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Cardaillac C, Planche L, Dorion A, Ploteau S, Thubert T, Lefizelier E, Winer N, Ducarme G. Ropivacaine perineal infiltration for postpartum pain management in episiotomy repair: a double-blind, randomised, placebo-controlled trial. BJOG 2024; 131:899-907. [PMID: 35876236 DOI: 10.1111/1471-0528.17266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether perineal infiltration of ropivacaine after episiotomy would decrease the incidence of postpartum pain compared with placebo. DESIGN Two-centre, double-blind, randomised, controlled trial. SETTING Two French maternity units, October 2017 to April 2020. POPULATION 272 women undergoing epidural analgesia with vaginal singleton delivery and mediolateral episiotomy at term (≥37 weeks) were randomly allocated perineal infiltration of ropivacaine (n = 135) or placebo (n = 137) in a 1:1 ratio before episiotomy repair. METHODS Patients were followed at short term (12, 24, 48 h), mid-term (day 7) and long-term (3 and 6 months). MAIN OUTCOME MEASURES The primary outcome was the rate of perineal pain, defined by a Numerical Pain Rating Scale (NPRS) exceeding 3/10, in the mid-term (day 7) postpartum period. Secondary outcomes were perineal pain (NPRS) and analgesic intake, quality of life (SF-36), postpartum depression (EPDS), pain neuropathic component (DN4) and sexual health (FSFI). RESULTS Perineal pain occurred to an equal extent in the ropivacaine and placebo groups at day 7 (34.2% versus 30.4%, odds ratio 1.1, 95% confidence interval 0.7-1.8, p = 0.63). Similar results were recorded in the short and long term. High rates of dyspareunia and postpartum depression were documented in both groups. No differences were highlighted between the groups in terms of analgesic intake, adverse events, pain neuropathic component and postpartum quality of life. CONCLUSIONS This study did not demonstrate any benefit of ropivacaine infiltration over placebo.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
- Federative Pelvic Pain Centre, Nantes University Hospital, Nantes, France
| | - Lucie Planche
- Clinical Research Centre, Centre Hospitalier Departemental (Departmental Hospital Centre), La Roche sur Yon, France
| | - Agnès Dorion
- Clinical Research Centre, Centre Hospitalier Departemental (Departmental Hospital Centre), La Roche sur Yon, France
| | - Stéphane Ploteau
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
- Federative Pelvic Pain Centre, Nantes University Hospital, Nantes, France
| | - Thibault Thubert
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Emelyne Lefizelier
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Norbert Winer
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, La Roche sur Yon, France
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Zhang D, Bo K, Montejo R, Sánchez-Polán M, Silva-José C, Palacio M, Barakat R. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials. Acta Obstet Gynecol Scand 2024; 103:1015-1027. [PMID: 38140841 DOI: 10.1111/aogs.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens' health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear. MATERIAL AND METHODS A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted. RESULTS Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%). CONCLUSIONS PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.
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Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Norway
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Montse Palacio
- BCNatal, Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain
- Hospital Universitario Clinic, Barcelona, Spain
| | - Rubén Barakat
- AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
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Rodrigues S, Silva P, Vieira R, Duarte A, Escuriet R. Midwives' practices on perineal protection and episiotomy decision-making: A qualitative and descriptive study. Eur J Midwifery 2024; 8:EJM-8-19. [PMID: 38736456 PMCID: PMC11082654 DOI: 10.18332/ejm/174126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 10/09/2023] [Accepted: 11/23/2023] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Perineal trauma is associated with both short- and long-term morbidity which in turn relates to the degree of trauma. The objective of this study was to understand midwives' practices regarding perineal protection during the second phase of labor, emphasizing decision-making to perform an episiotomy. METHODS A descriptive and explanatory study was conducted with an intentional sample of twenty-two midwives working in the labor ward of a tertiary hospital in a metropolitan location and in the public service, in Portugal. A semi-open interview was applied to collect the data from 5 to 15 January 2019. The computer software package, NVivo version 10, was used to perform the thematic analysis. RESULTS Four main themes arose from the midwives' data: 1) Factors affecting the application of perineal protection techniques', 2) Birth position, 3) Techniques for perineal protection, and 4) Episiotomy. The reasons for performing an episiotomy were the presence of tense perineum, large weight baby, previous obstetric anal sphincter injury, and Kristeller maneuver. CONCLUSIONS Midwives' practices regarding perineal protection techniques and reasons for performing an episiotomy were not all in line with the evidence. Perineal massage was not mentioned as a perineal protection technique.
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Affiliation(s)
- Silvia Rodrigues
- Biomedical Sciences Institute Abel Salazar, Porto, Portugal
- Hospital of Braga, Braga, Portugal
| | | | | | | | - Ramon Escuriet
- Health and Integrated Care division, Catalan Health Service, Barcelona, Spain
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Watanabe K, Totsu Y. Development of aids to relieve vulvodynia during the postpartum period. Glob Health Med 2024; 6:149-155. [PMID: 38690132 PMCID: PMC11043126 DOI: 10.35772/ghm.2023.01045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/08/2023] [Accepted: 12/24/2023] [Indexed: 05/02/2024]
Abstract
Postpartum women live with a low quality of life due to pain caused by episiotomy and perineal laceration. In particular, they endure pain when sitting for long periods of time to breastfeed. The purpose of this study is to develop a sitting aid to alleviate postpartum vulvodynia. This study was conducted in the following four phases from July 2017 to May 2019. They are: material selection and molding, cleaning and disinfection testing, pressure distribution measurement testing, and trial testing by postpartum women. The main material was a 100% polypropylene object with a three-dimensional reticular fiber spring structure and fiber density of 3.8 kg/m2. As a result, a sitting aid that withstands washing and disinfection well in the medical field and is breathable. It had moderate resilience and elasticity and reduced pressure on the seating surface for women weighing approximately 45 kg and 55 kg, but we were skeptical about its use for women weighing more than that. The completed sitting aid is noninvasively effective in improving the quality of life of many postpartum women, but the density and thickness of the main material should be reexamined to meet the needs of women in a wider weight range. In addition, a self-administered questionnaire survey of trial users revealed that some women did not experience relief from vulvodynia even after using the sitting aid. Such women also had physical problems such as discomfort in the lower back, difficulty breastfeeding, and difficulty standing up. For women with multiple physical problems, individual causes should be addressed.
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Affiliation(s)
- Kaori Watanabe
- Department of Midwifery, National College of Nursing, Japan, Tokyo, Japan
| | - Yumiko Totsu
- Department of Midwifery, National College of Nursing, Japan, Tokyo, Japan
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Simpson AN, Sutradhar R, Benchimol EI, Chan WC, Porter J, Moore S, Dossa F, Huang V, Maxwell C, Targownik L, Liu N, Baxter NN. Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study. J Obstet Gynaecol Can 2024; 46:102463. [PMID: 38631434 DOI: 10.1016/j.jogc.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES It is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. METHODS Retrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15-55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. RESULTS We matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20-1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03,;95% CI 1-1.07). CONCLUSIONS The higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Joan Porter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Sarah Moore
- Department of Surgery, MacKenzie Health, Vaughan, ON
| | - Fahima Dossa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian Huang
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Laura Targownik
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4:CD004667. [PMID: 38597126 PMCID: PMC11005019 DOI: 10.1002/14651858.cd004667.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. OBJECTIVES To compare the effects of midwife continuity of care models with other models of care for childbearing women and their infants. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (17 August 2022), as well as the reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished trials in which pregnant women are randomly allocated to midwife continuity of care models or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion criteria, scientific integrity, and risk of bias, and carried out data extraction and entry. Primary outcomes were spontaneous vaginal birth, caesarean section, regional anaesthesia, intact perineum, fetal loss after 24 weeks gestation, preterm birth, and neonatal death. We used GRADE to rate the certainty of evidence. MAIN RESULTS We included 17 studies involving 18,533 randomised women. We assessed all studies as being at low risk of scientific integrity/trustworthiness concerns. Studies were conducted in Australia, Canada, China, Ireland, and the United Kingdom. The majority of the included studies did not include women at high risk of complications. There are three ongoing studies targeting disadvantaged women. Primary outcomes Based on control group risks observed in the studies, midwife continuity of care models, as compared to other models of care, likely increase spontaneous vaginal birth from 66% to 70% (risk ratio (RR) 1.05, 95% confidence interval (CI) 1.03 to 1.07; 15 studies, 17,864 participants; moderate-certainty evidence), likelyreduce caesarean sections from 16% to 15% (RR 0.91, 95% CI 0.84 to 0.99; 16 studies, 18,037 participants; moderate-certainty evidence), and likely result in little to no difference in intact perineum (29% in other care models and 31% in midwife continuity of care models, average RR 1.05, 95% CI 0.98 to 1.12; 12 studies, 14,268 participants; moderate-certainty evidence). There may belittle or no difference in preterm birth (< 37 weeks) (6% under both care models, average RR 0.95, 95% CI 0.78 to 1.16; 10 studies, 13,850 participants; low-certainty evidence). We arevery uncertain about the effect of midwife continuity of care models on regional analgesia (average RR 0.85, 95% CI 0.79 to 0.92; 15 studies, 17,754 participants, very low-certainty evidence), fetal loss at or after 24 weeks gestation (average RR 1.24, 95% CI 0.73 to 2.13; 12 studies, 16,122 participants; very low-certainty evidence), and neonatal death (average RR 0.85, 95% CI 0.43 to 1.71; 10 studies, 14,718 participants; very low-certainty evidence). Secondary outcomes When compared to other models of care, midwife continuity of care models likely reduce instrumental vaginal birth (forceps/vacuum) from 14% to 13% (average RR 0.89, 95% CI 0.83 to 0.96; 14 studies, 17,769 participants; moderate-certainty evidence), and may reduceepisiotomy 23% to 19% (average RR 0.83, 95% CI 0.77 to 0.91; 15 studies, 17,839 participants; low-certainty evidence). When compared to other models of care, midwife continuity of care models likelyresult in little to no difference inpostpartum haemorrhage (average RR 0.92, 95% CI 0.82 to 1.03; 11 studies, 14,407 participants; moderate-certainty evidence) and admission to special care nursery/neonatal intensive care unit (average RR 0.89, 95% CI 0.77 to 1.03; 13 studies, 16,260 participants; moderate-certainty evidence). There may be little or no difference in induction of labour (average RR 0.92, 95% CI 0.85 to 1.00; 14 studies, 17,666 participants; low-certainty evidence), breastfeeding initiation (average RR 1.06, 95% CI 1.00 to 1.12; 8 studies, 8575 participants; low-certainty evidence), and birth weight less than 2500 g (average RR 0.92, 95% CI 0.79 to 1.08; 9 studies, 12,420 participants; low-certainty evidence). We are very uncertain about the effect of midwife continuity of care models compared to other models of care onthird or fourth-degree tear (average RR 1.10, 95% CI 0.81 to 1.49; 7 studies, 9437 participants; very low-certainty evidence), maternal readmission within 28 days (average RR 1.52, 95% CI 0.78 to 2.96; 1 study, 1195 participants; very low-certainty evidence), attendance at birth by a known midwife (average RR 9.13, 95% CI 5.87 to 14.21; 11 studies, 9273 participants; very low-certainty evidence), Apgar score less than or equal to seven at five minutes (average RR 0.95, 95% CI 0.72 to 1.24; 13 studies, 12,806 participants; very low-certainty evidence) andfetal loss before 24 weeks gestation (average RR 0.82, 95% CI 0.67 to 1.01; 12 studies, 15,913 participants; very low-certainty evidence). No maternal deaths were reported across three studies. Although the observed risk of adverse events was similar between midwifery continuity of care models and other models, our confidence in the findings was limited. Our confidence in the findings was lowered by possible risks of bias, inconsistency, and imprecision of some estimates. There were no available data for the outcomes: maternal health status, neonatal readmission within 28 days, infant health status, and birth weight of 4000 g or more. Maternal experiences and cost implications are described narratively. Women receiving care from midwife continuity of care models, as opposed to other care models, generally reported more positive experiences during pregnancy, labour, and postpartum. Cost savings were noted in the antenatal and intrapartum periods in midwife continuity of care models. AUTHORS' CONCLUSIONS Women receiving midwife continuity of care models were less likely to experience a caesarean section and instrumental birth, and may be less likely to experience episiotomy. They were more likely to experience spontaneous vaginal birth and report a positive experience. The certainty of some findings varies due to possible risks of bias, inconsistencies, and imprecision of some estimates. Future research should focus on the impact on women with social risk factors, and those at higher risk of complications, and implementation and scaling up of midwife continuity of care models, with emphasis on low- and middle-income countries.
