Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby,...Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.展开更多
Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are...Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman’s preference during delivery.展开更多
Introduction: The ideal method for perineal repair should be quick, easy to perform and preferably, with minimal pain. Aim: To compare skin adhesive tape and interrupted?absorbable subcuticular suture for episiotomy r...Introduction: The ideal method for perineal repair should be quick, easy to perform and preferably, with minimal pain. Aim: To compare skin adhesive tape and interrupted?absorbable subcuticular suture for episiotomy repair after birth as regard postoperative pain, skin closure time and wound infection. Design: Prospective double-blinded randomized controlled trial. Methods: Three-hundred qualified patients were equally distributed between two groups. Group 1 underwent skin repair with skin adhesive tape, while group 2 underwent the currently traditional method for perineal repair by interrupted suture. Pain was evaluated at 2, 4, 6 and 12 hours after birth then daily until one week using Wong-Baker faces pain rating scale with verbal expression for pain intensity as primary outcome. Skin closure time and wound infection were also evaluated as secondary outcomes. Results: Statistically significant difference in pain was?found at 4 and 6 hours, and 3,?4,?5 and 7 days after perineal repair in favor of the adhesive tape group (p = 0.04 and 0.02 respectively) (p = 0.002, 0.002, 0.003 and 0.001 respectively). No statistically significant difference was found in skin closure time between both groups, and no cases of wound infection occurred in both groups (p = 0.3). Conclusion: Skin adhesive tape may be superior to skin suturing in decreasing pain resulting from perineal repair after birth;however, further studies are needed to assess long-term effects, calculate costs and accurately measure patients’ satisfaction, which were not addressed in this study.展开更多
Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routi...Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.展开更多
Endometriosis is defined as the presence of endometrial tissue apart from its usual location (endometrium). It is the second most prevalent benign gynecologic disease after the presence of fibroids in women of childbe...Endometriosis is defined as the presence of endometrial tissue apart from its usual location (endometrium). It is the second most prevalent benign gynecologic disease after the presence of fibroids in women of childbearing age (incidence of 10% - 25%). Endometriosis predominantly locates on peritoneal surfaces, but it also affects the vagina, vulva, recto-vaginal septum and perineum, usually secondary to surgical or obstetric trauma. We present a case of a patient with perineal endometriosis (single nodule) in the scar of episiotomy and involvement of external anal sphincter with local and catamenial pain but with continence maintained. The endometric nodule was removed, and wide dissection and sphincteroplasty were performed. Afterwards, treatment with GnRh analogues was prescribed for a four-month period. Surgical outcome was successful and the patient was asymptomatic during subsequent menstruations.展开更多
Objectives: To study the epidemiological aspects, indications and short and medium term prognosis of episiotomy in the health district of Bogodogo in Ouagadougou, Burkina Faso. Materials and Method: It was a descripti...Objectives: To study the epidemiological aspects, indications and short and medium term prognosis of episiotomy in the health district of Bogodogo in Ouagadougou, Burkina Faso. Materials and Method: It was a descriptive prospective study over 4 months from 1 July 2016 to 30 October 2016. It was conducted in 4 health facilities in the health district of Bogodogo in the city of Ouagadougou. The study concerned the patients who gave birth after 28 gestational age (GA) and more, vaginally with episiotomy, in the 4 health facilities and who were reviewed at the appointment of the 9th day and the 3rd month. The data were collected using a questionnaire developed for the purposes of the study, seized with a laptop, then analyzed using the Epi-info software in its 3.5.1 version of the Atlanta C.D.C. Statistical comparisons were made using the Pearson chi-square test, with a significance level of p 0.05. Results: The overall episiotomy rate was 22%. For follow-up, 248 patients were reviewed on the 9th day and 109 patients on the 3rd month. The average age of our patients was 23.1 years. The average number of pregnancies was 1.7 with nulliparous women predominating (60.5% of cases). Excision was associated with episiotomy in 92.3% of cases, with perineal narrowing in 82.5% of patients. The mediolateral episiotomy was the most performed, in 76.6% of patients. Vulvo-perineal stricture was the main indication (75% of cases). The experience during the episiotomy and the evolution following the immediate layer was marked by pain. Dyspareunia was the main difficulty in resuming sexual intercourse. Conclusion: The episiotomy rate in our study was 22%. A program of continuous improvement of the quality of care concerning episiotomy encompassing various actions (audits, training) could reduce the use of episiotomies.展开更多
