Department of Obstetrics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingjie Sun
- Department of Hospital Infection Control, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
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Puissegur A, Accoceberry M, Rouzaire M, Pereira B, Herault M, Bruhat C, Delabaere A, Gallot D. Risk Factors for Perineal Wound Breakdown in Early Postpartum: A Retrospective Case-Control Study. J Clin Med 2023; 12:jcm12083036. [PMID: 37109371 PMCID: PMC10146046 DOI: 10.3390/jcm12083036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
We conducted a retrospective case-control study in patients presenting a perineal tear (second degree or higher) or episiotomy complicated by wound breakdown during maternity stay to identify risk factors associated with wound breakdown in early postpartum with a view to improving the quality of care. We collected ante- and intrapartum characteristics and outcomes at the postpartum visit. In all, 84 cases and 249 control subjects were included. In univariate analysis, primiparity, absence of history of vaginal delivery, a longer second phase of labour, instrumental delivery, and a higher degree of laceration emerged as risk factors for early perineal suture breakdown postpartum. Gestational diabetes, peripartum fever, streptococcus B, and suture technique did not emerge as risk factors for perineal breakdown. Multivariate analysis confirmed that instrumental delivery (OR = 2.18 [1.07; 4.41], p = 0.03) and a longer second phase of labour (OR = 1.72 [1.23; 2.42], p = 0.001) were risk factors for early perineal suture breakdown.
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Affiliation(s)
- Amandine Puissegur
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie Accoceberry
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marion Rouzaire
- CIC 1405 CRECHE Unit, INSERM, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie Herault
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Clément Bruhat
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Amélie Delabaere
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Denis Gallot
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- Translational Approach to Epithelial Injury and Repair Team, GReD, CNRS, INSERM, Auvergne University, 63000 Clermont-Ferrand, France
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Humphreys ABC, Linsell L, Knight M. Factors associated with infection after operative vaginal birth-a secondary analysis of a randomized controlled trial of prophylactic antibiotics for the prevention of infection following operative vaginal birth. Am J Obstet Gynecol 2023; 228:328.e1-328.e11. [PMID: 36027955 DOI: 10.1016/j.ajog.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND A recent randomized controlled trial of prophylactic antibiotics for the prevention of infection following operative vaginal birth showed that women allocated prophylactic intravenous amoxicillin and clavulanic acid had a significantly lower risk of developing confirmed or suspected infection within 6 weeks after operative vaginal birth (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.49-0.69; P < .001). Some international and national guidelines have subsequently been updated to include prophylactic antibiotics after operative vaginal birth. However, the generalizability of the trial results may be limited in settings where the episiotomy rate is lower (89% of women in the trial had an episiotomy). In addition, there was a high burden of infection in the prophylactic antibiotics group despite the administration of prophylactic antibiotics. It is essential to identify modifiable risk factors for infection after operative vaginal birth, including the timing of antibiotic administration. OBJECTIVE This study aimed to evaluate if the effectiveness of the prophylactic antibiotic in reducing confirmed or suspected infection was independent of perineal trauma, identify risk factors for infection after operative vaginal birth, and investigate variation in efficacy with the timing of antibiotic administration. STUDY DESIGN This study was a secondary analysis of 3225 women with primary outcome data from the prophylactic antibiotics for the prevention of infection following operative vaginal birth randomized controlled trial. Women were divided into subgroups according to the perineal trauma experienced (episiotomy and/or perineal tear). The consistency of the prophylactic antibiotics in preventing infection across the subgroups was assessed using log-binomial regression and the likelihood ratio test. Multivariable log-binomial regression was used to investigate factors associated with infection. The multivariable risk factor model was subsequently fitted to the group of women who received amoxicillin and clavulanic acid to investigate the timing of antibiotic administration. RESULTS Of the 3225 women included in the secondary analysis, 2144 (66.5%) had an episiotomy alone, 726 (22.5%) had an episiotomy and a tear, 277 (8.6%) had a tear alone, and 78 (2.4%) had neither episiotomy nor tear. Among women who experienced perineal trauma, amoxicillin and clavulanic acid administration was protective against infection in all subgroups compared with placebo with no significant interaction between subgroup and trial allocation (P=.17). Moreover, 2925 women were included in the multivariable risk factor analysis. The following were associated with adjusted risk ratios of infection: episiotomy, 2.94 (95% confidence interval, 1.62-5.31); forceps, 1.37 (95% confidence interval, 1.12-1.69) compared to vacuum extraction; primiparity, 1.34 (95% confidence interval, 1.05-1.70); amoxicillin and clavulanic acid administration, 0.60 (95% confidence interval, 0.51-0.72); body mass index of 25.0 to 29.9 kg/m2, 1.21 (95% confidence interval, 1.00-1.47), and body mass index of ≥30 kg/m2, 1.22 (95% confidence interval, 0.98-1.52) compared to body mass index of <25 kg/m2. Each 15-minute increment between birth and antibiotic administration was associated with a 3% higher risk of infection (adjusted risk ratio, 1.03; 95% confidence interval, 1.01-1.06). CONCLUSION Timely prophylactic antibiotics should be administered to all women after operative vaginal birth, irrespective of the type of perineal trauma. The use of episiotomy, forceps birth, primiparity, and overweight were associated with an increased risk of confirmed or suspected infection after operative vaginal birth.