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Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Declan Devane
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Leanne V Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Laderas Díaz E, Rodríguez‐Almagro J, Picón Rodríguez R, Martínez Galiano JM, Martínez Rodríguez S, Hernández‐Martínez A. Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain. Nurs Open 2024; 11:e2160. [PMID: 38660722 PMCID: PMC11043828 DOI: 10.1002/nop2.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
AIM Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN Observational cross-sectional study. METHODS Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Estíbaliz Laderas Díaz
- Department of Obstetrics & GynecologyLa Mancha Centro General HospitalAlcázar de San Juan, Ciudad RealSpain
| | - Julián Rodríguez‐Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Rafael Picón Rodríguez
- Department of General and Digestive SurgerySanta Bárbara HospitalPuertollano, Ciudad RealSpain
| | - Juan Miguel Martínez Galiano
- Department of NursingJaen UniversityJaenSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Sandra Martínez Rodríguez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Antonio Hernández‐Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
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Lorthe E, Severo M, Hamwi S, Rodrigues T, Teixeira C, Barros H. Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal. Int J Public Health 2024; 69:1606296. [PMID: 38577390 PMCID: PMC10991787 DOI: 10.3389/ijph.2024.1606296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.
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Affiliation(s)
- Elsa Lorthe
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sousan Hamwi
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Teresa Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Cristina Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Alsuraykh LA, Alnadawi AA, Alharbi A, Alhumaidi KA, Alhabardi N, Almarshud R. Women's Perceptions and Knowledge Toward Episiotomy in Qassim Region, Saudi Arabia. Cureus 2024; 16:e55383. [PMID: 38562338 PMCID: PMC10984130 DOI: 10.7759/cureus.55383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Episiotomy, despite being one of the most common interventions during childbirth, carries significant risks and uncertain benefits. Previous global studies highlight varying awareness levels and practices, with decreasing episiotomy rates attributed to increased knowledge. This study aims to assess women's knowledge to enhance intrapartum decision-making and communication between patients and obstetricians, ultimately improving maternal outcomes in the region. METHODOLOGY The study was a cross-section design. It was conducted through an online survey that was distributed by different social media platforms (Twitter, WhatsApp, and Telegram) from February 2023 to January 2024. It included women living in the Qassim region, Saudi Arabia, who were 15 years old or older. Data was analyzed using the SPSS program (IBM, Chicago, Illinois, USA). RESULTS Among the 402 participants, 62.7% demonstrated awareness of episiotomy, with 94.0% accurately identifying it as a surgical cutting with scissors. About 82.5% acknowledged that not all women require episiotomies, while 48.8% recognized the necessity of anesthesia before the procedure. Understanding the indications for episiotomy varied, with facilitating and accelerating childbirth (64.3%) and dealing with a large baby (62.3%) being the most recognized reasons. Impressively, 90.5% believed that there are methods to avoid perineal cutting, with knowing the correct mechanism for pushing during childbirth (69.4%) and exercise (54.4%) being the most acknowledged preventive measures. Regarding post-cutting care, antibiotics (61.5%) were identified as essential, followed by analgesia (52.8%) and laxatives (48.8%). CONCLUSION The study reveals a notable awareness among participants, with a majority demonstrating a solid understanding of the procedure, its indications, and post-procedure care. It identified specific knowledge gaps, such as the need for anesthesia awareness and divergent beliefs about post-episiotomy care practices.
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Affiliation(s)
- Lubna A Alsuraykh
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aseel A Alnadawi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aeshah Alharbi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Kadi A Alhumaidi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Nadiyah Alhabardi
- Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Raghad Almarshud
- General Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Okeahialam NA, Sultan AH, Thakar R. The prevention of perineal trauma during vaginal birth. Am J Obstet Gynecol 2024; 230:S991-S1004. [PMID: 37635056 DOI: 10.1016/j.ajog.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 08/29/2023]
Abstract
Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%. The incidence of obstetrical anal sphincter injury is approximately 3%, with a significantly higher rate in primiparous than in multiparous women (6% vs 2%). Obstetrical anal sphincter injury is a significant risk factor for the development of anal incontinence, with approximately 10% of women developing symptoms within a year following vaginal birth. Obstetrical anal sphincter injuries have significant medicolegal implications and contribute greatly to healthcare costs. For example, in 2013 and 2014, the economic burden of obstetrical anal sphincter injuries in the United Kingdom ranged between £3.7 million (with assisted vaginal birth) and £9.8 million (with spontaneous vaginal birth). In the United States, complications associated with trauma to the perineum incurred costs of approximately $83 million between 2007 and 2011. It is therefore crucial to focus on improvements in clinical care to reduce this risk and minimize the development of perineal trauma, particularly obstetrical anal sphincter injuries. Identification of risk factors allows modification of obstetrical practice with the aim of reducing the rate of perineal trauma and its attendant associated morbidity. Risk factors associated with second-degree perineal trauma include increased fetal birthweight, operative vaginal birth, prolonged second stage of labor, maternal birth position, and advanced maternal age. With obstetrical anal sphincter injury, risk factors include induction of labor, augmentation of labor, epidural, increased fetal birthweight, fetal malposition (occiput posterior), midline episiotomy, operative vaginal birth, Asian ethnicity, and primiparity. Obstetrical practice can be modified both antenatally and intrapartum. The evidence suggests that in the antenatal period, perineal massage can be commenced in the third trimester of pregnancy to increase muscle elasticity and allow stretching of the perineum during birth, thereby reducing the risk of tearing or need for episiotomy. With regard to the intrapartum period, there is a growing body of evidence from the United Kingdom, Norway, and Denmark suggesting that the implementation of quality improvement initiatives including the training of clinicians in manual perineal protection and mediolateral episiotomy can reduce the incidence of obstetrical anal sphincter injury. With episiotomy, the International Federation of Gynecology and Obstetrics recommends restrictive rather than routine use of episiotomy. This is particularly the case with unassisted vaginal births. However, there is a role for episiotomy, specifically mediolateral or lateral, with assisted vaginal births. This is specifically the case with nulliparous vacuum and forceps births, given that the use of mediolateral or lateral episiotomy has been shown to significantly reduce the incidence of obstetrical anal sphincter injury in these groups by 43% and 68%, respectively. However, the complications associated with episiotomy including perineal pain, dyspareunia, and sexual dysfunction should be acknowledged. Despite considerable research, interventions for reducing the risk of perineal trauma remain a subject of controversy. In this review article, we present the available data on the prevention of perineal trauma by describing the risk factors associated with perineal trauma and interventions that can be implemented to prevent perineal trauma, in particular obstetrical anal sphincter injury.
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Affiliation(s)
| | - Abdul H Sultan
- Croydon University Hospital, London, United Kingdom; St George's University of London
| | - Ranee Thakar
- Croydon University Hospital, London, United Kingdom; St George's University of London.
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11
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Chervenak FA, McLeod-Sordjan R, Pollet SL, De Four Jones M, Gordon MR, Combs A, Bornstein E, Lewis D, Katz A, Warman A, Grünebaum A. Obstetric violence is a misnomer. Am J Obstet Gynecol 2024; 230:S1138-S1145. [PMID: 37806611 DOI: 10.1016/j.ajog.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.
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Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY
| | - Susan L Pollet
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Monique De Four Jones
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Hospital, Manhasset, NY
| | | | - Adriann Combs
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Dawnette Lewis
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Ashley Warman
- Division of Medical Ethics, Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
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Eggebø TM, Rygh AB, von Brandis P, Skjeldestad FE. Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study. Acta Obstet Gynecol Scand 2024; 103:488-497. [PMID: 38053429 PMCID: PMC10867358 DOI: 10.1111/aogs.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION There are many risk factors for obstetric anal sphincter injury (OASIS) and the interaction between these risk factors is complex and understudied. The many observational studies that have shown a reduction of OASIS rates after implementation of perineal support have short follow-up time. We aimed to study the effect of integration of active perineal support and lateral episiotomy on OASIS rates over a 15-year period and to study interactions between risk factors known before delivery. MATERIAL AND METHODS We performed a historical cohort study over the periods 1999-2006 and 2007-2021 at Stavanger University Hospital, Norway. The main outcome was OASIS rates. Women without a previous cesarean section and a live singleton fetus in cephalic presentation at term were eligible. The department implemented in 2007 the Finnish concept of active perineal protection, which includes support of perineum, control of fetal expulsion, good communication with the mother and observation of perineal stretching. The practice of mediolateral episiotomy was replaced with lateral episiotomy when indicated. We analyzed the OASIS rates in groups with and without episiotomy stratified for delivery mode, fetal position at delivery and for parity, and adjusted for possible confounders (maternal age, gestational age, oxytocin augmentation and epidural analgesia). RESULTS We observed a long-lasting reduction in OASIS rates from 4.9% to 1.9% and an increase in episiotomy rates from 14.4% to 21.8%. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with instrumental vaginal deliveries and occiput anterior (OA) position; 3.4% vs 10.1% (OR 0.31; 95% CI: 0.24-0.40) and 6.1 vs 13.9% (OR 0.40; 95% CI: 0.19-0.82) in women with occiput posterior (OP) position. Lateral episiotomy was also associated with lower OASIS rates in nulliparous women with spontaneous deliveries and OA position; 2.1% vs 3.2% (OR 0.62; 95% CI: 0.49-0.80). The possible confounders had little confounding effects on the risk of OASIS in groups with and without episiotomy. CONCLUSIONS We observed a long-lasting reduction in OASIS rates after implementation of preventive procedures. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with an instrumental delivery. Special attention should be paid to deliveries with persistent OP position.
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Affiliation(s)
- Torbjørn M. Eggebø
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway
| | - Astrid Betten Rygh
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway
| | - Phillip von Brandis
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Institute of Community MedicineUiT the Arctic University of NorwayTromsøNorway
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D’Sa JL, Jahlan IO, Alsatari ES, Zamzam S, Martin CR. Psychometric properties of a Saudi Arabian version of the Birth Satisfaction Scale-Revised (BSS-R). Belitung Nurs J 2024; 10:105-113. [PMID: 38425689 PMCID: PMC10900059 DOI: 10.33546/bnj.3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background Maternal outcomes are closely associated with birth satisfaction, and the Birth Satisfaction Scale-Revised (BSS-R), a concise, multidimensional self-report measure, has undergone translation and validation internationally. However, research on birth satisfaction in Saudi Arabia is scarce. The absence of valid Arabic-language tools for the Saudi population may impede critical research on this topic, necessitating the translation and use of psychometrically sound instruments for measuring birth satisfaction in Saudi women. Objective This study aimed to translate and evaluate the psychometric properties of the Saudi Arabian version of the BSS-R (SA-BSS-R). Methods A total of 218 Saudi women participated in the study, and psychometric analysis of the translated SA-BSS-R involved confirmatory factor analysis, divergent validity analysis, and known-group discriminant validity assessment within a cross-sectional study design. Results The three-factor BSS-R measurement model displayed poor fit, and internal consistency fell below the threshold value. Additionally, it was observed that women undergoing an episiotomy had significantly lower overall SA-BSS-R scores. Conclusion The SA-BSS-R manifested atypical measurement properties in this population. Despite insightful observations related to episiotomy, the identified measurement shortcomings highlight the need for a more robust and culturally sensitive translation to enhance measurement characteristics.
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Affiliation(s)
- Juliana Linnette D’Sa
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Ibtesam Omar Jahlan
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Eman S. Alsatari
- School of Nursing, University of Louisville, Louisville, KY 40202, United States
| | - Sahar Zamzam
- Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
- Faculty of Nursing, Alexandria University, Egypt
| | - Colin R. Martin
- Institute for Health and Wellbeing, University of Suffolk, Ipswich, Neptune Quay, IP4 1QJ, United Kingdom
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Muraca GM, Desai A, Hébert V, Mann GK, Park M, Lisonkova S, Joseph KS. Variation in Episiotomy Use Among Nulliparous Individuals by Maternity Care Provider and Associated Rates of Obstetric Anal Sphincter Injury. J Obstet Gynaecol Can 2024; 46:102415. [PMID: 38387834 DOI: 10.1016/j.jogc.2024.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To quantify variation in the association between episiotomy and obstetric anal sphincter injury (OASI) by maternity care provider in spontaneous and operative vaginal deliveries (SVDs and OVDs). METHODS Population-based retrospective cohort study of vaginal, term deliveries among nullipara in Canada (2004-2015). Adjusted rate ratios (ARRs) and 95% CIs were estimated using log-binomial regression to quantify the associations between episiotomy and OASI, stratified by care provider (obstetrician [OB], family physician [FP], or registered midwife [RM]) while adjusting for potential confounders. RESULTS The study included 631 642 deliveries. Episiotomy use varied by provider: among SVDs, the episiotomy rate was 19.6%, 14.4%, and 8.4% in the OB, FP, and RM groups, respectively. The rate of OASI was higher among SVDs with versus without episiotomy (5.8% vs 4.6%). Conversely, OASI occurred less frequently in operative vaginal deliveries with episiotomy (15.3%) compared with those without (16.7%). In all provider groups, the ARR for OASI was increased with episiotomy in SVD and decreased with episiotomy with forceps delivery. No differences in these associations were observed by provider except among vacuum delivery (ARR with episiotomy vs. without, OB: 0.88, 95% CI 0.84-0.92; FP: 0.89, 95% CI 0.83-0.96, RM: 1.22, 95% CI 1.02-1.48). CONCLUSIONS In nullipara, irrespective of maternity care provider, there is a positive association between episiotomy and OASI among SVDs and an inverse association between episiotomy and deliveries with forceps. The relationship between episiotomy and OASI is modified by maternity care providers among vacuum deliveries.