Objective: Despite the fact that a restrictive use of episiotomy has proven to be beneficial, it continues to be widely used in vaginal births. Our aim was to compare women with episiotomy, to women with an intact per...Objective: Despite the fact that a restrictive use of episiotomy has proven to be beneficial, it continues to be widely used in vaginal births. Our aim was to compare women with episiotomy, to women with an intact perineum, 3 months after delivery, regarding several sexual variables, namely: sexual desire, arousal, orgasm, pain, sexual satisfaction and sexual function. Methods: An exploratory, descriptive and quantitative study using a non-probabilistic, convenience sample of 147 Portuguese women, of which 54 belonged to a control group, was performed. The groups were not significantly different regarding socio-demographic aspects. Three instruments were used: the Female Sexual Function Index, a Socio-demographic and Clinical Questionnaire and the Female Sexual Function Questionnaire. Results: Most women mentioned a moderate level of sexual interest. Women with episiotomy present higher pain intensity, less sexual satisfaction, greater changes regarding the orgasm’s duration and intensity, lower levels of sexual arousal and total sexual function, than women with intact perineum. Discussion: We found no significant differences between women with episiotomy and women with an intact perineum in most variables. However, women with episiotomy presented higher levels of pain and a lower sexual satisfaction, being these significant differences.展开更多
BACKGROUND： Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area. OBJECTIVE： The aim of this study was to assess t...BACKGROUND： Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area. OBJECTIVE： The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d. MAIN OUTCOME MEASURES： Perineal pain and wound healing were assessed using visual analogue scale （0-10）and Redness, Edema, Ecchymosis, Discharge, Approximation scale （0-15）, respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratified factors. RESULTS： Follow-up rate was 100% up to the 8 h time point in both groups, and 86% （62 of 72） in the cinnamon group and 85% （61 of 72） in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was significantly lower than that in the placebo group at （4±1） h （adjusted difference： -0.6, 95% confidence interval： -1.0 to -0.2） and （8＋1） h （-0.9, -1.4 to -0.3） after intervention, and on the 10-11th day after delivery （-1.4, -2.0 to -0.7）. Also the cinnamon group showed significantly more improvement than the control group in healing score at （8±1） h （-0.2, -0.4 to -0.04） and the 10-11th day after delivery （-1.6, -2.0 to -1.1）. CONCLUSION： Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.展开更多
Episiotomy is a protocol that became obsolete in 1983[1].When randomized,controlled studies of episiotomy were carried out,episiotomy was found to be associated with more third-degree extensions,more anal muscle damag...Episiotomy is a protocol that became obsolete in 1983[1].When randomized,controlled studies of episiotomy were carried out,episiotomy was found to be associated with more third-degree extensions,more anal muscle damage,more short-and long-term fecal incontinence,more bleeding,more pain,more short-and long-term sexual discomfort and more sexual dissatisfaction[1].Most fecal incontinence is[2].Minmizngperineal damage on first vaginal births is critical to the perineal outcomes of subsequent births because the biggest risk factor for perineal damage on subsequent births is a previous episiotomy： 55% of women who had previously had an episiotomy needed to be sutured at subsequent birthst31. A previous third-degree extension of an episiotomy frequently results in a third-degree tear on subsequent births.展开更多
Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,suc...Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.展开更多
Urinary incontinence(UI) is a common condition affecting adult women of all ages and it could have a negative infl uence on quality of life. The etiology of UI is multifactorial, but some of the most important risk fa...Urinary incontinence(UI) is a common condition affecting adult women of all ages and it could have a negative infl uence on quality of life. The etiology of UI is multifactorial, but some of the most important risk factors are obesity and ageing, as well as adverse obstetric events. Pregnancy and delivery per se have been implicated in the etiology of UI. Although several studies have demonstrated a direct association between UI and vaginal delivery in short, medium and long-term, the role of childbirth on the risk of UI remains controversial. The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birth weights have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce signifi cantly the incidence of UI. The role of pelvic fl oor muscle training(PFMT) in the prevention and treatment of UI is still unclear. However, PFMT seems to be useful when supervised training is conducted and it could be incorporated as a routine part of women's exercise programmes during pregnancy and after childbirth.展开更多