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Affiliation(s)
- Anna B C Humphreys
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
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10
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Jung YM, Lee SM, Kim SY, Chung JH, Won HS, Lee KA, Park MH, Cho GJ, Oh MJ, Choi ES, Ahn KH, Hong SC, Sung JH, Roh CR, Kim SM, Kim BJ, Kim HJ, Oh KJ, Hong S, Park IY, Park JS. The Skin Antiseptic agents at Vaginal dElivery (SAVE) trial: study protocol for a randomized controlled trial. Trials 2023; 24:130. [PMID: 36810189 PMCID: PMC9942633 DOI: 10.1186/s13063-023-07101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/18/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Cleansing of the vulva and perineum is recommended during preparation for vaginal delivery, and special attention is paid to cleansing before episiotomy because episiotomy is known to increase the risk of perineal wound infection and/or dehiscence. However, the optimal method of perineal cleansing has not been established, including the choice of antiseptic agent. To address this issue, we designed a randomized controlled trial to examine whether skin preparation with chlorhexidine-alcohol is superior to povidone-iodine for the prevention of perineal wound infection after vaginal delivery. METHODS In this multicenter randomized controlled trial, term pregnant women who plan to deliver vaginally after episiotomy will be enrolled. The participants will be randomly assigned to use antiseptic agents for perineal cleansing (povidone-iodine or chlorhexidine-alcohol). The primary outcome is superficial or deep perineal wound infection within 30 days after vaginal delivery. The secondary outcomes are the length of hospital stay, physician office visits, or hospital readmission for infection-related complications, endometritis, skin irritations, and allergic reactions. DISCUSSION This study will be the first randomized controlled trial aiming to determine the optimal antiseptic agent for the prevention of perineal wound infections after vaginal delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT05122169. First submitted date on 8 November 2021. First posted date on 16 November 2021.
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Affiliation(s)
- Young Mi Jung
- grid.31501.360000 0004 0470 5905Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Seung Mi Lee
- grid.31501.360000 0004 0470 5905Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - So Yeon Kim
- grid.413967.e0000 0001 0842 2126Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin Hoon Chung
- grid.413967.e0000 0001 0842 2126Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hye-Sung Won
- grid.413967.e0000 0001 0842 2126Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung A Lee
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Mi Hye Park
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Geum Joon Cho
- grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, South Korea
| | - Min-Jeong Oh
- grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, South Korea
| | - Eun Saem Choi
- grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, South Korea ,grid.411134.20000 0004 0474 0479Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, South Korea
| | - Ki Hoon Ahn
- grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, South Korea ,grid.411134.20000 0004 0474 0479Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, South Korea
| | - Soon-Cheol Hong
- grid.222754.40000 0001 0840 2678Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, South Korea ,grid.411134.20000 0004 0474 0479Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, South Korea
| | - Ji-Hee Sung
- grid.264381.a0000 0001 2181 989XDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Cheong-Rae Roh
- grid.264381.a0000 0001 2181 989XDepartment of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Min Kim
- grid.412479.dDepartment of Obstetrics and Gynecology, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byoung Jae Kim
- grid.412479.dDepartment of Obstetrics and Gynecology, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyeon Ji Kim
- grid.412480.b0000 0004 0647 3378Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do South Korea
| | - Kyung Joon Oh
- grid.31501.360000 0004 0470 5905Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea ,grid.412480.b0000 0004 0647 3378Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do South Korea
| | - Subeen Hong
- grid.411947.e0000 0004 0470 4224Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In Yang Park
- grid.411947.e0000 0004 0470 4224Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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11
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Hjertberg L, Pihl S, Blomberg M, Uustal E. Body mass index and complications after obstetric anal sphincter injury, 8 weeks postpartum. Int Urogynecol J 2022; 33:3465-3472. [PMID: 36085318 PMCID: PMC9666295 DOI: 10.1007/s00192-022-05328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of body mass index (BMI) on pelvic floor recovery after an obstetric anal sphincter injury (OASI) is unclear. The aim of this study was to evaluate the hypothesis that urinary incontinence (UI) and anal incontinence (AI) are more common in overweight and obese women than in normal-weight women 8 weeks postpartum in women with OASI. METHODS A population-based cohort study including 6,595 primiparous women, with an OASI, delivered between 2014 and 2019. Exposure and questionnaire data were retrieved from the Swedish Perineal Laceration Registry. Uni- and multivariate analyses were used to compare normal-weight (BMI ≤24.9, reference), overweight (25.0-29.9), and obese (≥ 30) women with regard to UI and AI at 8 weeks post-partum. RESULTS Multivariate analyses showed an increased risk for urinary incontinence (OR 1.54, 95% CI 1.27-1.87) among overweight women as well as among obese women (OR 1.72, 95% CI 1.32-2.24). In contrast to our hypothesis, both overweight women (OR 0.68, 95% CI 0.56-0.83) and obese women (OR 0.65, 95% CI 0.49-0.87) were at a decreased risk for any gas and/or faecal incontinence after adjustment to possible confounding factors. The absolute rate of AI was 40.1% among normal-weight women, 34.2% among overweight women, and 29.1% in the obese group. CONCLUSIONS Urinary incontinence is more common, whereas AI is less common among overweight and obese women than in primiparous women with a BMI <24.9, 8 weeks after an OASI. The new finding, that overweight women report less AI than normal-weight women, merits further study.