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Affiliation(s)
- Giulia M Muraca
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden.
| | - Anvi Desai
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Vanessa Hébert
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Gurkiran K Mann
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Meejin Park
- Department of Global Health, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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André K, Stuart A, Källén K. Maternal origin matters: Country of birth as a risk factor for obstetric anal sphincter injuries. Int J Gynaecol Obstet 2024. [PMID: 38358267 DOI: 10.1002/ijgo.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Obstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potential long-term consequences. Maternal origin has been proposed to affect the overall risk, but the association and underlying explanation are uncertain. The objective was to assess the association between maternal country of birth and OASIS. METHODS A Swedish nationwide cohort study including singleton term vaginal births during 2005-2016. Data were extracted from the Swedish Medical Birth Registry and Statistics Sweden. Modified Poisson regression analyses were performed to obtain crude and adjusted risk ratios (RRs). Adjustments were made in four cumulative steps. Sub-analyses were performed to investigate the risk of OASIS associated with female genital circumcision (FGC). RESULTS In all, 988 804 births were included. The rate of OASIS in Swedish-born women was 3.5%. Women from East/Southeast Asia had an increased risk of OASIS (adjusted RR [aRR] 1.71, 95% confidence interval [CI] 1.60-1.83), as did women born in Sub-Saharan Africa (aRR 1.60, 95% CI 1.49-1.72). The risk remained significantly increased also after adjustment for maternal height. By contrast, women from South/Central America had a decreased risk of OASIS (aRR 0.65, 95% CI 0.56-0.76). FGC was associated with an increased risk of OASIS (aRR 3.05, 95% CI 2.60-3.58). Episiotomy appeared to have an overall protective effect (aRR 0.95, 95% CI 0.92-0.98), but not significantly more protective among women with female genital mutilation. CONCLUSIONS Country of birth plays an important role in the risk of OASIS. Women from East/Southeast Asia and Sub-Saharan Africa are at significantly increased risk as compared with Swedish-born women, whereas women from South/Central America are at lower risk. FGC is also a significant risk factor for OASIS.
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Affiliation(s)
- Kristin André
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Andrea Stuart
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Karin Källén
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Centre for Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Martín-Vázquez C, Goás-Gómez N, Calvo-Ayuso N, Rosón-Matilla L, Quiroga-Sánchez E, García-Fernández R. Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives. Healthcare (Basel) 2024; 12:441. [PMID: 38391816 PMCID: PMC10888027 DOI: 10.3390/healthcare12040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences.
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Affiliation(s)
- Cristian Martín-Vázquez
- Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Noelia Goás-Gómez
- Centro de Salud Vilalba, Servizo Galego de Saúde (SERGAS), 27800 Lugo, Spain
| | - Natalia Calvo-Ayuso
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | | | - Enedina Quiroga-Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal
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Karim KK, Gan F, Hong J, Hamdan M, Razali N, Tan PC. Cold compared with room temperature compress on the repaired primiparous perineum following injury at normal vaginal delivery: a randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101271. [PMID: 38147896 DOI: 10.1016/j.ajogmf.2023.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The perineum is typically injured at the first vaginal birth. The application of a cold compress to the perineal repair site can reduce pain; however, the effect usually dissipates after a couple of hours. Repeated applications may be needed for sustained analgesia. However, the medium-term effect of repeated applications of cold compress on the perineal repair site on the recovery of sexual function and perineal healing is not known. OBJECTIVE This study aimed to evaluate repeated applications of cold vs room temperature (placebo control) compress to the repaired primiparous perineum on pain upon movement. STUDY DESIGN A randomized controlled trial was conducted in a university hospital in Malaysia from May 2022 to February 2023. A total of 224 women with a repaired episiotomy or spontaneous second-degree tear sustained at normal delivery were randomized as follows: 113 to frozen gel pack and 111 to room temperature gel pack, as wound compress. The compress was applied to the perineal repair site at 3 timepoints: immediately after repair, and at 4 and 8 hours after delivery, for 20 minutes at each application. The primary outcomes were pain during movement at 12 and 24 hours after delivery, scored using the 0 to 10 numerical rating scale. The secondary outcomes include duration of hospital stay; analgesic consumption; recovery and functional metrics of reestablishing flatus, mobilization, and urination, breastfeeding; maternal satisfaction with the allocated compress; and after hospital discharge for up to 6 weeks after birth through telephone interview, analgesic consumption, perineal pain, resumption of vaginal sex, and women's perception of perineal wound healing. RESULTS The median (interquartile range) of pain at movement scores were 4 (4-5) vs 5 (4-5) (P=.018) at 12 hours and 2 (1-3) vs 2 (2-3) (P=.173) at 24 hours after birth for cold vs room temperature compress, respectively. Maternal satisfaction scores were 8 (7-9) vs 7 (6-8) (P=.119), oral analgesic for perineal pain while at the postnatal ward was taken by 94 of 113 (83.2%) vs 85 of 109 (78.0%) (relative risk, 1.07; 95% confidence interval, 0.94-1.21), and time to the first satisfactory breastfeeding episode was 11.6 (7.9-15.5) vs 13.0 (8.0-20.7) hours (P=.303) for cold vs room temperature compress, respectively. At 2 weeks telephone follow-up, analgesic intake and perineal pain were not different. At 6 weeks, analgesic intake, perineal pain, resumption of vaginal sex, exclusive breastfeeding, and maternal perception of perineal healing were not different. CONCLUSION Intermittent cold compress in the first 8 hours to the repaired perineum reduces pain at 12 hours but the effect attenuates by 24 hours. Maternal satisfaction with their allocated compress was not different. There was no suggestion of harm or benefit on the other secondary outcomes.
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Affiliation(s)
- Khaliza Kazrin Karim
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Farah Gan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Jesrine Hong
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Mukhri Hamdan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Nuguelis Razali
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, Malaysia.
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Ferraz Barbosa B, de Moraes FCA, Araujo Alves da Silva B, Bordignon Barbosa C, Pereira da Silva I, da Silva ER, Barros JCM, Rebouças LWC, dos Santos NPC, Fernandes MR. The Use of Honey for Cicatrization and Pain Control of Obstetric Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:185. [PMID: 38257078 PMCID: PMC10820177 DOI: 10.3390/nu16020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Several studies point to antibacterial properties and beneficial effects of honey on scar tissue formation, which is a low-cost and easy-to-use option. This study aimed to compare honey versus a placebo for cicatrization and pain control of obstetric wounds, and determine if one is superior to the other, in terms of efficacy, through a meta-analysis. METHODS We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent investigators identified randomized controlled trials (RCTs) comparing honey and a placebo for obstetric wounds. The primary outcomes were wound healing and pain control. RESULTS Five randomized controlled trials and 353 patients were included, of whom, 177 (50.1%) were treated with honey. Differences were not found in the final wound healing between the honey and placebo groups (MD -0.34; 95% CI -1.13, 0.44; p = 0.39); however, there was a decrease in pain levels in the middle of the treatment (SMD -0.54; 95% CI 0.83 to 0.25, p = 0.03), reduction in the use of pain medication (ORR 0.26; 95% CI 0.08, 0.86; p = 0.03), increase in personal satisfaction in women who underwent the intervention (ORR 0.81; 95% CI 0.65, 0.98), and reduction in complications. CONCLUSION According to the study results, honey treatments showed greater efficiency and provided benefits to the patients by accelerating wound healing and decreasing reported pain.
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Affiliation(s)
- Bárbara Ferraz Barbosa
- Department of Medicine, University of Aquino Bolivia, Santa Cruz de la Sierra 0701, SC, Bolivia; (B.F.B.); (C.B.B.)
| | - Francisco Cezar Aquino de Moraes
- Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil; (E.R.d.S.); (J.C.M.B.); (N.P.C.d.S.); (M.R.F.)
| | | | - Camila Bordignon Barbosa
- Department of Medicine, University of Aquino Bolivia, Santa Cruz de la Sierra 0701, SC, Bolivia; (B.F.B.); (C.B.B.)
| | | | - Emanuele Rocha da Silva
- Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil; (E.R.d.S.); (J.C.M.B.); (N.P.C.d.S.); (M.R.F.)
| | - Jamile Cristine Marques Barros
- Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil; (E.R.d.S.); (J.C.M.B.); (N.P.C.d.S.); (M.R.F.)
| | - Laissa Wane Cavalcante Rebouças
- Gynecology and Obstetrics Service of Clinical Hospital of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil;
| | - Ney Pereira Carneiro dos Santos
- Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil; (E.R.d.S.); (J.C.M.B.); (N.P.C.d.S.); (M.R.F.)
| | - Marianne Rodrigues Fernandes
- Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil; (E.R.d.S.); (J.C.M.B.); (N.P.C.d.S.); (M.R.F.)
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Ratiu D, Hayder AQ, Gilman E, Ludwig S, Ratiu J, Mallmann-Gottschalk N, Mallmann P, Gruttner B, Baek S. Shifting Trends in Obstetrics: An 18-year Analysis of Low-risk Births at a German University Hospital. In Vivo 2024; 38:390-398. [PMID: 38148051 PMCID: PMC10756433 DOI: 10.21873/invivo.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM At the beginning of the 21st century, obstetric medicine took a turn from interventional to restrictive in low-risk birth. The present study examined the changes in peripartum management over the past 20 years at the Women's University Hospital Cologne. The attitudes of the becoming mother and physicians towards anesthesia, episiotomy, and vaginal-operative deliveries were compared and the factors influencing the duration of birth over the past 20 years were examined. PATIENTS AND METHODS In this retrospective study, the low-risk singleton birth of 955 in 2000/2001 and 944 births in 2018 at the Women's University Hospital Cologne were analyzed. RESULTS The age of women who tended to give birth has significantly increased at present compared to 20 years ago. In 2018, labor was induced significantly more often than in 2000/2001. The rate of vaginal operative deliveries has fluctuated between 15% and 20% in the last 20 years. Forceps are no longer used. The use of episiotomy has taken a fundamental turn in the last 20 years. Prophylactic episiotomy is not performed anymore, most vaginal operative deliveries take place without the episiotomy. The birth duration has been significantly shortened at present compared to 20 years ago. CONCLUSION Pregnancy and childbirth over the last years are not considered as a disease, but as a natural course, and the trend of minimizing interventions in low-risk delivery has a positive effect on childbirth.
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Affiliation(s)
- Dominik Ratiu
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Al-Qaddo Hayder
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Elena Gilman
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Jessika Ratiu
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Nina Mallmann-Gottschalk
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Berthold Gruttner
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Sunhwa Baek
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
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Filippini M, Angioli R, Luvero D, Sammarini M, De Felice G, Latella S, de Góis Speck NM, Farinelli M, Martire FG, Gulino FA, Incognito GG, Capriglione S. The Utility of CO 2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery. J Pers Med 2023; 14:60. [PMID: 38248761 PMCID: PMC10817595 DOI: 10.3390/jpm14010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
This study aimed to examine the impact of fractional CO2 laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor (n = 11); and (2) women who had experienced spontaneous tears during vaginal delivery (n = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, p = 0.03; 6.5 vs. 3 after the second treatment, p = 0.01; 3 vs. 1 after the third treatment, p = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, p = 0.01; 8 vs. 4 after the second treatment, p = 0.02; 3 vs. 1 after the third treatment, p = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO2 laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, 00128 Rome, Italy; (R.A.); (D.L.)