Aim: The aim of this article is to present the knowledge of current literature regarding epidemiology and predisposing factors, classification and surgical treatment of third degree perineal tears. Materials and Metho...Aim: The aim of this article is to present the knowledge of current literature regarding epidemiology and predisposing factors, classification and surgical treatment of third degree perineal tears. Materials and Methods: We reviewed current articles in English language from medline and Pub-Med using as key words “vaginal repair, third degree tear, episiotomy and vaginal delivery”. We summarized literature regarding predisposing factors, epidemiology, prevention and surgical treatment of third degree perineal tears. Results: it is demonstrated today by several studies that widespread episiotomy is responsible for the increasing frequency of 3rd degree lace-rations of the perineum which are significantly associated with forceps and the use of gynecological chair (boom) for vaginal delivery. Primiparous women with babies weighting >4 kgr, are at greater risk. Two types of surgical repair: end-to-end approximation and overlapping of torn ends of the anal sphincter, are both related to the functional outcome of the repair. Conclusion: Episiotomy is an important risk factor for severe lacerations after vaginal delivery. Midline episiotomy and assisted vaginal delivery should be avoided whenever possible, especially in the presence of a large baby. Recent evidence suggests that there is no significant advantage between overlap repair and approximation technique, with regard to fecal incontinence.展开更多
Background: Vulva haematoma is an uncommon complication of childbirth that can cause maternal death if not properly managed. We present a case of large vulva haematoma managed conservatively with good outcome in UNTH ...Background: Vulva haematoma is an uncommon complication of childbirth that can cause maternal death if not properly managed. We present a case of large vulva haematoma managed conservatively with good outcome in UNTH Enugu. Clinical Presentation: This was a case of an unbooked 24 years old primiparous woman referred from a private hospital to UNTH, Enugu on account of left-sided vulva swelling of four hours duration following a spontaneous vaginal delivery of a live male baby that weighed 3.6 kilogrammes. She was given episiotomy which was repaired. Vaginal examination showed a swelling involving left labia majora and minora and extending to the perineal region and vagina. It measured 12 cm × 10 cm, firm and mildly tender. She was resuscitated with intravenous fluid, transfused with two units of blood and commenced on antibiotic and analgesic. The vulva haematoma was monitored and it remained the same size for two days, and then progressively regressed. She was discharged home on the 9th day. Conclusion: Conservative management of large vulva haematoma involving good counseling, correction of anaemia, institution of antibiotics, analgesic and close monitoring leads to effective resolution, reduced cost, scarring, pain and dyspareunia.展开更多
BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if...BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if severe, poorly managed or delayed in repair. It is a frequent complication of vaginal delivery. This study was aimed at determining the prevalence, demographic characteristics, risk factors, patterns and the t-term maternal outcomes of lower genital tract injuries in the labour room and the post-natal ward of the Bamenda Regional Hospital. METHODS: This was a hospital-based cross-sectional study of women managed for genital tract injuries following vaginal birth in the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A non-probabilistic, consecutive and exhaustive sampling technique was used to select participants (sample size estimated at 237). Among those selected were women who had a vaginal birth. However, the researchers’ interest was particularly centered on the women who had genital tract injuries. Data was collected using a pretested questionnaire and analyzed using the SPSS version 22 software. RESULTS: In total, 310 participants were included in this study. The mean age of the participants was 26.1 years (SD = 5.2), while the median age was 25 years (interquartile range = 22 - 29). Of the 310 participants included in the study, 128 developed a birth tract injury giving a prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We did not have any cases of fourth-degree perineal tears. We also encountered a few cases of cervical tears (0.6%). The factors associated with birth tract injury were assessed using bivariate and multiple logistic regression analysis. On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 - 5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002), being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p < 0.015), and foetal head circumference greater than 36 cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were statistically significantly associated with birth tract injuries. The majority of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc and above. Also, the severity of genital pain lasting beyond 24 hours postpartum was mostly less than 5/10 (50.6%) followed by genital pains > 7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no maternal death from injury was recorded. CONCLUSION: The prevalence of lower genital tract injuries in the Bamenda Regional hospital is high. First-degree tears were the most common followed by episiotomies. The perineal outcome in the BRH is poor and should be improved upon.展开更多
Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane ...Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane and blood vessel permeability. This review discusses the indication, usage, effects, and safety of hyaluronidases in obstetrics. Materials and Methods: MEDLINE/</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">PubMed and the Cochrane Library were searched using the following terms: </span><span style="font-family:Verdana;">(“hyaluronidase” [Title/Abstract]) OR (“hyaluronidases” [Title/Abstract]) AND </span><span style="font-family:Verdana;">(“therapeutic use” [Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical ripening” [Title/Abstract]). Results: This review included four randomized controlled trials (RCT) that randomized a total of 642 pregnant women and two interventional non-RCTs that included a total of 2824 pregnant women. The data from two RCTs suggested that the incidence of perineal trauma was significantly lower in the intervention (perineal hyaluronidase injection in stage two of labor) than the control group (no intervention). However, both groups did not differ significantly in the incidence of first- and second-degree tears. Similarly, no significant difference in the incidence </span><span style="font-family:Verdana;">of episiotomy was found between both groups. In one interventional non-RCT, </span><span style="font-family:Verdana;">the administration of intracervical hyaluronidase was associated with a statistically significant acceleration and shortening of labor by approximately 1.95 hours after the injection of intracervical hyaluronidase. However, it had no effect on uterine contractions or the duration of stages two and three labor. Conclusions: While it is safe, clinicians should consider patient acceptance and the effectiveness of hyaluronidase compared to conventional less invasive methods.展开更多
Endometriosis is a common clinical condition where functional endometrial tissue is found outside the uterine cavity.Although most of this ectopic tissue tends to occur within the pelvis,on rare occasions,they can als...Endometriosis is a common clinical condition where functional endometrial tissue is found outside the uterine cavity.Although most of this ectopic tissue tends to occur within the pelvis,on rare occasions,they can also be found in unusual locations,such as the thoracic cavity,perianal,episiotomy scar,and previous abdominal wound sites.This is a case report of a healthy 41-year-old Chinese female who presented with a painful perianal lump which was subsequently investigated and excised.The diagnosis of perianal endometriosis was made upon histological examination of the tissue.Many theories attempt to explain the phenomenon of endometriosis in the perianal region.In this case,the implantation theory is the likely explanation as the patient had a significant history of 3 normal vaginal deliveries which were followed by episiotomies.Advancements in endo-anal ultrasound(EAUS)have aided in the planning of surgery for this lesion.展开更多
文摘Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.
文摘Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman’s preference during delivery.
文摘Introduction: The ideal method for perineal repair should be quick, easy to perform and preferably, with minimal pain. Aim: To compare skin adhesive tape and interrupted?absorbable subcuticular suture for episiotomy repair after birth as regard postoperative pain, skin closure time and wound infection. Design: Prospective double-blinded randomized controlled trial. Methods: Three-hundred qualified patients were equally distributed between two groups. Group 1 underwent skin repair with skin adhesive tape, while group 2 underwent the currently traditional method for perineal repair by interrupted suture. Pain was evaluated at 2, 4, 6 and 12 hours after birth then daily until one week using Wong-Baker faces pain rating scale with verbal expression for pain intensity as primary outcome. Skin closure time and wound infection were also evaluated as secondary outcomes. Results: Statistically significant difference in pain was?found at 4 and 6 hours, and 3,?4,?5 and 7 days after perineal repair in favor of the adhesive tape group (p = 0.04 and 0.02 respectively) (p = 0.002, 0.002, 0.003 and 0.001 respectively). No statistically significant difference was found in skin closure time between both groups, and no cases of wound infection occurred in both groups (p = 0.3). Conclusion: Skin adhesive tape may be superior to skin suturing in decreasing pain resulting from perineal repair after birth;however, further studies are needed to assess long-term effects, calculate costs and accurately measure patients’ satisfaction, which were not addressed in this study.