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Affiliation(s)
- Linda Hjertberg
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sofia Pihl
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Eva Uustal
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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12
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Use of Autologous Platelet Rich Plasma (A-PRP) for Postpartum Perineal Repair Failure: A Case Report. J Pers Med 2022; 12:jpm12111917. [PMID: 36422093 PMCID: PMC9697075 DOI: 10.3390/jpm12111917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Perineal wound dehiscence is an uncommon but important postpartum complication. In many cases, it leads to extreme pain and urinary and defecation problems. For up to several weeks, it can interfere with the mother’s daily activity, affecting psychosexual health and body image. The best way to manage perineal wound breakdown (resuturing vs. spontaneous closure) after childbirth remains controversial. A-PRP is the autologous human plasma containing an increased platelet concentration, rich in growth factors, and mediators with hemostatic, anti-inflammatory, and antimicrobial properties. It accelerates the natural healing process. Even though A-PRP is widely used in orthopedics and dermatology, its use in gynecological injuries is limited. We describe here a case of a woman with postpartum perineal dehiscence treated with A-PRP with positive outcomes.
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13
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TUĞRUL ERSAK D, ERSAK B, ZORLU U, KOKANALI MK, MORALOĞLU TEKİN Ö, DOĞANAY M. Düşük riskli kadınlarda enfekte epizyotomi riskini öngören bir model. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Infected episiotomy (IE) is a rare complication of vaginal delivery. However, the practical use of the risk factors involved in the development of IE is unclear. The aim of this study is to create a risk scoring model to be applied in clinical practice with the risk factors we will determine so as to predict the development of IE.
Materials and Methods: All women who were delivered vaginally with mediolateral episiotomy within a 1-year period were included in this retrospective study. While 42 women (cases) with the diagnosis of IE were eligible for inclusion in the study and formed the case group, randomly selected 168 women in whom IE was not detected formed the control group. Possible risk factors for the development of IE were evaluated by multivariate regression analysis.
Results: The analysis revealed 5 significant independent factors related to IE. Among these factors, 5 points were given to current smoking presence, 4 points to weight gain during pregnancy ≥11.5 kg, 3 points to postpartum neutrophil to lymphocyte ratio ≥10.4, 2 points to presence of diabetes mellitus, and 1 point to presence of hospitalization before active phase of labor. And a cut-off value of 5.5 was found to be moderately effective in predicting IE.
Conclusion: Consequently, this five-variable model can predict the presence of IE with significant efficiency. In the presence of these variables, the clinician can identificate the patients at risk of IE. In this way, individualized patient risk assessment and situation-specific counseling can be made.