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, 00128 Rome, Italy; (R.A.); (D.L.)
| | - Margaret Sammarini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Giovanna De Felice
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Silvia Latella
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Neila Maria de Góis Speck
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Paulista Medical School (UNIFESP/EPM), Federal University of São Paulo, São Paulo 04023-062, Brazil;
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Francesco Giuseppe Martire
- Gynecological Unit, Department of Surgical Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Ferdinando Antonio Gulino
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adults and Developmental Age, “G. Martino” University Hospital, 98122 Messina, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, “Santa Maria alla Gruccia” Hospital, 52025 Montevarchi, Italy;
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Ragusa A, Ficarola F, Svelato A, De Luca C, D'Avino S, Carabaneanu A, Ferrari A, Cundari GB, Angioli R, Manella P. Is an episiotomy always necessary during an operative vaginal delivery with vacuum? A longitudinal study. J Matern Fetal Neonatal Med 2023; 36:2244627. [PMID: 37553125 DOI: 10.1080/14767058.2023.2244627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
Objective: The use of episiotomy during operative vaginal birth (OVB) is rather debated among operators and in literature. It is also important to evaluate the indications for which episiotomy is performed. In fact, the consequences of an episiotomy can be invalidating for patients with long-lasting results. The aim of this study is the evaluation of the role of episiotomy during OVB with the vacuum extractor and its correlation with Obstetric Anal Sphincter Injuries (OASIs).Methods: On of 9165 vaginal births, a total of 498 OVB (5.4%) were enrolled in a longitudinal prospective observational study. The incidence of OASIs was evaluated in our population after OVB performed with the vacuum extractor, during which the execution of episiotomy was performed indicated by clinician in charge.Results: OASIs occurred in 4% of the patients (n = 20). Episiotomy was performed in 39% of them (n = 181). OASIs incidence was 6% (n = 17) in the No Episiotomy and 1.8% (n = 3) in Episiotomy group (p<.001). Performance of episiotomy during OVB determined a protective effect against OASIs (p = 0.025 in full cohort and p = 0.013 in the primiparous group). An expulsive phase under one hour was an almost significant protective factor (p = 0.052).Conclusions: The use of episiotomy during OVB was associated with much lower OASIs rates in nulliparous women with a vacuum extraction; OR 0.23 (CI 95% 0.07-0.81) p = 0.037 in nulliparous women and the number necessary to treat was 18 among nulliparous women to prevent 1 OASIs. A further risk factor that emerged from the analysis is a prolonged expulsive period, whereas fundal pressure does not seem to have a statistically significant influence.
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Affiliation(s)
- Antonio Ragusa
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation Rome, Rome, Italy
| | - Fernando Ficarola
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation Rome, Rome, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Caterina De Luca
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Alis Carabaneanu
- Department of Obstetrics and Gynecology, Prato General Hospital, Prato, Italy
| | - Amerigo Ferrari
- Sant'Anna School of Advanced Studies, Institute of Management, MeS (Management and Health) Laboratory, Pisa, Italy
| | - Gianna Barbara Cundari
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation Rome, Rome, Italy
| | - Paolo Manella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Alkharouf F, Joyce N, Ward D, Walsh F, Eogan M, Geary M. Trends in obstetric anal sphincter injury in spontaneous vaginal delivery versus operative vaginal delivery over a 10-year period: Lessons learned. Int J Gynaecol Obstet 2023; 163:888-893. [PMID: 37232141 DOI: 10.1002/ijgo.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate trends in the incidence of women with obstetric anal sphincter injuries (OASIS) over a 10-year period comparing spontaneous vaginal delivery (SVD) and operative vaginal delivery (OVD). METHODS A retrospective study was performed in which all women who underwent vaginal delivery over a 10-year period (n = 86 242, 2009-2018) at the Rotunda Hospital were reviewed. The overall incidence of OASIS was compared with incidence rates stratified by parity and type of vaginal birth. RESULTS The 10-year vaginal delivery rate was 69% (n = 59 187) where 24 580 women (42%) were primiparous and 34 607 women (58%) were multiparous. SVD rate was 74% and OVD rate was 26%. The overall incidence of OASIS was 2.9%. The incidence of OASIS in OVD was 5.5% and the incidence in SVD was 2%. Of 498 multipara who sustained OASIS, 366 (73%) had an SVD without episiotomy compared with 14 (3%) who had an episiotomy. There was a significant reduction of OASIS over the 10-year period in primipara who had an OVD but no reduction in the other groups. CONCLUSION The primiparous OVD group had a significant reduction of OASIS. Continued education around perineal protection and episiotomy at SVD could positively impact further reduction in OASIS, particularly in the SVD groups.
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Affiliation(s)
- Feras Alkharouf
- Rotunda Hospital, Dublin, Ireland
- Department of Obstetrics & Gynaecology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Aragaw FM, Belay DG, Endalew M, Asratie MH, Gashaw M, Tsega NT. Level of episiotomy practice and its disparity among primiparous and multiparous women in Ethiopia: a systematic review and meta-analysis. Front Glob Womens Health 2023; 4:1153640. [PMID: 38025985 PMCID: PMC10657876 DOI: 10.3389/fgwh.2023.1153640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Episiotomy at the time of vaginal birth is a common lifesaving surgical procedure. In Ethiopia, several studies have been conducted concerning the proportion of episiotomy. However, its prevalence varies across these series of studies. Thus, this systematic review and meta-analysis aimed to estimate the level of episiotomy practice and its disparity among primiparous and multiparous women in Ethiopia. Methods This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the PubMed/MEDLINE, EMBASE, Google Scholar, and Science Direct databases for studies conducted in Ethiopia focusing on episiotomy. We included all cross-sectional studies published until October 5,2022. Data were analyzed using R version 4.2.1 software. The pooled estimates with 95% confidence intervals (CIs) were presented using forest plots. A random-effects meta-analysis was conducted on extracted crude rates to calculate the national and regional pooled estimates for the country. The I-squared test and Egger's regression test were used to assess heterogeneity and publication bias, respectively. Results Our search yielded 390 articles. A total of 13 studies covering five administrative regions and 6,404 women who delivered vaginally were involved. The mean age of the study participants ranged from 22 to 27.7 years. The estimated overall pooled prevalence rate of episiotomy in Ethiopian women was 42.75% (95% CI: 34.97%-50.54%). In the subgroup analysis, the pooled prevalence rate of episiotomy was 61.45% (95% CI: 51.11%-71.80%) among primiparous women. Meanwhile, the pooled estimate appears to be approximately 30.47% (95% CI: 22.08%-38.85%) among multiparous women. Conclusion Our findings concluded that the pooled prevalence rate of episiotomy was higher than the evidence-based WHO recommendations for optimal patient care. Parallel to this, nulliparous women had a higher episiotomy rate than multiparous women. These findings highlight the importance of continued training for labor ward staff, particularly healthcare providers who often perform the majority of deliveries.
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Affiliation(s)
- Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Packet B, Page AS, Cattani L, Bosteels J, Deprest J, Richter J. Predictive factors for obstetric anal sphincter injury in primiparous women: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2023; 62:486-496. [PMID: 37329513 DOI: 10.1002/uog.26292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The primary objective was to perform a systematic review of predictive factors for obstetric anal sphincter injury (OASI) occurrence at first vaginal delivery, with the diagnosis made by ultrasound (US-OASI). The secondary objective was to report on incidence rates of sonographic anal sphincter (AS) trauma, including trauma that was not clinically reported at childbirth, among the studies providing data for our primary objective. METHODS We conducted a systematic search of MEDLINE, EMBASE, Web of Science, CINAHL, The Cochrane Library and ClinicalTrials.gov databases. Both observational cohort studies and interventional trials were eligible for inclusion. Study eligibility was assessed independently by two authors. Random-effects meta-analyses were performed to pool effect estimates from studies reporting on similar predictive factors. Summary odds ratio (OR) or mean difference (MD) is reported with 95% CI. Heterogeneity was assessed using the I2 statistic. Methodological quality was assessed using the Quality in Prognosis Studies tool. RESULTS A total of 2805 records were screened and 21 met the inclusion criteria (16 prospective cohort studies, three retrospective cohort studies and two interventional non-randomized trials). Increasing gestational age at delivery (MD, 0.34 (95% CI, 0.04-0.64) weeks), shorter antepartum perineal body length (MD, -0.60 (95% CI, -1.09 to -0.11) cm), labor augmentation (OR, 1.81 (95% CI, 1.21-2.71)), instrumental delivery (OR, 2.13 (95% CI, 1.13-4.01)), in particular forceps extraction (OR, 3.56 (95% CI, 1.31-9.67)), shoulder dystocia (OR, 12.07 (95% CI, 1.06-137.60)), episiotomy use (OR, 1.85 (95% CI, 1.11-3.06)) and shorter episiotomy length (MD, -0.40 (95% CI, -0.75 to -0.05) cm) were associated with US-OASI. When pooling incidence rates, 26% (95% CI, 20-32%) of women who had a first vaginal delivery had US-OASI (20 studies; I2 = 88%). In studies reporting on both clinical and US-OASI rates, 20% (95% CI, 14-28%) of women had AS trauma on ultrasound that was not reported clinically at childbirth (16 studies; I2 = 90%). No differences were found in maternal age, body mass index, weight, subpubic arch angle, induction of labor, epidural analgesia, episiotomy angle, duration of first/second/active-second stages of labor, vacuum extraction, neonatal birth weight or head circumference between cases with and those without US-OASI. Antenatal perineal massage and use of an intrapartum pelvic floor muscle dilator did not affect the odds of US-OASI. Most (81%) studies were judged to be at high risk of bias in at least one domain and only four (19%) studies had an overall low risk of bias. CONCLUSION Given the ultrasound evidence of structural damage to the AS in 26% of women following a first vaginal delivery, clinicians should have a low threshold of suspicion for the condition. This systematic review identified several predictive factors for this. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Packet
- Department of Development and Regeneration, Unit of Woman and Child, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - A-S Page
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - L Cattani
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - J Bosteels
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
| | - J Deprest
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
- Research Department of Maternal-Fetal Medicine, Institute for Women's Health, University College London, London, UK
| | - J Richter
- Department of Development and Regeneration, Unit of Woman and Child, Catholic University of Leuven (KU Leuven), Leuven, Belgium
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Vu DH, Ta BTT, Aasen IL, Le DQT, Mathisen R, Becker GE, Phan HT, Bui CM, Nguyen TTK, Hoang STT, Cashin J. Promoting Respectful Maternity Care by Reducing Unnecessary Episiotomies: Experiences from Centers of Excellence for Breastfeeding in Vietnam. Healthcare (Basel) 2023; 11:2520. [PMID: 37761718 PMCID: PMC10530948 DOI: 10.3390/healthcare11182520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Routine episiotomy is not recommended by international guidelines; however, it occurs at a high rate in Vietnam. (2) Methods: A process to reduce unnecessary episiotomies was developed and implemented as part of the Centers of Excellence for Breastfeeding initiative, which aims to deliver high-quality breastfeeding and early essential newborn care services within a supportive policy environment. The aim of this project report is to outline the steps undertaken to reduce episiotomies, the experience in pilot hospitals, and the process towards changing policy. (3) Results: During the 14 months following the change in episiotomy policy, pilot hospital records showed no infant death or injury. Monthly monitoring data from four pilot hospitals showed that the prevalence of episiotomy was substantially lower than the average in national hospitals in Vietnam. Facilitators to reducing the episiotomy rate include the incentive of Centers of Excellence for Breastfeeding designation and supportive hospital leadership. Challenges include the ambiguity of Vietnam's national guideline on episiotomy and lack of routine monitoring on the episiotomy rate and indications. (4) Discussion: Our experience suggests that through training and routine monitoring hospitals can apply a policy of selective episiotomy and reduce the practice, particularly among multiparous women, and improve breastfeeding rates.(5) Conclusions: Sharing our experience of implementing this process and offering four areas for action will hopefully contribute to expanded use of mother-friendly, evidence-based care as policy and routine practice in Vietnam and similar settings.
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Affiliation(s)
- Duong Hoang Vu
- Alive & Thrive East Asia Pacific, FHI Solutions, Hanoi 11022, Vietnam (R.M.)
| | - Binh T. T. Ta
- Alive & Thrive East Asia Pacific, FHI Solutions, Hanoi 11022, Vietnam (R.M.)
| | - Ina Landau Aasen
- Norwegian Institute of Public Health (NIPH), N-0473 Oslo, Norway
| | - Dai Q. T. Le
- Alive & Thrive East Asia Pacific, FHI Solutions, Hanoi 11022, Vietnam (R.M.)
| | - Roger Mathisen
- Alive & Thrive East Asia Pacific, FHI Solutions, Hanoi 11022, Vietnam (R.M.)
| | | | - Hang Thi Phan
- Hung Vuong Hospital, Ho Chi Minh City 72700, Vietnam
| | - Cuong Minh Bui
- Quang Ninh Obstetrics and Pediatrics Hospital, Ha Long City 01100, Vietnam
| | | | | | - Jennifer Cashin
- Alive & Thrive East Asia Pacific, FHI Solutions, Washington, DC 20037, USA
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McComb K, Barghash M, Eltayef S. Perianal Endometriosis: An Uncommon Site for a Common Problem. Cureus 2023; 15:e44840. [PMID: 37809144 PMCID: PMC10559834 DOI: 10.7759/cureus.44840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Endometriosis is the presence of uterine glands and stroma outside of the uterus. It is highly prevalent in women of reproductive age. It is usually found in the pelvis, with most cases being found on the peritoneum, ovaries, or deep in the pelvis. Extraperitoneal endometriosis is uncommon. Perianal endometriosis has an incidence of only 0.2%. We present the case of a 37-year-old woman with recurrent pain and swelling in the perineum at the site of a previous episiotomy scar. Initial imaging and assessment determined this to be scar tissue. Following re-presentation, it was mistakenly diagnosed as a perianal abscess, and the patient underwent incision and drainage. The wound failed to heal with significant induration. Further assessment of the wound was undertaken under general anesthesia. An excision of the affected area was performed, with histological analysis confirming endometriosis. This case highlights that extra-peritoneal endometriosis is a rare but treatable cause of recurrent, cyclical pelvic pain and swelling in the perineum. A high index of clinical suspicion is required due to its ability to mimic other pathologies, including abscesses and cysts. The primary management of perianal endometriosis is surgical excision. Where complete excision is not possible, medical management with hormone therapy should be considered.
