Abstract
Introduction and hypothesisThe 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.MethodsThis 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.ResultsThere 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.ConclusionWe 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.
Highlights
Introduction and hypothesisThe 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 described the clinical presentation and outcomes of women seen in our tertiary one-stop perineal clinic based on data collected over an 11-year period
Referrals are accepted for women in both the postpartum period following OASIs and antepartum period with history of OASIs in a subsequent pregnancy, postpartum perineal wound complications such as infection, dehiscence, pain or dyspareunia, women with FGM either pregnant or outside of pregnancy, new symptoms of anal incontinence (AI) in the antenatal or postnatal period, complaints suggestive of a missed clinical diagnosis of OASIs or other symptoms of pelvic floor dysfunction in the peripartum period such as urinary incontinence, prolapse or sexual dysfunction
Summary
Introduction and hypothesisThe 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). Up to 50% of women suffer from perineal pain and dyspareunia following OASIs, and these symptoms can last for years [4, 5]. There is mounting evidence that the management and outcome of wound complications, persistent perineal pain or postpartum dyspareunia in those without OASIs remain unknown, serious problems greatly affecting the physical and mental health of women have been reported [6]. These women frequently do not receive the dedicated care they need because of lack of knowledge in both healthcare professionals and women as well as poor care. Postpartum women with perineal complications not related to OASIs should be expected to have an opportunity for a similar assessment
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