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Affiliation(s)
- Duygu TUĞRUL ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Burak ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Uğurcan ZORLU
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Mahmut Kuntay KOKANALI
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Özlem MORALOĞLU TEKİN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Melike DOĞANAY
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
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14
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Okeahialam NA, Wong KW, Thakar R, Sultan AH. The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:182-191. [PMID: 35550375 DOI: 10.1016/j.ajog.2022.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to systematically determine the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair. DATA SOURCES MEDLINE, Embase, CINAHL, EmCare, the Cochrane Library, and Trip Pro databases were searched from inception to February 2021. STUDY ELIGIBILITY CRITERIA We included observational clinical studies reporting the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair. Case series and reports were excluded. Conference articles and observational study abstracts were included if they contained enough information regarding study design and outcome data. METHODS Data were analyzed as incidence (percentage) with 95% confidence intervals. Moreover, the prediction intervals were calculated to provide a predicted range for the potential incidence of wound complications when applied to an individual study setting. Study quality and risk of bias were assessed using the relevant tool from the Joanna Briggs Institute. RESULTS Of 956 studies found, 39 were selected for full-text review. Moreover, 10 studies (n=4767 women) were eligible and included in the meta-analysis. All 10 studies were conducted in high-income countries (Denmark [n=1], the United Kingdom [n=3], and the United States [n=6]). The incidences of wound infection (n=4593 women) and wound dehiscence (n=3866 women) after primary obstetric anal sphincter injury repair ranged between 0.1% to 19.8% and 1.9% to 24.6%, respectively. The overall incidences were 4.4% (95% confidence interval, 0.4-8.4) for wound infection and 6.9% (95% confidence interval, 1.6-12.2) for wound dehiscence. The prediction intervals were wide and suggested that the true incidences of wound infection and dehiscence in future studies could lie between 0.0% to 11.7% and 0.0% to 16.4%, respectively. Overall, 8 studies had a high or unclear risk of bias across ≥1 assessed element. None of the studies used the same set of clinical parameters to define wound infection or dehiscence. Furthermore, microbiological confirmation with wound swabs was never used as a diagnostic measure. CONCLUSION This was a systematic review and meta-analysis of wound infection and dehiscence incidences after primary obstetric anal sphincter injury repair. The incidence estimates from this review will be useful for clinicians when counseling women with obstetric anal sphincter injury and when consenting them for primary surgical repair.
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Affiliation(s)
| | - Ka Woon Wong
- Croydon University Hospital, Thornton Heath, England
| | - Ranee Thakar
- Croydon University Hospital, Thornton Heath, England; St George's University of London, London, United Kingdom
| | - Abdul H Sultan
- Croydon University Hospital, Thornton Heath, England; St George's University of London, London, United Kingdom.
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15
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Yan W, Machowska A, Sihavong A, Sychareun V, Chaleunvong K, Keohavong B, Eriksen J, Hanson C, Vongsouvath M, Brauner A, Mayxay M, Kounnavong S, Stålsby Lundborg C. Antibiotic Prescribing in Connection to Childbirth: An Observational Study in Two Districts in Lao PDR. Antibiotics (Basel) 2022; 11:antibiotics11040448. [PMID: 35453200 PMCID: PMC9029038 DOI: 10.3390/antibiotics11040448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Overuse and misuse of antibiotics has frequently been reported for obstetric conditions and procedures, which may impact both the mother and the unborn baby and increase antibiotic resistance. This study aimed to investigate the antibiotic prescribing pattern in connection to childbirth in two districts in Lao PDR. It is a cross-sectional observational study. Antibiotic prescription data related to childbirth was collected via reviews of medical records in two district hospitals and five health centers in Lao PDR from September 2019 to November 2020. In total, antibiotic prescription data for 1777 women were extracted from their medical records. It was found that all women received antibiotics during in-patient care irrespective of delivery mode. When in hospital, 85.5% of the women who underwent a caesarean section got antibiotic treatment for 5 days and women who had a vaginal delivery usually had antibiotic treatment for one day or less. All the women got oral antibiotics for an additional 4–5 days upon discharge. Antibiotic prescription rate in connection to childbirth was very high in comparison with the WHO guidelines, and antibiotics were used extensively in the participating health facilities. Interventions to guide appropriate prescribing behavior in relation to childbirth are urgently needed in Lao PDR.
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Affiliation(s)
- Weirong Yan
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
- Correspondence:
| | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane 01030, Laos;
| | - Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane 7444, Laos;
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
| | - Bounxou Keohavong
- Food and Drug Department, Ministry of Health, Vientiane 01030, Laos;
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
- Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital,118 83 Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Division of Clinical Microbiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos;
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
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16
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Okeahialam NA, Thakar R, Sultan AH. Healing of disrupted perineal wounds after vaginal delivery: a poorly understood condition. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S8-S16. [PMID: 34781764 DOI: 10.12968/bjon.2021.30.sup20.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perineal injury following childbirth can result in complications such as wound infection and dehiscence. The reported incidence of these complications in the literature range between 0.1-23.6% and 0.2-24.6%, respectively. However, the healing of disrupted perineal wounds is poorly understood. In addition, it is a neglected area in maternity services. In this review, the authors explore the process of wound healing in the context of infected perineal wounds following childbirth. In addition, the authors describe the management of complications including hypergranulation, perineal pain and dyspareunia.