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Affiliation(s)
- Katie McComb
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | | | - Saleh Eltayef
- General and Colorectal Surgery, North Manchester General Hospital, Manchester, GBR
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Marcos-Rodríguez A, Leirós-Rodríguez R, Hernandez-Lucas P. Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 162:802-810. [PMID: 36808391 DOI: 10.1002/ijgo.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Numerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage. OBJECTIVE To determine the efficacy of perineal massage during the second stage of labor to prevent perineal damage. SEARCH STRATEGY Systematic search in PubMed, Pedro, Scopus, Web of Science, ScienceDirect, BioMed, SpringerLink, EBSCOhost, CINAHL, and MEDLINE with the terms Massage, Second labor stage, Obstetric delivery, and Parturition. SELECTION CRITERIA The articles must have been published in the last 10 years; the perineal massage was administered to the study sample; and the experimental design consisted of randomized controlled trial. DATA COLLECTION AND ANALYSIS Tables were used to describe both the studies' characteristics and the extracted data. The PEDro and Jadad scales were used to assess the quality of studies. MAIN RESULTS Of the 1172 total results identified, nine were selected. Seven studies were included in the meta-analysis and indicated a statistically significant decreased number of episiotomies in perineal massage. CONCLUSIONS Massage during the second stage of labor appears to be effective in preventing episiotomies and reducing the duration of the second stage of labor. However, it does not appear to be effective in reducing the incidence and severity of perineal tears.
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Affiliation(s)
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Ponferrada, Spain
| | - Pablo Hernandez-Lucas
- Functional Biology and Health Sciences Department, University of Vigo, Pontevedra, Spain
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Nk R, Devgarha G, Subha Shree Rao YA, N R, Moharana AK, Ts D. A Randomized, Single-Blind Study Comparing the Clinical Equivalence of Truglyde Fast® and Safil Quick® Polyglycolic Acid Fast-Absorbing Sutures for Episiotomy Repair Following Vaginal Delivery. Cureus 2023; 15:e42348. [PMID: 37621806 PMCID: PMC10445051 DOI: 10.7759/cureus.42348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Episiotomy, the deliberate surgical incision on the vaginal orifice during vaginal delivery, requires prompt repairing of the incised tissue. It may be associated with bleeding, infection, dehiscence, dyspareunia, short-term pain, and prolonged hospital stay. The outcome of surgery depends on the suture material and technique to repair the episiotomy. OBJECTIVE We aim to subjectively assess perineal pain and maternal morbidity following episiotomy repair with Truglyde Fast® (Healthium Medtech Limited, Bengaluru, India) and Safil Quick® (B. Braun Medical Private Limited, Mumbai, India) polyglycolic acid fast-absorbing suture. MATERIALS AND METHODS This multicentric, prospective, randomized (1:1), two-arm, parallel-group, single-blind study was started in August 2020 and completed in March 2021. Ninety-nine primiparous or multiparous eligible women requiring episiotomy were recruited to Truglyde Fast® (n=51) and Safil Quick® (n=48) groups. The primary outcome measure was post-episiotomy perineal pain to be assessed using a visual analog scale (VAS). Secondary endpoints included evaluation of local anesthesia (quantity), intraoperative suture handling, number of sutures utilized, time spent for episiotomy repair and complete healing, analgesic number and dosage, early and late wound complications, presence of residual suture and frequency of re-suturing, resumption of sexual activity and dyspareunia, and adverse events. The threshold to discriminate significant from non-significant outcomes was p<0.05. RESULTS At all visits, a non-significant change in perineal pain was noted between Truglyde Fast® and Safil Quick® groups. A significant difference (p<0.05) in the number of sutures used and intraoperative handling characteristics was observed between thegroups. Results of other secondary endpoints showed non-significant differences. CONCLUSION Truglyde Fast® and Safil Quick® polyglycolic acid fast-absorbing sutures are clinically equivalent. Both sutures are safe and effective for episiotomy repair following vaginal delivery with minimal perineal pain and risk of maternal morbidity.
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Affiliation(s)
- Roopa Nk
- Department of Obstetrics and Gynecology, BGS Global Institute of Medical Sciences and Hospital, Bengaluru, IND
| | | | - Y Aruna Subha Shree Rao
- Department of Obstetrics and Gynecology, King George Hospital/Andhra Medical College, Visakhapatnam, IND
| | - Rekha N
- Department of Obstetrics and Gynecology, BGS Global Institute of Medical Sciences and Hospital, Bengaluru, IND
| | - Ashok K Moharana
- Department of Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Department of Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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Orhan M, Bülez A. The Effect of Virtual Reality Glasses Applied During the Episiotomy On Pain and Satisfaction: A Single Blind Randomized Controlled Study. J Pain Res 2023; 16:2227-2239. [PMID: 37404226 PMCID: PMC10317539 DOI: 10.2147/jpr.s412883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023] Open
Abstract
Objective The research was conducted as a randomized controlled study to determine the effect of virtual reality glasses on the mother's pain and satisfaction during episiotomy. Methods The sample consisted of 50 pregnant women determined by randomization among primiparous pregnant women. Data were collected with the Mother Information Form and Visual Analog Scales Pain and Satisfaction Evaluation forms. 5 mL of lidocaine was administered to mothers in the intervention and control groups during episiotomy repair. Only the mothers in the intervention group watched a video with virtual reality glasses for an average of 10 minutes during the episiotomy procedure. SPSS 22.0 was used in the analysis. Results In the comparison between the groups, it was found that the mean pain score measured during episiotomy inner and episiotomy skin suturing was statistically significantly lower in the intervention group than in the control group; there was no significant difference between the intervention and control groups in the mean pain scores measured before and after episiotomy repair. It was determined that the mean satisfaction score of the intervention group was higher than that of the control group. Conclusion Virtual reality glasses reduced pain during episiotomy and increased satisfaction. According to the results, it is recommended to be used by midwives because it is an easily applicable non-pharmacological method and increases the mother's birth satisfaction.
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Affiliation(s)
- Merva Orhan
- Kahramanmaras Necip Fazil City Hospital, Obstetric Clinic, Kahramanmaraş, Turkey
| | - Aysel Bülez
- Kahramanmaras Sütcü Imam University, Faculty of Health Sciences, Midwifery Department, Kahramanmaraş, Turkey
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Giroux M, Emslie E, Karreman E, Jabs C. Implementation of Episcissors-60 for Prevention of Obstetric Anal Sphincter Injuries (OASIS) in a Centre with Low Episiotomy Rates. J Obstet Gynaecol Can 2023; 45:410-416. [PMID: 37085090 DOI: 10.1016/j.jogc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether introduction of Episcissors-60 into a labour and birth unit would decrease the incidence of Obstetric Anal Sphincter Injuries (OASIS). METHODS A before-and-after quality improvement study was conducted between April 1, 2020 and March 31, 2021. All patients who had a vaginal delivery were included in this study. All healthcare providers who perform vaginal deliveries were offered an educational session. Episcissors-60 were then introduced into a labour and birth unit. The primary outcome measure was the change in incidence of OASIS before and after introduction of Episcissors-60. Secondary outcome measures were episiotomy rates before and after introduction of Episcissors-60, device-related adverse events, and provider satisfaction and feedback. Data was analyzed using chi-square tests, independent t-tests, and Mann-Whitney tests. RESULTS A total of 1383 vaginal deliveries occurred prior and 1254 vaginal deliveries after introduction of Episcissors-60. There was a decrease in the total OASIS rate from 7.37% of all vaginal deliveries prior to 5.37% after introduction of Episcissors-60 (P = .037). The episiotomy rate was 11.42% prior to and 9.97% after introduction of Episcissors-60 (P = .228). OASIS rate in women who had an episiotomy was 12.02% before and 13.60% after introduction of Episcissors-60 (P = .421). CONCLUSION Although introduction of Episcissors-60 was associated with a statistically significant decrease in total OASIS rate, there was no difference in OASIS rates within the subgroup that received an episiotomy. Therefore, reduction in the total OASIS rate in this study cannot be attributed to the use of Episcissors-60.
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Affiliation(s)
| | - Ethan Emslie
- College of Medicine, University of Saskatchewan, Regina, SK
| | - Erwin Karreman
- Research Department, Saskatchewan Health Authority, Regina, SK
| | - Corrine Jabs
- Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, SK
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Cormier J, Merrer J, Blondel B, Le Ray C. Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study. Acta Obstet Gynecol Scand 2023; 102:438-449. [PMID: 36852493 PMCID: PMC10008350 DOI: 10.1111/aogs.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. MATERIAL AND METHODS We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. RESULTS A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). CONCLUSIONS Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.
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Affiliation(s)
- Julie Cormier
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
| | - Jade Merrer
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Clinical Epidemiology Unit, Robert Debré HospitalAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
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Housmans S, Gillor M, Shek KL, Dietz HP. Assessment of Perineal Scars on Translabial Pelvic Floor Ultrasound: A Pilot Study. J Ultrasound Med 2023; 42:881-888. [PMID: 36661310 DOI: 10.1002/jum.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/17/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We aimed to describe a method for identifying and evaluating perineal scars using translabial pelvic floor ultrasound. We hypothesized that translabial ultrasound can identify a perineal scar and can differentiate episiotomies from spontaneous tears. METHODS This pilot study is a secondary analysis of data obtained in the Epi-No® trial. Perineal integrity was assessed using volumes acquired on pelvic floor muscle contraction according to the method previously described for anal sphincter imaging. A scar was diagnosed if a hypoechoic distortion in the perineum was noted. We postulated that an episiotomy would result in a linear scar visible on four dimensional translabial ultrasound whereas nonlinear scars were considered the result of spontaneous perineal tear of grade 2 or higher. The results of this assessment were compared with data retrieved from electronic medical records. RESULTS A scar was identified in 79/120 women (66%): 42 (35%) linear and 37 (31%) nonlinear. Sonographic and clinical diagnosis agreed on the presence or absence of perineal trauma in 66%. Agreement for the type of laceration was 50%. CONCLUSION In this retrospective pilot study, a blinded assessment of translabial ultrasound volume data showed agreement between clinical data and sonographic assessment of perineal integrity in 66% and of type of laceration in 50%. More work is needed to optimize the method in assessment of perineal scars to improve its performance before it can be used in clinical audit and research.
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Affiliation(s)
- Susanne Housmans
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Moshe Gillor
- Nepean Clinical School, University of Sydney, Sydney, Australia
- Department of Obstetrics and Gynecology, Kaplan Medical Centre, Rehovot, Affiliated to the Hebrew University and Hadassah School of Medicine in Jerusalem, Jerusalem, Israel
| | - Ka Lai Shek
- Nepean Clinical School, University of Sydney, Sydney, Australia
- Department of Obstetrics and Gynecology, Liverpool Clinical School, Western Sydney University, Sydney, Australia
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Levaillant M, Loury C, Venara A, Hamel-Broza JF, Legendre G. Is there still an indication for episiotomy? Results from a French national database analysis. Int J Gynaecol Obstet 2023; 160:880-885. [PMID: 35942710 DOI: 10.1002/ijgo.14385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the link between mediolateral episiotomy and the occurrence of obstetrical anal sphincter injury (OASIS). METHODS Data were collected from the national database (PMSI; Programme de Médicalisation des Systèmes d'Information). Women between 18 and 50 years old, undergoing a vaginal delivery in France in 2018 were included. The main outcome was factors associated with a higher adjusted OASIS rate after a vaginal delivery. RESULTS Of 623 003 women with a vaginal delivery, 239 949 were primiparous (38.5%), 62 310 experienced mediolateral episiotomy (10.0%) and 7077 had a third- or fourth-degree perineal tear (1.14%). Risk factors for OASIS were primiparity (adjusted odds ratio [OR] 2.97), shoulder dystocia (aOR 2.57), instrumental delivery (aOR 2.81), gestational diabetes (aOR 1.20), and post-term delivery (aOR 1.53). Mediolateral episiotomy increased the occurrence of OASIS for women without an instrumental delivery, either for parous (OR 1.32, 95% confidence interval [CI] 1.07-1.62) or primiparous (OR 1.26, 95% CI 1.13-1.39) women. In contrast, episiotomy among primiparous women with episiotomy and a vacuum or forceps delivery significantly decreased the risk for OASIS (OR 0.62, 95% CI 0.56-0.67). CONCLUSIONS The practice of routine episiotomy should be discouraged. Selective mediolateral episiotomy should be considered with extreme caution and mainly for primiparous women during instrumental vaginal delivery. Further randomized trial may confirm such results.
