Managing perineal trauma after childbirth

Webb, Sara; Sherburn, Margaret; Ismail, Khaled

doi:10.1136/bmj.g6829

Cited by 43 publications

(32 citation statements)

References 26 publications

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“…Trauma can occur either spontaneously with vaginal delivery or secondarily because of an episiotomy. It is classified according to the anatomical structures involved, with a first‐degree tear involving the perineal skin only; a second‐degree tear involving the perineal muscles but not the anal sphincter complex; a third‐degree tear involving the anal sphincter; and a fourth‐degree tear involving both the anal sphincter and the anorectal mucosa . First‐degree lacerations sometimes do not require suturing; second‐degree lacerations can usually be sutured easily, with local analgesia; and third‐degree lacerations should always be sutured to prevent fistula formation and fecal incontinence.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of pelvic floor interventions during pregnancy

Schreiner

Crivelatti

Oliveira

et al. 2018

Intl J Gynecology & Obste

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Section: Introductionmentioning

confidence: 99%

Systematic review of pelvic floor interventions during pregnancy

Schreiner

Crivelatti

Oliveira

et al. 2018

Intl J Gynecology & Obste

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“…This could be due to unavailability of PDS in government hospitals in Palestine but Vicryl is still preferable to catgut which may cause adverse tissue reaction and increase the risk of infection. 17 22 …”

Section: Discussionmentioning

confidence: 99%

Diagnosis and repair of perineal injuries: knowledge before and after expert training—a multicentre observational study among Palestinian physicians and midwives

et al. 2017

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ObjectiveTo assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment.Study designMulticentre observational study.SettingObstetric departments in 6 government Palestinian hospitals.ParticipantsAll physicians and midwives who attended the training.MethodsA questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3 months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test.ResultsAmong physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p<0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p<0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p<0.001). The corresponding numbers for midwives were 0% and 18% (p<0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p<0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p<0.001).ConclusionsImprovement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2 days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge.

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“…An estimated 70 to 85% of women sustain some degree of trauma to the perineum during childbirth (Rikard-Bell et al, 2014;Webb et al, 2014). Correct prevention, diagnosis and management are essential to reduce the risk of short-term complications like bleeding, infection and pain.…”

Section: Introductionmentioning

confidence: 99%

Perineal trauma following vaginal delivery in a low-income area: A criterion-based audit

Mantzius¹,

Rudnicki²,

Skovbjerg³

et al. 2020

Int. J. Nurs. Midwifery

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Trauma to the perineum following vaginal delivery is common and can lead to anal incontinence and pain but can be prevented by perineal support. However, the incidence and how to prevent perineal injury in sub Saharan Africa has not previously been described. The objective of the study was to assess the incidence of perineal trauma at vaginal delivery and to assess a training intervention in perineal support using a criterion-based audit (CBA) design. A CBA was conducted at Kilimanjaro Christian Medical Centre in Tanzania. In total, 552 women who delivered vaginally were included, of whom 80% completed a follow-up interview after three months. Perineal support as trained for this study was not performed before the intervention but was performed in 78.6% of deliveries after the intervention (p<0.000). The number of women with second degree lacerations decreased after the intervention (RR 0.74, CI: 0.61-0.90), and more had an intact perineum (RR 2.85, CI: 1.74-4.69). Anal sphincter lacerations were not significantly changed by the intervention (6.6 to 3.4%, RR 0.52, CI: 0.24-1.14). The frequency of anal incontinence changed insignificantly from 6.1 to 4.9% (RR 0.81, CI: 0.37-1.77) after intervention. Perineal pain three months after delivery was reduced by 72% (RR 0.28, CI: 0.15-0.52). The study demonstrates that CBA may be useful in introducing a simple intervention such as perineal support thereby decreasing the number of women having perineal trauma following vaginal delivery. However, the impact of our intervention on the sustainability of our observations is uncertain and must await long-term studies.

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Managing perineal trauma after childbirth

Cited by 43 publications

References 26 publications

Systematic review of pelvic floor interventions during pregnancy

Systematic review of pelvic floor interventions during pregnancy

Diagnosis and repair of perineal injuries: knowledge before and after expert training—a multicentre observational study among Palestinian physicians and midwives

Perineal trauma following vaginal delivery in a low-income area: A criterion-based audit

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