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Affiliation(s)
| | - Ranee Thakar
- Consultant Obstetrician and Urogynaecologist, Croydon University Hospital, London, and Honorary Senior Lecturer, St George's University of London
| | - Abdul H Sultan
- Consultant Obstetrician and Urogynaecologist, Croydon University Hospital, London, and Honorary Reader, St George's University of London
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17
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Feng Y, Zhou L. Risk analysis of poor wound healing in forceps delivery. J Obstet Gynaecol Res 2021; 47:3509-3515. [PMID: 34365703 DOI: 10.1111/jog.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aims to explore the risk factors leading to poor wound healing after forceps delivery. METHOD In this retrospective study, 74 patients undergoing forceps delivery with poor wound healing were compared with contemporary randomly selected 74 patients undergoing forceps delivery but with normal wound healing. RESULTS Compared to the normal healing group, the poor healing group had larger birthweight (p = 0.01), longer labor length (805.9 ± 356.4 min vs. 572.9 ± 306.3 min, p < 0.001), more virginal checks (4.0 ± 1.5 vs. 3.4 ± 1.7, p = 0.029), and more contaminated amniotic fluid (p = 0.043). More patients in poor healing group suffered from postpartum fever (52.7% vs. 21.6%, p < 0.001), postpartum hemorrhage (p < 0.001), and anemia after delivery (p < 0.001). Labor length (odds ratio (OR) 1.125, 95% confidence interval [CI] = 1.033-1.226), anemia after delivery (OR 3.621, 95% CI = 2.077-6.314), postpartum fever (OR 7.100, 95% CI = 2.505-20.124), and degree of laceration (OR 3.067, 95% CI = 1.258-7.479) were the risk factors of poor healing of perineal wound after forceps delivery, while postpartum antibiotics (OR 0.303, 95% CI = 0.098-0.937) and suture removal days (OR 0.272, 95% CI = 0.133-0.556) were the protective factors. CONCLUSION To promote the wound healing from the forceps delivery, obstetricians may consider to control the patient's labor length and degree of laceration, increase patient's nutrition, apply prophylactic antibiotics, and prolong the suture removal days.
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Affiliation(s)
- Yi Feng
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Li Zhou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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18
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Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study. J Pers Med 2021; 11:jpm11080685. [PMID: 34442329 PMCID: PMC8398826 DOI: 10.3390/jpm11080685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period from January 2010 to April 2017. Results: During the study period, a total of 33,026 patients were included in the study. For maternal variables, the associated increased risk of severe perineal tearing in nulliparous women is OR = 3.48, for induced labor OR = 1.29, and for instrumental delivery by forceps OR = 4.52 or spatulas OR = 4.35; for the obstetric variable of episiotomy, it is OR = 3.41. For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears, and for birth weights of 3000 g (OR = 2.41), 3500 g (OR = 1.97), and 4000 g (OR = 2.17), statistically significant differences were found in each of the groups (p < 0.05). Conclusion: Primiparity, induction of labor, episiotomy, instrumental delivery with forceps or spatula, and a birth weight of 3000 g or more are significantly associated with an increased risk of third and fourth degree perineal tears.
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19
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Childs C, Sandy-Hodgetts K, Broad C, Cooper R, Manresa M, Verdú-Soriano J. Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. J Wound Care 2021; 29:S1-S48. [PMID: 33170077 DOI: 10.12968/jowc.2020.29.sup11a.s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Charmaine Childs
- Professor of Clinical Science, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow/Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia; Director, Skin Integrity Research Unit, University of Western Australia, Perth, Australia
| | - Carole Broad
- Clinical Specialist Physiotherapist in Pelvic Health, Department of Physiotherapy, Cardiff and Vale UHB, Cardiff, Wales, UK
| | - Rose Cooper
- Former Professor of Microbiology at Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Margarita Manresa
- Maternal and Fetal Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Verdú-Soriano
- Professor of Community Nursing and Wound Care, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pak J Med Sci 2021; 37:1118-1121. [PMID: 34290793 PMCID: PMC8281147 DOI: 10.12669/pjms.37.4.3671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 03/20/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn't help in healing of wound and reclosure of the dehisced abdominal wound is needed.