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Affiliation(s)
- Mathieu Levaillant
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France.,Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
| | - Charlotte Loury
- Faculté de Santé, Département de Médecine, Angers, France.,Service de gynécologie-Obstétrique, CHU d'Angers, Angers, France
| | - Aurélien Venara
- Faculté de Santé, Département de Médecine, Angers, France.,Service de chirurgie digestive, CHU d'Angers, Angers, France.,UMR_S1085, University of Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Jean-François Hamel-Broza
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France.,Faculté de Santé, Département de Médecine, Angers, France.,Service de chirurgie digestive, CHU d'Angers, Angers, France.,UMR_S1085, University of Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Guillaume Legendre
- Faculté de Santé, Département de Médecine, Angers, France.,Service de gynécologie-Obstétrique, CHU d'Angers, Angers, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ram-Weiner M, Hayman-Mendelson A, Allouche-Kam H, Lev-Sagie A. Postpartum dyspareunia: clinical evaluation, causes, and treatment outcomes. J Sex Med 2023; 20:324-331. [PMID: 36763952 DOI: 10.1093/jsxmed/qdac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dyspareunia affects approximately half of postpartum women and is attributed to multiple factors. Despite its high prevalence and resultant negative effects, data are lacking regarding the causes and different pain components, the usefulness of recommended treatments, and the prognosis. AIM To evaluate causes of postpartum dyspareunia, targeted treatment modalities, and their effectiveness. METHODS A retrospective observational study was conducted of women diagnosed with postpartum dyspareunia between September 2008 and January 2017 at a single designated vulvovaginal disorder clinic. The inclusion criterion was complaint of painful intercourse commencing postdelivery. The cohort was divided into 4 groups based on the causes of dyspareunia: muscle hypertonicity, scar tenderness, vestibular tenderness, and atrophy. OUTCOMES The following were assessed for each group: patient background demographics, clinical and obstetric data, physical findings, recommended therapy, adherence to the suggested treatment, level of improvement at follow-up visits, and length of time until maximal improvement. RESULTS A hundred women met the inclusion criterion; the majority (n = 60) presented with >1 causative factor. The most common finding was vestibular tenderness (n = 78, 78%), which was significantly associated with atrophy (adjusted odds ratio [aOR], 15.08; 95% CI, 2.45-93.35), contraceptive usage (aOR, 4.76; 95% CI, 1.07-21.39), and primiparity (aOR, 4.89; 95% CI, 1.01-23.88). Episiotomy was the only risk factor for scar tenderness (aOR, 5.43; 95% CI, 1.20-24.53), while the existence of a spontaneous perineal tear was not. No specific correlation was found with pelvic floor muscle hypertonicity. Targeted treatment resulted in significant improvement in most patients. CLINICAL IMPLICATIONS A targeted diagnostic and treatment approach for postpartum dyspareunia is effective and can be beneficial for caregivers treating postpartum women. STRENGTHS AND LIMITATIONS A uniform and consistent protocol for patient selection and management is a major strength, which magnifies the clinical implication of our findings. The retrospective nature of the study is the primary limitation. CONCLUSION Postpartum dyspareunia is a common problem; however, many women refrain from discussing it with their providers. Therefore, it is important to assess this condition with all women during the postpartum visit as targeted diagnosis and treatment can significantly improve outcomes.
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Affiliation(s)
| | | | - Hadas Allouche-Kam
- Department of Obstetrics and Gynecology, Hadassah University Medical Center-Mt Scopus, Jerusalem 9190501, Israel
| | - Ahinoam Lev-Sagie
- Clalit Health Organization, Jerusalem 9780214, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, 9190401, Israel
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Perrin A, Korb D, Morgan R, Sibony O. Effectiveness of episiotomy to prevent OASIS in nulliparous women at term. Int J Gynaecol Obstet 2023. [PMID: 36728572 DOI: 10.1002/ijgo.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the association between episiotomy and severe obstetric anal sphincter injury (OASIS) in nulliparous women at term according to the use of an instrument for delivery with control confounding by indication. METHODS This was an observational retrospective cohort study including 12 346 women from 2004 to 2020. All nulliparous women with a cephalic singleton pregnancy were included. The primary outcome was the occurrence of OASIS. Association between episiotomy and OASIS was assessed by multivariate logistic regression with adjustment for confounding factors and stratification on the use of an instrument at delivery. Propensity score matching was used to account for indication bias. RESULTS Among 12 346 women included, 7803 (63.2%) had an episiotomy and 4543 (36.8%) did not have an episiotomy; the rate of OASIS was similar in both groups (0.7%). After stratification on use of instrument, an association between episiotomy and OASIS was shown in the case of instrumental delivery (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26-0.80) but not if the delivery was spontaneous (OR 0.76, 95% CI 0.29-1.98). The result was similar after matching on propensity score (in the case of operative vaginal delivery: OR 0.20, 95% CI 0.10-0.75). CONCLUSION Episiotomy seems to be a protective factor for OASIS in nulliparous woman at term only in the case of operative vaginal delivery.
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Affiliation(s)
- Antoine Perrin
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France.,Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, University Paris Cité, Paris, France
| | - Rosemary Morgan
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Olivier Sibony
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
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Alimi R, Marvi N, Azmoude E, Heidarian Miri H, Zamani M. Sexual function after childbirth: a meta-analysis based on mode of delivery. Women Health 2023; 63:83-96. [PMID: 36576252 DOI: 10.1080/03630242.2022.2158412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although many women report sexual dysfunction in the postpartum period, controversial research has been reported the relationship between delivery mode and sexual function. This meta-analysis aimed to investigate the sexual function after childbirth and identify the difference of sexual function based on the female sexual function index (FSFI) questionnaire in women with elective cesarean section, vaginal delivery with episiotomy and vaginal delivery without episiotomy. Studies were found by searching in Medline, PubMed, Web of Science, Scopus and considering the references of the related papers from their start dates until September 2021. All observational studies in English that reported the mean and SD of score of sexual function and its domains based on the mode of delivery were included in this meta-analysis. Random effect model was used to combine the results of included studies on female sexual function and its subdomains. Finally, 17 articles with a total population of 3410 were included in the meta-analysis. Total mean (95 percent CI) of sexual function was 24.27 (22.82, 25.72) with substantial heterogeneity among studies (χ2 = 7487.63, P < .001; I2 = 99.45). In subgroup analyses, the mean score of sexual function was significantly differed in terms of time elapsed since delivery (P = .04) and studied country (P < .001). But, the mode of delivery has no significant effect on postpartum sexual function and subdomains. The result indicated that elective cesarean section, vaginal delivery with episiotomy, vaginal delivery without episiotomy are not associated with the female sexual function.
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Affiliation(s)
- Rasoul Alimi
- Department of Epidemiology and Biostatistics, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Nahid Marvi
- Reproductive Health, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Azmoude
- Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hamid Heidarian Miri
- Social Determinants of Health Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zamani
- Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Brismar Wendel S, Liu C, Stephansson O. The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study. Acta Obstet Gynecol Scand 2023; 102:378-388. [PMID: 36691864 PMCID: PMC9951312 DOI: 10.1111/aogs.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Severe perineal injuries at childbirth affect women's postnatal health, including future childbirths. First births with vacuum extraction carry an increased risk of obstetric anal sphincter injuries (OASIS). Lateral or mediolateral episiotomy at vacuum extraction may decrease the risk of OASIS. Our aim was to assess whether lateral or mediolateral episiotomy, or OASIS, at vacuum extraction in nulliparous women is associated with prelabor cesarean delivery in the subsequent childbirth. MATERIAL AND METHODS This is a nationwide observational study using data from the Swedish Medical Birth Register, including women having a first birth with vacuum extraction and a second birth in 2000-2014. Both births were live, single, cephalic, ≥34 gestational weeks without malformations. The association between episiotomy or OASIS in the first birth and prelabor cesarean delivery in the second birth was examined using univariate and multivariate logistic regression with inverse probability of treatment weighting, and interaction analysis. Main outcome measure was prelabor cesarean delivery in the second birth. RESULTS In total, 44 656 women with vacuum extraction at their first birth were included. The rate of prelabor cesarean delivery in the second birth was 5.9% (824 of 13 950) in women with episiotomy, compared with 6.0% (1830 of 30 706) in women without episiotomy. Thus, women with episiotomy did not have an increased risk of prelabor cesarean delivery (adjusted odds ratio [aOR] 1.00, 95% confidence interval [95% CI] 0.83-1.20) compared with women without episiotomy. For comparison, the rate of prelabor cesarean delivery in the second birth was 20.6% (1275 of 6176) in women with OASIS, compared with 3.6% (1379 of 38 480) in women without OASIS (aOR 6.57, 95% CI 5.97-7.23). There was no interaction between episiotomy and OASIS. CONCLUSIONS Lateral or mediolateral episiotomy at vacuum extraction in nulliparous women did not increase the risk of prelabor cesarean delivery in the subsequent childbirth. OASIS increased the odds of prelabor cesarean delivery more than sixfold.
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Affiliation(s)
- Sophia Brismar Wendel
- Department of Clinical SciencesKarolinska Institutet, Danderyd HospitalStockholmSweden,Department of Women's HealthDanderyd HospitalStockholmSweden,Clinical Epidemiology Division, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Can Liu
- Clinical Epidemiology Division, Department of MedicineKarolinska InstitutetStockholmSweden,Department of Public Health SciencesStockholm UniversityStockholmSweden,Centre for Health Equity Studies (CHESS)Stockholm University/Karolinska InstitutetStockholmSweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of MedicineKarolinska InstitutetStockholmSweden,Department of Women's Health, Division of ObstetricsKarolinska University HospitalStockholmSweden
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Beenfeldt D, Johnson P, Watts C, Shannon S, Swanson D, Althausen P. Episiotomy-assisted Incarcerated Femoral Nail Removal: Technical Note. J Orthop Case Rep 2023; 13:70-73. [PMID: 37143564 PMCID: PMC10152952 DOI: 10.13107/jocr.2023.v13.i01.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/08/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction Incarceration of intramedullary nails can pose a significant challenge. There are many reported techniques of nail removal, but when these fail, it can be difficult to determine how to proceed. Here, it is shown that a proximal femoral episiotomy can be used with great effect. Case Report 64-year-old male developed hip arthritis. The patient had a solid antegrade femoral nail placed 22 years ago that required removal for a hip arthroplasty. A proximal femoral episiotomy-assisted approach was used with good results and patient outcome. Conclusion There are several well described techniques to assist with incarcerated nail removal that all trauma surgeons should be familiar with. Proximal femoral episiotomy is a useful technique, every surgeon should have in their arsenal.
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Affiliation(s)
- Davison Beenfeldt
- Reno Orthopedic Clinic, Reno, Nevada
- Address of Correspondence: Davison Beenfeldt, 1664 N Virginia Street, Reno, NV, 89557. E-mail:
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Hroncová M. Pelvic pain in women after childbirth and physiotherapy. Ceska Gynekol 2023; 88:214-220. [PMID: 37344188 DOI: 10.48095/cccg2023214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE There are many types of pelvic pain. Pelvic plexus pain, coccyx pain, pain from episiotomy scars, and vulvodynia are frequently seen in postpartum women. The aim of this study was to conduct a systematic review of studies on pelvic pain in postpartum women to assess the effect of physiotherapy interventions on each type of pain. METHODS A comprehensive literature review was conducted by searching on PubMed, Ovid Embase and Scopus Web of Science using the key words - pelvic pain, women after childbirth, pelvic girdle pain, coccygodynia, episiotomy, vulvodynia, and physiotherapy. The author reviewed all the identified articles and selected articles for inclusion according to relevance to the topic. CONCLUSION Based on the analysis of the above studies, it can be concluded that a comprehensive physiotherapy designed for postpartum women that includes manual techniques, behavioral techniques, relaxation of hypo-tonic and shortened muscles and strengthening of hypotonic muscles can positively affect a wide range of pain and associated dysfunctions of the pelvic floor and trunk muscles.
