Pelvic floor healing milestones after obstetric anal sphincter injury: a prospective case control feasibility study

Abstract

Introduction and hypothesis Severe perineal tears can predict bothersome pelvic floor disorders later in life. We have a poor understanding of pelvic floor changes during the third trimester and the first few postpartum months. We aimed to compare women with severe perineal trauma during childbirth with women who experienced minimal trauma, for condition-specific quality of life, sexual function, mental health and overall quality of life in the first 6 months postpartum. Methods We recruited primiparous women with third- or fourth-degree tears (obstetric anal sphincter injuries, OASIS) and age-matched controls with no tears or first-degree tears in the immediate postpartum period. Participants completed validated questionnaires at baseline, 2, 4 and 6 months postpartum. Mixed effects linear regression or quantile regression adjusted for baseline score were used to compare the groups as appropriate. Results A total of 74 women completed at least one questionnaire (35 OASIS, 39 controls). Both groups had similar demographics. Women with OASIS tended to have worse Pelvic Floor Distress Index-40 scores at month 2; median scores were similar in the two groups by month 6. They also had significantly lower Female Sexual Function Index scores (mean difference: −6.1; 95% CI: −11.9, −0.2, p =0.043) at month 2. There were no mental health group differences and quality of life improved over time, mainly in the OASIS group. Six-month participant attrition rate was 52%. Conclusions Women with OASIS encounter specific pelvic floor challenges during the first 6 months postpartum. Although our recruitment rate was high, the attrition rate was also high, demonstrating challenges with retention of postpartum women into longitudinal research.

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement

“…Pelvic health metrics—such as vaginal resting pressure, levator hiatus area, PFM strength and endurance, and bladder neck mobility—have been shown to be altered after childbirth, particularly vaginal delivery in the general postpartum population 47 48 53. Perineal trauma and surgical birth will also require adequate time for soft-tissue healing 6 140. Although rare, risk for blood clots, hypertensive disorders, haemorrhage and sepsis is elevated in the first 6 weeks postpartum 129 141 142.…”

“…47,48,53 Perineal trauma and surgical birth will also require adequate time for soft-tissue healing. 6,140 Although rare, risk for blood clots, hypertensive disorders, hemorrhage, and sepsis is elevated in the first 6 weeks postpartum. 129,141,142 ACOG recommends all females have healthcare provider contact within 3 weeks postpartum, with a "comprehensive postpartum visit and transition to well-woman care" between 4-12 weeks postpartum.…”

Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement

“…92 Only 30% of primiparous females with OASIS and 40% of primiparous females with no, or first-degree, perineal tears returned to normal urinary and colorectal function by 6 months postpartum. 92 Forceps-assisted vaginal delivery increases the odds of PFD 5-10 years after first delivery. 91 Females with PFM defects (such as avulsion) have been shown to have 47% lower strength and endurance, with no difference in VRP, compared with postpartum females without PFM defects.…”

“…Up to 61% of females experience an episiotomy and up to 57% sustain perineal tearing during vaginal birth 91. Although all degrees of perineal trauma increase the risk for pelvic floor dysfunction (PFD), females who sustain third-degree or fourth-degree obstetric anal sphincter injuries (OASIS) during childbirth are at a higher risk of experiencing symptoms such as incontinence, pelvic pain, sexual dysfunction or prolapse 92. Only 30% of primiparous females with OASIS and 40% of primiparous females with no, or first-degree, perineal tears returned to normal urinary and colorectal function by 6 months postpartum 92.…”

Asian-white disparities in obstetric anal sphincter injury: Protocol for a systematic review and meta-analysis

“…Recent evidence has shown that this rate has been increasing in Canada but reasons for this trend remain speculative [4]. Obstetric trauma contributes to short-term morbidity as well as long-term, life-changing complications such as mental health morbidity, female sexual dysfunction, pain and an increase in most pelvic floor disorders including anal incontinence [5][6][7][8][9][10].…”