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Affiliation(s)
- Ahmed Siddique Ammar
- Dr. Ahmed Siddique Ammar, MBBS, MS General Surgery Senior Registrar, EAST Surgical Ward, Mayo Hospital, Lahore, Pakistan
| | - Syed Asghar Naqi
- Prof. Dr. Syed Asghar Naqi, MBBS, FCPS, FRCS, MCPS-HPE Professor and Head of Surgical Department, EAST Surgical Ward, MAYO Hospital, Lahore, Pakistan. EAST Surgical Ward, Mayo Hospital, Lahore, Pakistan
| | - Shehrbano Khattak
- Dr. Shehrbano Khattak, MBBS, M-Phill Biochemistry Lecturer, Department of Biochemistry, King Edward Medical University, Lahore, Pakistan
| | - Ahmed Raza Noumani
- Dr. Ahmed Raza Noumani, MBBS, MS General Surgery Senior Registrar, EAST Surgical Ward, Mayo Hospital, Lahore, Pakistan
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21
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PrabhuDas M, Piper JM, Jean-Philippe P, Lachowicz-Scroggins M. Immune Regulation, Maternal Infection, Vaccination, and Pregnancy Outcome. J Womens Health (Larchmt) 2021; 30:199-206. [PMID: 33232632 PMCID: PMC8020511 DOI: 10.1089/jwh.2020.8854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
About 12.5% of all maternal deaths in the United States are due to infectious causes. This proportion, although stable during the past three decades, represents an increase in infectious causes of mortality, as the overall mortality rate in U.S. pregnant women had increased steadily during that same period. During healthy pregnancies, a delicate immunological balance-in which a mother's immune system tolerates the semi-allogeneic fetus yet maintains immune competency against infectious agents-is achieved and maintained. This immunological paradigm, however, results in increased susceptibility to infectious diseases during pregnancy, particularly in later stages and during the early postpartum period. The inflammatory process induced by these infectious insults, as well as some noninfectious insults, occurring during pregnancy can disrupt this carefully achieved balance and, in turn, lead to a state of rampant inflammation, immune activation, and dysregulation with deleterious health outcomes for the mother and fetus. Elucidating mechanisms contributing to the disruption of this immunologic homeostasis, and its disruption by infectious pathogens, might offer opportunities for interventions to reduce maternal and fetal morbidity and mortality.
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Affiliation(s)
- Mercy PrabhuDas
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Jeanna M. Piper
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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22
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Ochiai AM, Araújo NM, Moraes SDTA, Caroci-Becker A, Sparvoli LG, Teixeira TT, Carvalho RR. The use of non-surgical glue to repair perineal first-degree lacerations in normal birth: A non-inferiority randomised trial. Women Birth 2020; 34:e514-e519. [PMID: 33071207 DOI: 10.1016/j.wombi.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PROBLEM Surgical glue has been indicated for uncomplicated operatory wounds; however, it has a considerable cost. Non-surgical glue, a commercially available and cheaper product, has not been studied for repairing postpartum lacerations. AIM To compare non-surgical glue to traditional sutures on perineal first-degree lacerations after normal birth. METHODS In a prospective, open-label, non-inferiority, randomised controlled trial, we selected childbearing women who were admitted for normal term births and in whom skin lacerations occurred. They were assigned to laceration repair using either non-surgical glue (ethyl 2-cyanoacrylate; Glue group) or catgut sutures (Suture group). The primary endpoint was the occurrence of dehiscence >3mm. Secondary endpoints were procedure runtime, pain score, satisfaction level, and aspects of perineal repair by the REEDA score (hyperaemia, oedema, ecchymosis, exudation, and coaptation) immediately (T0), 24-48h (T1), and 7-10 days (T2) after childbirth. FINDINGS We included 126 women, 63 in each group, and found a non-inferiority dehiscence rate in the Glue Group compared to the Control group (T1=1.6% vs. 1.6%, P=0.999 and P<0.001 for non-inferiority; and T2=2.2% vs. 4.3%, P=0.557). In the Glue Group, the procedure runtime was shorter, pain score was lower, and women's satisfaction was greater. No women had any allergic reaction in the study. CONCLUSIONS Non-surgical glue was not inferior to traditional sutures to repair postpartum first-degree lacerations. In addition, non-surgical glue was associated with less pain and greater satisfaction. Brazilian Clinical Trials Registry (www.ensaiosclinicos.gov.br/rg/RBR-5Z8MKC).
