Incidence of and risk factors for perineal trauma: a prospective observational study

Smith, L. A.; Price, Natalia; Simonite, Vanessa; Burns, Ethel

doi:10.1186/1471-2393-13-59

Cited by 307 publications

(320 citation statements)

References 54 publications

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“…Consequently, our study has found evidence of the clear protective or preventive effect of episiotomy with respect to second degree tears for primiparous women. This association with a decreased risk of spontaneous perineal trauma was also evidenced in other studies (22,23). Potentially as much as 80% of the second degree tears in spontaneous deliveries could have been prevented or avoided if an episiotomy had been performed.…”

Section: Discussionsupporting

confidence: 52%

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Irene¹,

Sanchez²,

Francisco³

et al. 2015

IJWHR

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IntroductionHistorically, the use of episiotomy was common for primiparous women in order to prevent severe perineal trauma. Paradoxically, reviews indicate the opposite: episiotomy may actually contribute to severe perineal trauma rather than protect against it (1-4). Although current practice favours a reduction in episiotomies, perineal trauma rates remain high because of the increase in first and second degree tears (2,5,6). Prevalence rates of third and fourth degree perineal lacerations ranges widely from 0.3% to 6% or approximately 1.7% of all births (2.9% in primiparous). Most studies focus on the incidence and the risk factors of more severe perineal trauma including the anal sphincter (7-10). However, few studies have evaluated the incidence of perineal tears that do not affect the anal sphincter. Perineal tears are common following spontaneous vaginal deliveries and practically inevitable in forceps-assisted births (11). Even in mild tears, second degree perineal trauma deserves special consideration as it affects the muscular structure. The muscular damage classified as a second degree tear is equal to or worse than that which results from a routine episiotomy, if it affects the levator ani muscle. A published study on the correlation between episiotomy or perineal tears and pelvic disorders in women who had delivered vaginally 5 to 10 years earlier, concluded that perineal tear was a risk factor for pelvic floor dysfunction but that episiotomy was not (12). Only a small percentage of primiparous women will have an intact perineum after vaginal delivery. There is no data that analyzes the association between episiotomy and mild perineal trauma in primiparous women with spontaneous vaginal delivery. Knowing whether or not an association exists and being able to analyze the risk factors associated with mild perineal tears, would help us reach a better understanding of the appropriate use of episiotomy. The study aimed to estimate the incidence of different types of perineal tears [as classified by the Royal College of Obstetricians (13)] in a group of primiparous women with spontaneous vaginal delivery and to identify factors that could be associated with the presence of second degree perineal trauma. Materials and MethodsThis study is a subset analysis of women who had spontaneous vaginal deliveries from an institutional review Abstract Objectives: To estimate the incidence of perineal trauma in primiparous women with spontaneous vaginal delivery and to identify the factors associated with second-degree lacerations. Materials and Methods: A subset analysis of women with spontaneous vaginal deliveries (n=489) from an institutional review board-approved parent study in healthy, nulliparous, continent pregnant women, attending the public health care system of Catalonia (northeast Spain). Primary outcome measure was perineal trauma according to the RCOG classification. For the bivariate analysis, the Student's t-test, ANOVA and the chi-squared test, or the corresponding non-parametric tests were used. Rat...

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Section: Discussionsupporting

confidence: 52%

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Irene¹,

Sanchez²,

Francisco³

et al. 2015

IJWHR

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“…U většiny žen během porodu vzniká porodní poranění (1). Mezi nejčastější spontánní poranění patří ruptury hráze.…”

Section: Problém Literárního Přehledu Má Porodní Poranění Hráze (Sponunclassified

“…4. stupeň: ruptura zevního análního svěrače a vnitřní-ho análního svěrače a mukózy rekta. Dle studie autorů Smith et al (1), vznikají ruptury hráze 1. stupně u 5-18 % vaginálních porodů a ruptury 2. stupně u 20-38 % porodů. Rozsáhlé ruptury s poraněním análního sfinkteru postihují 1-4 % žen (5,6).…”