文摘Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.
文摘Endometriosis is defined as the presence of endometrial tissue apart from its usual location (endometrium). It is the second most prevalent benign gynecologic disease after the presence of fibroids in women of childbearing age (incidence of 10% - 25%). Endometriosis predominantly locates on peritoneal surfaces, but it also affects the vagina, vulva, recto-vaginal septum and perineum, usually secondary to surgical or obstetric trauma. We present a case of a patient with perineal endometriosis (single nodule) in the scar of episiotomy and involvement of external anal sphincter with local and catamenial pain but with continence maintained. The endometric nodule was removed, and wide dissection and sphincteroplasty were performed. Afterwards, treatment with GnRh analogues was prescribed for a four-month period. Surgical outcome was successful and the patient was asymptomatic during subsequent menstruations.
文摘Objectives: To study the epidemiological aspects, indications and short and medium term prognosis of episiotomy in the health district of Bogodogo in Ouagadougou, Burkina Faso. Materials and Method: It was a descriptive prospective study over 4 months from 1 July 2016 to 30 October 2016. It was conducted in 4 health facilities in the health district of Bogodogo in the city of Ouagadougou. The study concerned the patients who gave birth after 28 gestational age (GA) and more, vaginally with episiotomy, in the 4 health facilities and who were reviewed at the appointment of the 9th day and the 3rd month. The data were collected using a questionnaire developed for the purposes of the study, seized with a laptop, then analyzed using the Epi-info software in its 3.5.1 version of the Atlanta C.D.C. Statistical comparisons were made using the Pearson chi-square test, with a significance level of p 0.05. Results: The overall episiotomy rate was 22%. For follow-up, 248 patients were reviewed on the 9th day and 109 patients on the 3rd month. The average age of our patients was 23.1 years. The average number of pregnancies was 1.7 with nulliparous women predominating (60.5% of cases). Excision was associated with episiotomy in 92.3% of cases, with perineal narrowing in 82.5% of patients. The mediolateral episiotomy was the most performed, in 76.6% of patients. Vulvo-perineal stricture was the main indication (75% of cases). The experience during the episiotomy and the evolution following the immediate layer was marked by pain. Dyspareunia was the main difficulty in resuming sexual intercourse. Conclusion: The episiotomy rate in our study was 22%. A program of continuous improvement of the quality of care concerning episiotomy encompassing various actions (audits, training) could reduce the use of episiotomies.
文摘Objective: Despite the fact that a restrictive use of episiotomy has proven to be beneficial, it continues to be widely used in vaginal births. Our aim was to compare women with episiotomy, to women with an intact perineum, 3 months after delivery, regarding several sexual variables, namely: sexual desire, arousal, orgasm, pain, sexual satisfaction and sexual function. Methods: An exploratory, descriptive and quantitative study using a non-probabilistic, convenience sample of 147 Portuguese women, of which 54 belonged to a control group, was performed. The groups were not significantly different regarding socio-demographic aspects. Three instruments were used: the Female Sexual Function Index, a Socio-demographic and Clinical Questionnaire and the Female Sexual Function Questionnaire. Results: Most women mentioned a moderate level of sexual interest. Women with episiotomy present higher pain intensity, less sexual satisfaction, greater changes regarding the orgasm’s duration and intensity, lower levels of sexual arousal and total sexual function, than women with intact perineum. Discussion: We found no significant differences between women with episiotomy and women with an intact perineum in most variables. However, women with episiotomy presented higher levels of pain and a lower sexual satisfaction, being these significant differences.