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Affiliation(s)
- A M Ochiai
- University of São Paulo, School of Arts, Sciences and Humanities, São Paulo, São Paulo, Brazil.
| | - N M Araújo
- University of São Paulo, School of Arts, Sciences and Humanities, São Paulo, São Paulo, Brazil
| | - S D T A Moraes
- "Amador Aguiar" Municipal Hospital and Maternity, Osasco, São Paulo, Brazil
| | - A Caroci-Becker
- University of São Paulo, School of Arts, Sciences and Humanities, São Paulo, São Paulo, Brazil
| | - L G Sparvoli
- University of São Paulo, School of Pharmaceutical Sciences, São Paulo, São Paulo, Brazil
| | - T T Teixeira
- "Casa Angela" Freestanding Birth Centre, São Paulo, São Paulo, Brazil
| | - R R Carvalho
- "Casa Angela" Freestanding Birth Centre, São Paulo, São Paulo, Brazil
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Okeahialam NA, Thakar R, Kleprlikova H, Taithongchai A, Sultan AH. Early re-suturing of dehisced obstetric perineal wounds: A 13-year experience. Eur J Obstet Gynecol Reprod Biol 2020; 254:69-73. [PMID: 32942078 DOI: 10.1016/j.ejogrb.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe post-operative outcomes following early re-suturing of obstetric perineal wound dehiscence. STUDY DESIGN This was a retrospective series of 72 women who underwent re- suturing of a dehisced perineal wound at a tertiary urogynaecology department during a 13-year period (December 2006 - December 2019). RESULTS Seventy-two women with complete perineal wound dehiscence opted for secondary re-suturing. Other accompanying symptoms included purulent discharge from the wound (22.2 %), perineal pain (23.6 %) and both purulent discharge and pain (26.4 %). The median time taken for the wound to heal completely following re-suturing was 28 days (IQR 14.0-52.0); 49.2 % had healed completely by four weeks, 63.5 % by six weeks and 76.2 % by eight weeks. The median number of out-patient follow-up appointments required was 2 (IQR 1.0-3.0). No post-operative complications were experienced in 63.6 % of women, one complication occurred in 25.8 % and two complications in 10.6 %. Complications included skin dehiscence (33.3 %), granuloma (33.3 %), scar tissue (17.6 %), perineal pain (5.9 %) and sinus formation (5.9 %). Of the women who developed two complications, four developed skin dehiscence with granulation tissue and one had skin sinus formation. One developed granulation tissue with perineal pain. All complications were managed conservatively in an outpatient setting or surgically under local anaesthetic, without further complication. There was no significant difference (p = 0.443) in complication rates between the group (n = 10) with dehisced wounds with signs of wound infection (purulent discharge or the presence of both purulent discharge and pain) pre-operatively versus the group (n = 14) without signs of infection. CONCLUSIONS This study demonstrates the positive outcomes of early re-suturing of perineal wound dehiscence with faster healing, reduced follow-up requirements and few major complications. It provides information to clinicians who are uncertain about the effects of early re-suturing of perineal wounds which can be used to help counsel mothers with wound dehiscence on their management options.
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Affiliation(s)
| | - R Thakar
- Croydon University Hospital, London UK; Honorary Senior Lecturer St George's University of London, UK
| | - H Kleprlikova
- Croydon University Hospital, London UK; Department of General Anthropology, Faculty of Humanities, Charles University in Prague, Czech Republic
| | | | - A H Sultan
- Croydon University Hospital, London UK; Honorary Reader St. George's University of London, UK.
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Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis. Obstet Gynecol Int 2020; 2020:1582653. [PMID: 32934656 PMCID: PMC7479451 DOI: 10.1155/2020/1582653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue. Methods A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019. Results The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear. Conclusion Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3rd/4tht degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.
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The role of fetal head circumference in the formation of obstetric anal sphincter injuries following vacuum deliveries among primiparous women. Arch Gynecol Obstet 2020; 301:1423-1429. [PMID: 32363548 DOI: 10.1007/s00404-020-05558-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the association of sonographic fetal head circumference (HC) with obstetric anal sphincter injury (OASIS) occurrence among primiparous women who underwent vacuum-assisted delivery (VAD). METHODS A retrospective study of all primiparous women who delivered at term by VAD between 2011 and 2019 and underwent ultrasound with fetal biometry within 1 week prior to delivery. Women who suffered OASIS were compared to women without OASIS. RESULTS Overall, 74 of 3222 (2.3%) primiparous women suffered an OASIS. As compared with control, women with OASIS were younger (median 28 vs. 30 years, p = 0.001), had higher BMI (median 28.2 vs. 26.9 kg/m2, p = 0.03), and had a longer second stage of labor (median 190 vs. 168 min, p = 0.01). Fetal head circumference was larger in the OASIS group (mean 334 vs. 330 mm, p = 0.03), occiput posterior fetal head position was more prevalent (12 (16%) vs. 232 (7.4%), OR [95% CI]: 2.43 (1.29-4.57), p = 0.004), and the rate of mediolateral episiotomy performed was lower (58 (78.0%) vs. 2777 (88.2%), OR [95% CI]: 0.48 (0.27-0.85), p = 0.01). Multivariate regression modeling identified higher fetal HC (aOR [95% CI] 1.03 (1.001-1.06), p = 0.04) and occiput posterior (aOR [95% CI] 2.5 (1.16-5.71), p = 0.01) as independently positively associated with OASIS. Mediolateral episiotomy and maternal age were independently negatively associated with an OASIS (aOR [95% CI] 0.39 (0.18-0.85), p = 0.01); aOR [95% CI] 0.4 (0.17-0.60), p = 0.001). CONCLUSIONS Sonographic large fetal HC is associated with OASIS occurrence during VAD. The only modifiable predictor of OASIS detected was mediolateral episiotomy, found to be protective against OASIS.
