A one-stop perineal clinic: our eleven-year experience

Abstract

Introduction and hypothesis The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period. Methods This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and anal manometry and endoanal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes. Results There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management. Conclusion We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities.

Effectiveness of small-angle episiotomy on incisional laceration rate, suturing time, and incisional bleeding in primigravida: A meta-analysis

“…Episiotomy is intended to prevent severe perineal tears (e.g., OASIS) that may result during transvaginal delivery ( 40 ). Some studies have reported that the incidence of OASIS ranges from 0.25 to 7.31% in women who deliver vaginally, and this delivery complication can have a significant impact on maternal health and may lead to a range of problems such as anal incontinence, urinary incontinence, wound infection, perineal pain, sexual dysfunction, and postpartum depression, and a high proportion (42%) of wound complications required further specialist treatment ( 41 – 45 ). This analysis showed a lower rate of tearing with small-angle lateral perineotomy and no substantial difference in the rate of third- or fourth-degree perineal tears.…”

Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI)

“…This could explain why the iMSP, which correlates with anal sphincter function [18], increased significantly between the time period of 30 months following OASI and the subsequent pregnancy in those women with a sphincter defect ≤ 1 h. However, another reason for functional improvement is recovery of muscle strength with pelvic and anal sphincter exercises. In our dedicated perineal service, all women who have sustained an OASI are advised to start pelvic floor muscle training (PFMT) [25]. Information is provided using patient information leaflets and mobile health applications prior to discharge [26].…”

Bacterial autofluorescence in infected perineal wounds: A prospective cohort study

“…Briefly, this was a prospective cohort study at Croydon University Hospital (CUH), which was conducted to assess the clinical progression of perineal wound infection and its effect on anal sphincter integrity using endoanal (EAUS) and transperineal ultrasound (TPUS). The primary aim of the PERINEAL study was to evaluate the effect of perineal wound infection on anal sphincter integrity in women with and without obstetric anal sphincter injuries (OASIs) using 3D EAUS and 4D TPUS [6]. Ethical approval was obtained from NHS Health Research Authority, London -Surrey Research Ethics Committee (20/LO/0304).…”

“…Moreover, women often have poor experiences with the clinical management of perineal wound complications due to a paucity of information about clinical management and recovery [5]. Therefore, perineal clinics have been established to improve the care of perineal trauma in the postpartum period, however there is disparity with regards to the availability of these services [6].…”