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Faal Siahkal S, Abedi P, Iravani M, Esfandiarinezhad P, Dastoorpoor M, Bakhtiari S, Najafian M, Sharifipour F, Mohaghegh Z. Continuous non-locking vs. interrupted suturing techniques for the repair of episiotomy or second-degree perineal tears: A single-blind randomized controlled trial. Front Surg 2023; 10:1114477. [PMID: 37091272 PMCID: PMC10113503 DOI: 10.3389/fsurg.2023.1114477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Perineal trauma is a serious and frequent problem after childbirth which is experienced by millions of women worldwide. The technique used for perineal repair may have an impact on pain and wound healing. The aim of the present study was to compare the continuous non-locking technique with interrupted suturing for the repair of episiotomy or second-degree perineal tears. Methods A single-blind randomized-controlled trial was conducted from October 2021 to August 2022 in Sina Hospital, Ahvaz, Iran. Three hundred women were selected and randomly assigned into control and intervention groups using block randomization technique. The main outcomes included pain and wound healing that were assessed using visual analog scale (VAS), as well as redness, edema, ecchymosis/bruising, discharge, and approximation scale (REEDA). The secondary outcomes were the use of analgesics, duration of perineal repair, material used for suturing, pain during urination and defecation, and resumption of sexual intercourse. The participants were followed up on the first and seventh days and in the 6th week postpartum. Mann-Whitney, Chi-square, and Generalized Estimating Equations (GEE) model were used for data analysis. Results Wound healing was significantly better in the continuous non-locking suture technique compared to the interrupted technique (β = -1.98; P > 0.0001). Women also experienced less pain in the continuous non-locking suture technique (β = -2.46; P > 0.0001). There was a reduction in the use of analgesics, the duration of perineal repair, and the material used for suturing in the continuous non-locking suturing technique as opposed to the interrupted method (P < 0.0001).The odds of pain during urination and defecation significantly reduced in women who underwent the continuous non-locking method (P < 0.001). Also, women in the continuous non-locking group resumed their sexual intercourse earlier (P < 0.0001). Conclusion The findings of this study revealed that use of continuous non-locking technique for suturing was associated with reduced perineal pain and improved wound healing. Furthermore, it was associated with a shorter duration of perineal repair, less suture material used, and less need for analgesics compared with the interrupted method. There is, however, need for more studies to confirm the results of the present study.Iranian registry for randomized controlled trials (Ref. ID: IRCT20190415043283N1).
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Affiliation(s)
- Shahla Faal Siahkal
- Department of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Midwifery, Marand Branch, Islamic Azad University, Marand, Iran
| | - Parvin Abedi
- Department of Midwifery, Menopause Andropause Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Esfandiarinezhad
- Department of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahla Bakhtiari
- Midwifery Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Foruzan Sharifipour
- Department of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zaynab Mohaghegh
- Department of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Correspondence: Zaynab Mohaghegh
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Miani C, Wandschneider L, Batram-Zantvoort S, Covi B, Elden H, Nedberg IH, Drglin Z, Pumpure E, Costa R, Rozée V, Otelea MR, Drandić D, Radetic J, Abderhalden-Zellweger A, Ćerimagić A, Arendt M, Mariani I, Linden K, Ponikvar BM, Jakovicka D, Dias H, Ruzicic J, de Labrusse C, Valente EP, Zaigham M, Bohinec A, Rezeberga D, Barata C, Pfund A, Sacks E, Lazzerini M, Drandić Roda D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region. Int J Gynaecol Obstet 2022; 159 Suppl 1:9-21. [PMID: 36530006 DOI: 10.1002/ijgo.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. METHODS Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. RESULTS Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. CONCLUSION We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.
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Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Helen Elden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Zalka Drglin
- National Institute of Public Health, Ljubljana, Slovenia
| | - Elizabete Pumpure
- Riga Maternity Hospital, Riga, Latvia.,Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia
| | - Raquel Costa
- Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,Lusófona University/HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,SAMAS Association, Bucharest, Romania
| | | | | | - Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Karolina Linden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | - Heloisa Dias
- Administração Regional de Saúde do Algarve, Algarve, Portugal
| | | | - Claire de Labrusse
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden
| | - Anja Bohinec
- National Institute of Public Health, Ljubljana, Slovenia
| | - Dace Rezeberga
- Riga Maternity Hospital, Riga, Latvia.,Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal
| | - Anouk Pfund
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Min L, Xudong D, Qiubo L, Pingping L, Yuhan L, Guifang Z, Tianzi G, Qing F, Chunxue Y, Yaxin L. Two year follow-up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study. Acta Obstet Gynecol Scand 2022; 102:200-208. [PMID: 36448197 PMCID: PMC9889321 DOI: 10.1111/aogs.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Few prospective studies have revealed the long-term neuromuscular alterations of pelvic floor after vaginal delivery. The aim of this study was to evaluate the impact of episiotomy on the electrical activity of pelvic floor muscle 2 years following vaginal delivery, and explore the relation between surface electromyography (sEMG) amplitudes and urinary incontinence. MATERIAL AND METHODS A total of 427 primiparous women with full-term singleton vaginal delivery were included in the cohort and 362 with no further births within the 2 year follow-up completed observations. Of these, 200 underwent episiotomy and 162 underwent nonepisiotomy. Clinical demographic characteristics, vaginal EMG variables and urinary incontinence-specific questionnaire scores were collected at 6 weeks, 6, 12 and 24 months after childbirth, respectively. Primary outcomes were the comparison of sEMG values between the episiotomy and nonepisiotomy groups throughout 2 years. Secondary outcomes were the correlation between sEMG of both groups and the incidence and severity of urinary incontinence. Spearman's correlation analysis, Kruskal-Wallis test and ANOVA with Bonferroni correction were used to analyze the variables. RESULTS Amplitude of maximal fast and endurance contractions on sEMG in the episiotomy group was significantly lower than the nonepisiotomy counterpart. Such difference of sEMG persisted for a long period after birth: endurance contraction, 33.12 ± 8.92 vs 35.085 ± 9.98, p < 0.01 at 24 months, and fast contraction, 36.53 ± 8.87 vs 39.05 ± 9.98, p = 0.01 at 12-month. Although there was no significant difference in incidence and severity of urinary incontinence between both groups, a negative correlation existed between EMG values of muscle contraction and urinary incontinence symptoms throughout. CONCLUSIONS Primiparous women delivered with episiotomy demonstrated lower contractile sEMG activity of pelvic floor muscle in the long term. The lower sEMG values of fast contraction were associated with urinary incontinence symptoms.
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Affiliation(s)
- Li Min
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina,The First People's Hospital of Yunnan ProvinceAffiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Dong Xudong
- Department of Obstetrics, The First People's Hospital of Yunnan ProvinceAffiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Lyu Qiubo
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Li Pingping
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Lyu Yuhan
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Zhang Guifang
- Department of Epidemiology, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Gai Tianzi
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Feng Qing
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Yang Chunxue
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Liang Yaxin
- The Key Laboratory of Geriatrics, Beijing Institute of GeriatricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
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Radnia N, Khansari S, Jiriaei N, Hosseini SA, Salemi L, Hamoon M. The relationship between perineal size and episiotomy during delivery. J Med Life 2022; 15:1379-1383. [PMID: 36567847 PMCID: PMC9762365 DOI: 10.25122/jml-2021-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/08/2022] [Indexed: 12/27/2022] Open
Abstract
Women have anatomically different perineal sizes. Different perineal sizes in primiparous women may be related to episiotomy and its consequences. The aim of this study was to investigate the relationship between perineal size and episiotomy during delivery. 376 primiparous women referred to Fatemieh Hospital in Hamadan with single pregnancies, in the first stage of labor, and with a gestational age of 37 weeks and more, out of which 372 participated in this study. Before entering the first stage of labor, they underwent perineal measurements, such as perineal body (PB), genital hiatus (GH), and anogenital area (AGD), in a forced position. Then, they were followed up for episiotomy and vaginal wall rupture until the end of the second stage of labor. Our outcome in this study was an episiotomy during delivery. The mean gestational age was 39.10±1.21 weeks, and the neonatal weight was 3107.37±42.39 g. 86.3% of women had an episiotomy, and 5.4% experienced perineal tear (laceration). Mean perineal size was 3.99±0.77, genital hiatus was 3.040±0.74, GH+PB was 7.39±1.05, and AGD was 8.49±1.22 cm. There was a statistically significant relationship between perineal body size episiotomy (P=0.011), GH+PB (P=0.003), AGD (P=0.017), neonatal birth weight (P=0.021), as well as grade 1 and 2 rupture (P<0.001). The size of GH+PB at the cut-off point of 6.25 cm and AGD at the cut-off point of 9.25 cm significantly increased the chance of performing an episiotomy. In primiparous women with a gestational age of 37 to 42 weeks, vaginal delivery, shorter perineum, vaginal hiatus, and anogenital distance significantly increased the likelihood of an episiotomy. On the other hand, performing an episiotomy significantly reduced grade 1 and 2 perineal tear rates.
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Affiliation(s)
- Nahid Radnia
- Department of Obstetrics and Gynecology, School of Medicine, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahedeh Khansari
- Department of Obstetrics and Gynecology, School of Medicine, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran,Corresponding Author: Shahedeh Khansari, Department of Gynecology, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
| | - Nasrin Jiriaei
- Department of Social Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Arezoo Hosseini
- Department of Obstetrics and Gynecology, School of Medicine, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Laleh Salemi
- Department of Obstetrics and Gynecology, School of Medicine, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Minoo Hamoon
- Department of Obstetrics and Gynecology, School of Medicine, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Bekele H, Tamiru D, Debella A, Getachew A, Yohannes E, Lami M, Negash A, Asfaw H, Ketema I, Eyeberu A, Habte S, Eshetu B, Getachew T, Mesfin S, Birhanu B, Heluf H, Kibret H, Negash B, Alemu A, Dessie Y, Balis B. Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Front Glob Womens Health 2022; 3:911449. [PMID: 36312869 PMCID: PMC9608782 DOI: 10.3389/fgwh.2022.911449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Episiotomy is an intentional surgical incision made on the perineum with the aim of enlarging the introits during the second stage of labor or just before delivery of the baby. It sometimes also interferes with the mother's comfort during the postpartum period and has associated complications especially when it is done without indication. However, there is limited information regarding episiotomy practice in the study area. OBJECTIVE This study aimed to determine the magnitude of episiotomy practice and associated factors among women who gave birth at the Hiwot Fana Specialized University Hospital, Eastern Ethiopia, 2021. METHODS A facility-based cross-sectional study was conducted among 408 systematically selected mothers who gave birth at the Hiwot Fana Specialized University Hospital, from 1 January to 30 December 2021. Datas were collected from delivery medical records using a pretested checklist. The extracted data were checked, coded, and entered into the Epi-data version 3.1 and exported to the STATA version 16 software for analysis. Binary logistic regression was fitted to identify factors associated with episiotomy practice. P-values < 0.05 were considered to declare the presence of statistical significance. RESULTS The overall prevalence of episiotomy practice was found to be 43.4 % (95% CI: 38.7, 48.9), and mediolateral was the most commonly practiced episiotomy type (41.4%). Parity [AOR: 6.2; 95% CI (3.8-17.6)], 1st min Apgar score [AOR: 1.6; 95% CI (1.04-2.67)], presence of maternal medical disease [AOR: 3.3; 95% CI (1.09-6.9)], and induced labor [AOR: 1.6; 95%CI (1.12, 4.13)] were significantly associated with the episiotomy practice. CONCLUSION The prevalence of episiotomy practice in the study area was high. Parity, presence of maternal medical disease, induction of labor, and 1st min APGAR score were significant factors associated with episiotomy practice. Considering the presence of appropriate indications or preventing unjustifiable indications, can help to reduce the current high practice rates.