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Pergialiotis V, Bellos I, Fanaki M, Vrachnis N, Doumouchtsis SK. Risk factors for severe perineal trauma during childbirth: An updated meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247:94-100. [PMID: 32087423 DOI: 10.1016/j.ejogrb.2020.02.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
Several studies have investigated the importance of maternal, fetal factors and intrapartum characteristics in predicting severe perineal lacerations. The purpose of the present systematic review is to accumulate current evidence and provide estimated effect sizes for the various risk factors described. We reviewed Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar for published studies in the field for observational studies as well as randomized controlled trials. Two researchers independently assessed the included studies and documented outcomes. Data extraction was performed using a modified data form that was based in Cochrane`s data collection form for intervention reviews for RCTs and non-RCTs. Forty-three articles were selected for inclusion in the present systematic review. The analyzed population reached 716,031 parturient of whom 22,280 (3,1%) sustained third- and fourth-degree perineal lacerations. Several risk factors were identified. Instrumental delivery [RR 3.38 (2.21, 5.18)], midline episiotomy [RR 2.88 (1.79, 4.65)] and a persistent occiput posterior position [RR 2.73 (2.08, 3.58)] were associated with the higher risk of developing severe perineal lacerations. Mediolateral episiotomy did not increase, but was also not protective against perineal lacerations [RR 1.55 (0.95, 2.53)]. Several factors contribute to the development of severe perineal lacerations. The present meta-analysis presents accumulated data that may help physicians estimate risks and provide appropriate patient counseling.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece; Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Maria Fanaki
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Vrachnis
- Second Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Stergios K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece; Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom; St George's University of London, London, United Kingdom
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Iwabu K, Maeda Y, Tanimoto T. Prophylactic antibiotics after operative vaginal delivery. Lancet 2020; 395:189-190. [PMID: 31954461 DOI: 10.1016/s0140-6736(19)32631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Kaho Iwabu
- National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Yuto Maeda
- National Center for Child Health and Development, Tokyo 157-8535, Japan.
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Gommesen D, Nøhr E, Qvist N, Rasch V. Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study. BMJ Open 2019; 9:e032368. [PMID: 31848167 PMCID: PMC6937116 DOI: 10.1136/bmjopen-2019-032368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Sexuality is an important aspect of human identity and contributes significantly to the quality of life in women as well as in men. Impairment in sexual health after vaginal delivery is a major concern for many women. We aimed to examine the association between degree of perineal tear and sexual function 12 months postpartum. DESIGN A prospective cohort study SETTING: Four Danish hospitals between July 2015 and January 2019 PARTICIPANTS: A total of 554 primiparous women: 191 with no/labia/first-degree tears, 189 with second-degree tears and 174 with third-degree/fourth-degree tears. Baseline data were obtained 2 weeks postpartum by a questionnaire and a clinical examination. Sexual function was evaluated 12 months postpartum by an electronic questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)) and a clinical examination. PRIMARY OUTCOME MEASURES Total PISQ-12 score and dyspareunia RESULTS: Episiotomy was performed in 54 cases and 95 women had an operative vaginal delivery. The proportion of women with dyspareunia was 25%, 38% and 53% of women with no/labia/first-degree, second-degree or third-degree/fourth-degree tears, respectively.Compared with women with no/labia/first-degree tears, women with second-degree or third-degree/fourth-degree tears had a higher risk of dyspareunia (adjusted relative risk (aRR) 2.05; 95% CI 1.51 to 2.78 and aRR 2.09; 95% CI 1.55 to 2.81, respectively). Women with third-degree/fourth-degree tears had a higher mean PISQ-12 score (12.2) than women with no/labia/first-degree tears (10.4). CONCLUSIONS Impairment of sexual health is common among primiparous women after vaginal delivery. At 12 months postpartum, more than half of the women with a third-degree/fourth-degree tear experienced dyspareunia. Women delivering with no/labia/first-degree tears reported the best outcomes overall. Thus, it is important to minimise the extent of perineal trauma and to counsel about sexuality during and after pregnancy.
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Affiliation(s)
- Ditte Gommesen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ellen Nøhr
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gastroenterological Surgery, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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