文摘BACKGROUND： Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area. OBJECTIVE： The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d. MAIN OUTCOME MEASURES： Perineal pain and wound healing were assessed using visual analogue scale （0-10）and Redness, Edema, Ecchymosis, Discharge, Approximation scale （0-15）, respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratified factors. RESULTS： Follow-up rate was 100% up to the 8 h time point in both groups, and 86% （62 of 72） in the cinnamon group and 85% （61 of 72） in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was significantly lower than that in the placebo group at （4±1） h （adjusted difference： -0.6, 95% confidence interval： -1.0 to -0.2） and （8＋1） h （-0.9, -1.4 to -0.3） after intervention, and on the 10-11th day after delivery （-1.4, -2.0 to -0.7）. Also the cinnamon group showed significantly more improvement than the control group in healing score at （8±1） h （-0.2, -0.4 to -0.04） and the 10-11th day after delivery （-1.6, -2.0 to -1.1）. CONCLUSION： Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.
文摘Episiotomy is a protocol that became obsolete in 1983[1].When randomized,controlled studies of episiotomy were carried out,episiotomy was found to be associated with more third-degree extensions,more anal muscle damage,more short-and long-term fecal incontinence,more bleeding,more pain,more short-and long-term sexual discomfort and more sexual dissatisfaction[1].Most fecal incontinence is[2].Minmizngperineal damage on first vaginal births is critical to the perineal outcomes of subsequent births because the biggest risk factor for perineal damage on subsequent births is a previous episiotomy： 55% of women who had previously had an episiotomy needed to be sutured at subsequent birthst31. A previous third-degree extension of an episiotomy frequently results in a third-degree tear on subsequent births.
文摘Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.
文摘Urinary incontinence(UI) is a common condition affecting adult women of all ages and it could have a negative infl uence on quality of life. The etiology of UI is multifactorial, but some of the most important risk factors are obesity and ageing, as well as adverse obstetric events. Pregnancy and delivery per se have been implicated in the etiology of UI. Although several studies have demonstrated a direct association between UI and vaginal delivery in short, medium and long-term, the role of childbirth on the risk of UI remains controversial. The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birth weights have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce signifi cantly the incidence of UI. The role of pelvic fl oor muscle training(PFMT) in the prevention and treatment of UI is still unclear. However, PFMT seems to be useful when supervised training is conducted and it could be incorporated as a routine part of women's exercise programmes during pregnancy and after childbirth.
文摘Aim: The aim of this article is to present the knowledge of current literature regarding epidemiology and predisposing factors, classification and surgical treatment of third degree perineal tears. Materials and Methods: We reviewed current articles in English language from medline and Pub-Med using as key words “vaginal repair, third degree tear, episiotomy and vaginal delivery”. We summarized literature regarding predisposing factors, epidemiology, prevention and surgical treatment of third degree perineal tears. Results: it is demonstrated today by several studies that widespread episiotomy is responsible for the increasing frequency of 3rd degree lace-rations of the perineum which are significantly associated with forceps and the use of gynecological chair (boom) for vaginal delivery. Primiparous women with babies weighting >4 kgr, are at greater risk. Two types of surgical repair: end-to-end approximation and overlapping of torn ends of the anal sphincter, are both related to the functional outcome of the repair. Conclusion: Episiotomy is an important risk factor for severe lacerations after vaginal delivery. Midline episiotomy and assisted vaginal delivery should be avoided whenever possible, especially in the presence of a large baby. Recent evidence suggests that there is no significant advantage between overlap repair and approximation technique, with regard to fecal incontinence.
文摘Background: Vulva haematoma is an uncommon complication of childbirth that can cause maternal death if not properly managed. We present a case of large vulva haematoma managed conservatively with good outcome in UNTH Enugu. Clinical Presentation: This was a case of an unbooked 24 years old primiparous woman referred from a private hospital to UNTH, Enugu on account of left-sided vulva swelling of four hours duration following a spontaneous vaginal delivery of a live male baby that weighed 3.6 kilogrammes. She was given episiotomy which was repaired. Vaginal examination showed a swelling involving left labia majora and minora and extending to the perineal region and vagina. It measured 12 cm × 10 cm, firm and mildly tender. She was resuscitated with intravenous fluid, transfused with two units of blood and commenced on antibiotic and analgesic. The vulva haematoma was monitored and it remained the same size for two days, and then progressively regressed. She was discharged home on the 9th day. Conclusion: Conservative management of large vulva haematoma involving good counseling, correction of anaemia, institution of antibiotics, analgesic and close monitoring leads to effective resolution, reduced cost, scarring, pain and dyspareunia.
