Development and initial validation of a Swedish inventory to screen for symptoms of deficient perineum in women after vaginal childbirth: ‘Karolinska Symptoms After Perineal Tear Inventory’

Abstract

Background Perineal tears are common after vaginal birth and may result in pelvic floor symptoms. However, there is no validated questionnaire that addresses long-term symptoms in women with a deficient perineum after vaginal birth. Thus, the objective of this study was to develop and psychometrically evaluate a clinical screening inventory that estimates subjective symptoms in women with a deficient perineum more than one year after vaginal delivery. Material and methods The development and psychometric evaluation employed both qualitative and quantitative methods. Qualitative strategies involved content validity and Think Aloud protocol for generation of items. The psychometric evaluation employed principal component analysis to reduce the number of items. The inventory was completed by women with persistent symptoms after perineal tears (N = 170). Results were compared to those of primiparous women giving birth by caesarean section (N = 54) and nulliparous women (N = 338). Results A preliminary 41-item inventory was developed, and the psychometric evaluation resulted in a final 11-item inventory. Women with confirmed deficient perineum after perineal trauma scored significantly higher on the symptoms inventory than women in control groups. A cut-off value of ≥ 8 could distinguish patients from controls with high sensitivity (100%) and specificity (87–91%). Conclusions The Karolinska Symptoms After Perineal Tear Inventory, is a psychometrically valid 11-item patient-reported outcome measure for symptoms of deficient perineum more than one year after vaginal birth. More research is needed to validate the inventory in various patient populations as well as its use in pelvic floor interventions. The inventory has the potential to improve patient counseling and care in the future.

One‐year follow‐up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery

“…The KAPTAIN is a validated 11-item inventory addressing symptoms of a deficient perineum. 9 Each item is gradedd on a Likert scale of 0-3, thus the Conclusions: Our results show that perineal reconstructive surgery significantly decreases symptoms of deficient perineum after vaginal delivery. A concomitant levator ani defect does not affect the symptom reduction of an acquired sensation of a wide vagina or the total score reduction after surgery.…”

“…After consenting to participate in the study, participants completed the KAPTAIN inventory. The KAPTAIN is a validated 11‐item inventory addressing symptoms of a deficient perineum 9 . Each item is gradedd on a Likert scale of 0–3, thus the inventory has a maximum score of 33, with a higher score indicating more subjective symptoms.…”

“…Therefore, our research group has developed an inventory, the Karolinska Symptoms After Perineal Tear Inventory (KAPTAIN), evaluating symptoms of a deficient perineum more than 1 year after vaginal birth. 9 Perineal reconstruction is thought to reinforce a deficient perineal body. 10 The procedure of perineorrhaphy or perineoplasty is commonly performed concomitant to posterior colporrhaphy.…”

“…However, there is a lack of scientific papers that address a comprehensive summary of the symptomatology. Therefore, our research group has developed an inventory, the Karolinska Symptoms After Perineal Tear Inventory (KAPTAIN), evaluating symptoms of a deficient perineum more than 1 year after vaginal birth 9 …”

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

“…The Transverssii perineii muscle consists of striated muscles, defects in transversii perineii can give symptoms of soiling, anal incontinence (AI), and pelvic organ prolapse 12,13 . The Levator ani musclecomplex (LAM) consisting of the puborectalis muscle, pubococcygeus muscle and iliococcygeus muscle, is striated muscle complex that stabilize the pelvic floor and defects in the LAM can lead to AI, impaired sensation of the vagina, a sense of a wide vagina and vaginal bulging 14,15 . The EAS is also a striated muscle, and is under voluntary control.…”