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Affiliation(s)
- Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,*Correspondence: Habtamu Bekele
| | - Dawit Tamiru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Dawit Tamiru
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemeshet Getachew
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ephrem Yohannes
- School of Nursing and Midwifery, College of Health and Medical Sciences, Ambo University, Ambo, Ethiopia
| | - Magarsa Lami
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henock Asfaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Indeshaw Ketema
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sisay Habte
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bajrond Eshetu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sinetibeb Mesfin
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bekelu Birhanu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Helina Heluf
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haregeweyn Kibret
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Kanniyan K, Manivannun K. Wedge Episiotomy for Long Cemented Femoral Stem Removal and Reconstruction. A Case Report on One-Stage Revision for Failed Bipolar for Proximal Femur Giant Cell Tumor. J Orthop Case Rep 2022; 12:61-65. [PMID: 36874881 PMCID: PMC9983381 DOI: 10.13107/jocr.2022.v12.i10.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/27/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Osteotomy around proximal femur provides excellent exposure and helps in revision of both cemented and uncemented femoral stem. Hereby, describing our case report on wedge episiotomy, a new surgical technique for removal of distal fitting cemented or uncemented femoral stem in conditions were extended trochanteric osteotomy (ETO) becomes inappropriate and episiotomy becomes inadequate. Case Report A 35-year-old lady presented with painful right hip and difficulty in walking. Her X-rays showed a dissociated bipolar head and long cemented femoral stem prosthesis. She gave history of proximal femur giant cell tumor operated with cemented bipolar which failed in 4 months (Figs. 1, 2, 3). There were no signs of active infection such as discharging sinus and elevated blood infection markers. Hence, she was planned for one-stage revision of the femoral stem and conversion into total hip arthroplasty. Surgical Technique A small trochanter fragment, along with the abductor and vastus lateralis continuity, was preserved and mobilized away augmenting hip exposure. The long femoral stem was found well fixed with a cement mantle all around in an unacceptable retroversion. There was metallosis with no macroscopic signs of infection. Taking in consideration of her young age and the long femoral prosthesis with cement mantle, the idea of ETO was considered inappropriate and more iatrogenic.Initially, an episiotomy was done along the lateral border of femur with an oscillating saw to interrupt the radio compressive force of the bone along the cement mantle and stem. However, the lateral episiotomy was not sufficient to loosen up the tight fit between bone and cement interface. Hence, a small wedge episiotomy was done along the full length lateral border of the femur (Figs. 5 and 6). A lateral wedge of 5 mm bone was removed increasing the exposure of bone cement interface with intact 3/4th cortical rim. This exposure allowed 2 mm K-wire, drill bit, flexible osteotome, and micro saw to go in between the bone and cement mantle to dissociate it. A 240 x 14 mm long uncemented femoral stem was fixed using bone cement extending along the entire femur length, With utmost care, all the cement mantle and implant were removed. The wound was soaked with three minutes of hydrogen peroxide and betadine solution and washed with high jet pulse lavage. A long 305 × 18 mm Wagner-SL revision uncemented stem was placed with adequate axial and rotational stability (Fig. 7). The long straight stem of 4 mm wider than the extracted was passed along the anterior femoral bowing augmenting the axial fit and the wagner fins helped in getting the much need rotational stability (Fig. 8). The acetabular socket was prepared with uncemented cup size of 46 mm with a posterior lip liner poly and 32 mm metal head was used. The wedge of bone was kept back along the lateral border and help with 5-ethibond sutures. Intraoperative histopathology sampling did not show any evidence of giant cell tumor recurrence, ALVAL score of 5 and microbiology culture grew negative. The physiotherapy protocol included non-weight-bearing walking for 3 months, later then partial loading was started and complete loading was done by end of fourth month. The patient had no complication such as tumor recurrence, periprosthetic joint infection (PJI) and implant failure at end of 2 years(Fig. 9).
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Affiliation(s)
- Kalaivanan Kanniyan
- Department of Arthroplasty and Oncology, Asian Institute of Orthopaedics, SIMS Hospitals, Chennai, Tamil Nadu, India
| | - K Manivannun
- Director, Department of Orthopaedics, Manisundaram Medical Mission, Vellore, Tamil Nadu, India
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Le Ray C, Rozenberg P, Kayem G, Harvey T, Sibiude J, Doret M, Parant O, Fuchs F, Vardon D, Azria E, Sénat MV, Ceccaldi PF, Seco A, Garabedian C, Chantry AA. Alternative to intensive management of the active phase of the second stage of labor: a multicenter randomized trial (Phase Active du Second STade trial) among nulliparous women with an epidural. Am J Obstet Gynecol 2022; 227:639.e1-639.e15. [PMID: 35868416 DOI: 10.1016/j.ajog.2022.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND There is no consensus on an optimal strategy for managing the active phase of the second stage of labor. Intensive pushing could not only reduce pushing duration, but also increase abnormal fetal heart rate because of cord compression and reduced placental perfusion and oxygenation resulting from the combination of uterine contractions and maternal expulsive forces. Therefore, it may increase the risk of neonatal acidosis and the need for operative vaginal delivery. OBJECTIVE This study aimed to assess the effect of the management encouraging "moderate" pushing vs "intensive" pushing on neonatal morbidity. STUDY DESIGN This study was a multicenter randomized controlled trial, including nulliparas in the second stage of labor with an epidural and a singleton cephalic fetus at term and with a normal fetal heart rate. Of note, 2 groups were defined: (1) the moderate pushing group, in which women had no time limit on pushing, pushed only twice during each contraction, and observed regular periods without pushing, and (2) the intensive pushing group, in which women pushed 3 times during each contraction and the midwife called an obstetrician after 30 minutes of pushing to discuss operative delivery (standard care). The primary outcome was a composite neonatal morbidity criterion, including umbilical arterial pH of <7.15, base excess of >10 mmol/L, lactate levels of >6 mmol/L, 5-minute Apgar score of <7, and severe neonatal trauma. The secondary outcomes were mode of delivery, episiotomy, obstetrical anal sphincter injuries, postpartum hemorrhage, and maternal satisfaction. RESULTS The study included 1710 nulliparous women. The neonatal morbidity rate was 18.9% in the moderate pushing group and 20.6% in the intensive pushing group (P=.38). Pushing duration was longer in the moderate group than in the intensive group (38.8±26.4 vs 28.6±17.0 minutes; P<.001), and its rate of operative delivery was 21.1% in the moderate group compared with 24.8% in the intensive group (P=.08). The episiotomy rate was significantly lower in the moderate pushing group than in the intensive pushing group (13.5% vs 17.8%; P=.02). We found no significant difference for obstetrical anal sphincter injuries, postpartum hemorrhage, or maternal satisfaction. CONCLUSION Moderate pushing has no effect on neonatal morbidity, but it may nonetheless have benefits, as it was associated with a lower episiotomy rate.
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Affiliation(s)
- Camille Le Ray
- Assistance Publique-Hôpitaux de Paris, Maternity Port Royal, Fighting Prematurity University Hospital Federation, Paris, France; Obstetrical Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, National Institute of Health and Medical Research, French National Institute for Agricultural Research, University of Paris, Paris, France.
| | - Patrick Rozenberg
- Service d'Obstétrique et Gynécologie, Centre Hospitalier Intercommunal Poissy-Saint Germain, Poissy, France; Université Paris Saclay, University of Versailles Saint-Quentin-en-Yvelines, French National Institute of Health and Medical Research, Epidémiologie Clinique, Centre for Research in Epidemiology and Population Health, Montigny-le-Bretonneux, France
| | - Gilles Kayem
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, National Institute of Health and Medical Research, French National Institute for Agricultural Research, University of Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Service d'Obstétrique et Gynécologie, Hôpital Trousseau, Fighting Prematurity University Hospital Federation, Paris, France
| | - Thierry Harvey
- Hospital Group Diaconesses Croix Saint-Simon (Groupe Hospitalier Diaconesses Croix Saint-Simon), Paris, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Infection, Antimicrobials, Modelling, Evolution, National Institute of Health and Medical Research, Université de Paris, Paris, France
| | - Muriel Doret
- Department of Obstetrics and Gynecology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Olivier Parant
- Hospital Center University De Toulouse, Pole de Gynécologie Obstétrique, Hospital Paule De Viguier, Toulouse, France
| | - Florent Fuchs
- Montpellier Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France; Reproduction and Child Development, National Institute of Health and Medical Research, Centre for Research in Epidemiology and Population Health, Villejuif, France; Desbret Institute of Epidemiology and Public Health, University of Montpellier, Montpellier, France
| | - Delphine Vardon
- Department of Obstetrics and Gynecology, Pôle Femme-Enfant, Caen University Hospital, Caen, France
| | - Elie Azria
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, National Institute of Health and Medical Research, French National Institute for Agricultural Research, University of Paris, Paris, France; Maternity Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Marie-Victoire Sénat
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Pierre-François Ceccaldi
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire Beaujon Clichy-la-garenne, Université de Paris, France
| | - Aurélien Seco
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, National Institute of Health and Medical Research, French National Institute for Agricultural Research, University of Paris, Paris, France; Clinical Research Unit Necker/Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles Garabedian
- Department of Obstetrics, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Anne Alice Chantry
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, National Institute of Health and Medical Research, French National Institute for Agricultural Research, University of Paris, Paris, France
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Subramaniam N, Shek KL, Dietz HP. Imaging Characteristics of Episiotomy Scars on Translabial Ultrasound: An Observational Study. J Ultrasound Med 2022; 41:2287-2293. [PMID: 34888905 DOI: 10.1002/jum.15915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Episiotomy has been purported to protect the anal sphincter from injury; efficacy is, however, disputed. Correct execution of episiotomy may have substantial implications. We aimed to describe the characteristics of episiotomy scars on translabial ultrasound (TLUS). METHODS In this retrospective observational study involving women after repair of obstetric anal sphincter injuries, 76 women with a history of episiotomy were analyzed. Episiotomy scars were assessed on tomographic ultrasound in the transverse plane using volumes acquired on pelvic floor muscle contraction. We measured scar length, depth, and angle relative to a vertical reference line. Episiotomy scars were described as 1) ipsilateral if they started on the same side as the direction of the episiotomy, 2) contralateral if on the opposite side, and 3) mediolateral if the scar began in the midline. RESULTS The mean scar angle was 50.5° (SD 14°; range 14.4°-79.3°) while mean scar length was 14.2 mm (SD 4.5; range 5.7-27.5 mm) and depth was 8.4 mm (SD 2.8, range 3.1-18.2 mm). Sixteen (21%) scars were located mediolateral while 32 (42%) were ipsilateral. In 28 (37%) women, the starting point of the episiotomy was located contralateral to the direction of the episiotomy. CONCLUSION In this pilot series, the mean angle of episiotomy scars was within the safe zone of 40° to 60°, however, in one-third of cases the cut may have been initially directed toward the sphincter, not away from it. This observation suggests that not all episiotomies are performed optimally.
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Affiliation(s)
- Nishamini Subramaniam
- Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia
- Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Ka Lai Shek
- Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia
- Western Sydney University, Liverpool, NSW, Australia
| | - Hans Peter Dietz
- Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia
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Schmidt PC, Fenner DE. Repair of episiotomy and obstetrical perineal lacerations (first-fourth). Am J Obstet Gynecol 2022:S0002-9378(22)00541-5. [PMID: 37427859 DOI: 10.1016/j.ajog.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 07/11/2023]
Abstract
Perineal injury after vaginal delivery is common, affecting up to 90% of women. Perineal trauma is associated with both short- and long-term morbidity, including persistent pain, dyspareunia, pelvic floor disorders, and depression, and may negatively affect a new mother's ability to care for her newborn. The morbidity experienced after perineal injury is dependent on the type of laceration incurred, the technique and materials used for repair, and the skill and knowledge of the birth attendant. After all vaginal deliveries, a systematic evaluation including visual inspection and vaginal, perineal, and rectal exams is recommended to accurately diagnose perineal lacerations. Optimal management of perineal trauma after vaginal birth includes accurate diagnosis, appropriate technique and materials used for repair, providers experienced in perineal laceration repair, and close follow-up. In this article, we review the prevalence, classification, diagnosis, and evidence supporting different closure methods for first- through fourth-degree perineal lacerations and episiotomies. Recommended surgical techniques and materials for different perineal laceration repairs are provided. Finally, best practices for perioperative and postoperative care after advanced perineal trauma are reviewed.
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Affiliation(s)
- Payton C Schmidt
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Bączek G, Rychlewicz S, Sys D, Rzońca P, Teliga-Czajkowska J. Episiotomy for Medical Indications during Vaginal Birth-Retrospective Analysis of Risk Factors Determining the Performance of This Procedure. J Clin Med 2022; 11:4334. [PMID: 35893429 DOI: 10.3390/jcm11154334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
The WHO (World Health Organization) recommends that the percentage of perineal incisions should not exceed 10%, indicating that this is a good goal to achieve, despite the fact that it is still a frequently used medical intervention in Poland. The risk factors for perineal incision that have been analyzed so far in the literature allow, among others, to limit the frequency of performing this procedure. Are they still valid? Have there been new risk factors that we should take into account? We have conducted this study to find the risk factors for performing perineal incision that would reduce the frequency of this procedure. The aim of the study was to check whether the risk factors that were analyzed in the literature are still valid, to find new risk factors for perineal incisions and to compare them among Polish women. This was a single-center retrospective case-control study. The electronic patient records of Saint Sophia's Hospital in Warsaw, Poland, a tertiary hospital was used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included the analysis of two groups, the study group of patients who had had an episiotomy, and the control group-patients without an episiotomy in cases where an episiotomy was indicated. A logistic regression model was developed to assess the risk factors for perineal laceration. Independent risk factors for episiotomy in labor include oxytocin use in the second stage of labor (OR (Odds Ratio) = 6.00; 95% CI (Confidence Interval): 4.76-7.58), the supply of oxytocin in the first and the second stage of labor (OR = 3.18; 95% CI: 2.90-3.49), oxytocin use in the first stage of labor (OR = 2.72; 95% CI: 2.52-3.51), state after cesarean section (OR = 2.97; 95% CI: 2.52-3.51), epidural anesthesia use (OR = 1.77; 95% CI: 1.62-1.93), male gender (OR = 1.10; 95% CI: 1.02-1.19), and prolonged second stage of labor (OR = 1.01; 95% CI: 1.01-1.01). A protective factor against the use of an episiotomy was delivery in the Birth Centre (OR = 0.43; 95% CI: 0.37-0.51) and mulitpara (OR = 0.31; 95% CI: 0.27-0.35). To reduce the frequency of an episiotomy, it is necessary consider the risk factors of performing this procedure in everyday practice, e.g., limiting the use of oxytocin or promoting alternative places of delivery.
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