文摘BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if severe, poorly managed or delayed in repair. It is a frequent complication of vaginal delivery. This study was aimed at determining the prevalence, demographic characteristics, risk factors, patterns and the t-term maternal outcomes of lower genital tract injuries in the labour room and the post-natal ward of the Bamenda Regional Hospital. METHODS: This was a hospital-based cross-sectional study of women managed for genital tract injuries following vaginal birth in the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A non-probabilistic, consecutive and exhaustive sampling technique was used to select participants (sample size estimated at 237). Among those selected were women who had a vaginal birth. However, the researchers’ interest was particularly centered on the women who had genital tract injuries. Data was collected using a pretested questionnaire and analyzed using the SPSS version 22 software. RESULTS: In total, 310 participants were included in this study. The mean age of the participants was 26.1 years (SD = 5.2), while the median age was 25 years (interquartile range = 22 - 29). Of the 310 participants included in the study, 128 developed a birth tract injury giving a prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We did not have any cases of fourth-degree perineal tears. We also encountered a few cases of cervical tears (0.6%). The factors associated with birth tract injury were assessed using bivariate and multiple logistic regression analysis. On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 - 5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002), being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p < 0.015), and foetal head circumference greater than 36 cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were statistically significantly associated with birth tract injuries. The majority of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc and above. Also, the severity of genital pain lasting beyond 24 hours postpartum was mostly less than 5/10 (50.6%) followed by genital pains > 7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no maternal death from injury was recorded. CONCLUSION: The prevalence of lower genital tract injuries in the Bamenda Regional hospital is high. First-degree tears were the most common followed by episiotomies. The perineal outcome in the BRH is poor and should be improved upon.
文摘Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane and blood vessel permeability. This review discusses the indication, usage, effects, and safety of hyaluronidases in obstetrics. Materials and Methods: MEDLINE/</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">PubMed and the Cochrane Library were searched using the following terms: </span><span style="font-family:Verdana;">(“hyaluronidase” [Title/Abstract]) OR (“hyaluronidases” [Title/Abstract]) AND </span><span style="font-family:Verdana;">(“therapeutic use” [Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical ripening” [Title/Abstract]). Results: This review included four randomized controlled trials (RCT) that randomized a total of 642 pregnant women and two interventional non-RCTs that included a total of 2824 pregnant women. The data from two RCTs suggested that the incidence of perineal trauma was significantly lower in the intervention (perineal hyaluronidase injection in stage two of labor) than the control group (no intervention). However, both groups did not differ significantly in the incidence of first- and second-degree tears. Similarly, no significant difference in the incidence </span><span style="font-family:Verdana;">of episiotomy was found between both groups. In one interventional non-RCT, </span><span style="font-family:Verdana;">the administration of intracervical hyaluronidase was associated with a statistically significant acceleration and shortening of labor by approximately 1.95 hours after the injection of intracervical hyaluronidase. However, it had no effect on uterine contractions or the duration of stages two and three labor. Conclusions: While it is safe, clinicians should consider patient acceptance and the effectiveness of hyaluronidase compared to conventional less invasive methods.
文摘Endometriosis is a common clinical condition where functional endometrial tissue is found outside the uterine cavity.Although most of this ectopic tissue tends to occur within the pelvis,on rare occasions,they can also be found in unusual locations,such as the thoracic cavity,perianal,episiotomy scar,and previous abdominal wound sites.This is a case report of a healthy 41-year-old Chinese female who presented with a painful perianal lump which was subsequently investigated and excised.The diagnosis of perianal endometriosis was made upon histological examination of the tissue.Many theories attempt to explain the phenomenon of endometriosis in the perianal region.In this case,the implantation theory is the likely explanation as the patient had a significant history of 3 normal vaginal deliveries which were followed by episiotomies.Advancements in endo-anal ultrasound(EAUS)have aided in the planning of surgery for this lesion.