Section: Problém Literárního Přehledu Má Porodní Poranění Hráze (Sponunclassified

Perineal trauma and its effect on the pelvic floor and urinary incontinence

Kramná¹,

Vrublová²

2016

Profese on-line

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1Ústav ošetřovatelství a porodní asistence, Lékařská fakulta, Ostravská univerzita, Ostrava, Česká republika 2 Gynekologicko-porodnická klinika, Lékařská fakulta, Ostravská univerzita, Ostrava, Česká republika ABSTRAKT Východiska: Vysoká prevalence močové inkontinence u žen představuje celosvětový problém. Častější výskyt problémů s únikem moči byl zaznamenán u žen po porodu. Některé studie zjistily souvislost mezi močovou inkontinencí a porodním poraněním. Cíl: Zjistit vliv porodního poranění hráze (epiziotomie, spontánní ruptury) na pánevní dno a močovou inkontinenci. Metody: K vyhledávání literárních zdrojů byly využity elektronické databáze Medline, Cinahl, Pub Med, Science Direct, Scopus, Medvik a elektronické vyhledávače Google a Google Scholar. Byly vyhledávány články v českém nebo anglickém jazyce. Při vyhledávání byla zadána klíčová slova: perineal trauma, episiotomy, childbirth, urinary incontinence. Celkem bylo dohledáno 21 studií: 1 metaanalýza, 3 systematická review, 2 randomizované kontrolované studie a 15 kohortových studií. Výsledky: Ženy s intaktní hrází měly silnější pánevní dno než ženy s porodním poraněním, přestože se významně nelišily ve výskytu močové inkontinence. Nebyla prokázána souvislost mezi močovou inkontinencí a rozsahem spontánního poranění. Epiziotomie nechrání pánevní dno a neredukuje výskyt močové inkontinence u žen po porodu. Závěr: Snahou porodníků a porodních asistentek by měla být maximální redukce porodních poranění hráze. V žádné studii nebyl ale prokázán pozitivní vliv epiziotomie na pánevní dno a snížení výskytu močové inkontinence, proto by v praxi měly být epiziotomie prováděny jen v indikovaných případech. ABSTRACTBackground: High prevalence of urinary incontinence in women is a worldwide problem. Higher incidence of problems with urinary incontinence was observed in women after childbirth. Some studies have found a connection between urinary incontinence and perineal trauma. Aim: To determine the influence of perineal trauma (episiotomy, spontaneous rupture) on the pelvic floor and urinary incontinence. Methods: In search for sources we used the electronic databases Medline, CINAHL, PubMed, Science Direct, Scopus, Medvik, and the electronic search engines Google and Google Scholar. We searched for articles in Czech or English. The following keywords were used: perineal trauma, episiotomy, childbirth, urinary incontinence. A total of 21 studies were found: 1 meta-analysis, 3 systematic reviews, 2 randomized controlled trials, and 15 cohort studies. Results: Women with an intact perineum had a stronger pelvic floor than women with a perineal injury, although they did not differ significantly in the incidence of urinary incontinence. A relationship between urinary incontinence and the extent of a spontaneous injury has not been proved. Episiotomy does not protect the pelvic floor and does not reduce the incidence of urinary incontinence in women after childbirth. Conclusion: Obstetricians and midwives should maximally reduce perineal injuries. No study has yet proven a...

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“…This is a common event that affects women across a variety of international settings (Barreto-Scarabotto and Gonzalez-Riesco, 2008;Kettel et al, 2010;Ismail et al, 2013;Smith et al, 2013). Despite the frequency of the event there is a dearth of research which relates to women's experience of perineal suturing or the clinician's decision to suture.…”

Section: To Pain Associated With Suturing Second Degree Perineal Tearmentioning

confidence: 99%

A mixed methods study to explore women and clinician׳s response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE]

et al. 2015

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Incidence of and risk factors for perineal trauma: a prospective observational study

Cited by 307 publications

References 54 publications

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Perineal trauma and its effect on the pelvic floor and urinary incontinence

A mixed methods study to explore women and clinician׳s response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE]

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