Incidence Of Perineal Lacerations Research Articles

The association between postpartum perineal laceration with anatomy and pelvic floor muscle strength

Link of Video Abstract: https://youtu.be/lrnQiVZyH8Q Background: Perineal lacerations damage the tissues around the vagina and rectum and can cause disruption of the anatomy and function of the pelvic floor. The incidence of perineal lacerations after vaginal delivery ranges from 53-89%. This anatomical damage and muscle dysfunction can cause urinary incontinence, anal incontinence, and uterovaginal prolapse. This study aims to evaluate the effects of postpartum perineal lacerations on the anatomy and strength of the pelvic floor muscles. Methods: The sample of this study is primiparous women who experienced perineal lacerations. Sampling was carried out prospectively using the consecutive sampling method. Pelvic floor anatomy and strength were measured using a POP-Q system and a perineometer. The 1st and 2nd degree laceration group measurements will be compared using the chi-square, and Mann-Whitney tests will be carried out. Results: Of the 123 research samples that met the criteria, a significant difference was found in the strength of the pelvic floor muscles in the first-degree perineal laceration and second-degree perineal laceration groups at 1st day and 12 weeks postpartum (p = 0.000 and p = 0.042). The only significant difference found for pelvic floor muscle anatomy is in perineal body length at 12 weeks postpartum. Conclusion: The degree of perineal laceration is related to the strength of the pelvic floor muscles after delivery and the length of the perineal body 12 weeks postpartum.

The Effect of Prenatal Yoga on Perineal Lacerations in Maternity Mothers at Midwife's Independent Practice Place in the Working Area of Tanjunganom Public Health Center, Nganjuk Regency 2022

Childbirth is a physiological process that allows a series of great changes in the mother to be able to give birth to her fetus through the birth canal. During the delivery process, the mother often has lacerations or tears in the perineum. According to a preliminary study conducted at BPM in the working area of puskemas Tanjunganom Nganjuk, it was found that out of 10 maternity mothers, 6 (60%) of them experienced 3rd degree lacerations and 2 (20%) had 2nd degree lacerations and 2 (20%) maternity mothers experienced 1st degree lacerations. The purpose of this study is to analyze the effect of pregnant yoga on the incidence of perineal lacerations in maternity mothers at midwife’s independent practice palace in the Working Area Of Tanjunganom’s Public Health, Nganjuk Regency 2022. The research method used is quasy experiment with desaign posttest only control design research. The sample in this study was maternity mothers in July until October 2022 who were distinguished between the control group and the treatment group. The results showed that there was an influence of pregnant yoga on the incidence of perineal lacerations in maternity mothers with a value of ρ value 0.000 < α 0.05 with a difference in lacerations of degrees 1 and 3. From the results of this study, it can be concluded that pregnant yoga is very effective in preparing the elasticity of the perineal muscles so that it can help to prevent rupture during the labor process.

Suda doğum

Objective: Immersion in water during labor and delivery has been studied as an alternative form of obstetric care. The aim of this study was to evaluate obstetrics and neonatal outcomes of women intending to use immersion in water for labor and delivery. Methods: This was a retrospective observational study conducted at a single center in Italy from January 2004 to January 2016. The clinical records of pregnant women intending to use immersion in water for labor and delivery were collected in a dedicated database and included in the study. Only the women who underwent immersion in water starting from the first stage of labor were included in the study. Inclusion criteria were women with uncomplicated singleton gestations and cephalic presentation at or later than 37 weeks of gestation, and with spontaneous onset of labor. The primary outcome of the study was the percentage of women who had both labor and delivery in water. Results: 389 women met the inclusion criteria and were included in the study. 256 (66%) were nulliparous, and 133 (34%) were multiparous. Out of the 389 women intending to use immersion in water for labor and delivery, 278 (71.5%) had labor and delivery in the water, 31 (8.0%) labor in water and delivery on land, and 80 (20.5%) had the first stage of labor in water, and the second stage and delivery on land. The incidence of perineal lacerations was 61.4%. Conclusion: The vast majority of the women who set out to labor and delivery in water achieve their aim.

Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study.

In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of <7, compared to the hospitals. This study was the first to compare important maternal and neonatal outcomes of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes.

PROMOTE Study: Safety of Osteopathic Manipulative Treatment During the Third Trimester by Labor and Delivery Outcomes.

Few quality data exist on the safety of osteopathic manipulative treatment (OMT) during pregnancy. The Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE) study was a randomized controlled clinical trial that studied the application of an OMT protocol to manage pain and dysfunction in pregnant patients during their third trimester. To evaluate the safety of an OMT protocol applied during the third trimester of pregnancy by analyzing incidence of high-risk status and labor and delivery outcomes. In the PROMOTE study, 400 pregnant patients were randomly assigned to 1 of 3 study groups: usual care plus OMT (OMT), usual care plus placebo ultrasound treatment (PUT), or usual care only (UCO). The incidence of high-risk status of participants and outcomes of labor and delivery, including length of labor, fever in mother during labor, operative vaginal delivery, conversion to cesarean delivery, need for forceps or vacuum device, need for episiotomy, incidence of perineal laceration, meconium-stained amniotic fluid, and infants' Apgar scores, were analyzed. Data from 380 participants were studied. High-risk status was less likely to develop in participants who received OMT (95% CI, 0.16-0.91; P=.03). The OMT protocol also did not increase risk of precipitous labor, operative vaginal delivery, conversion to cesarean delivery, need for forceps or vacuum device, need for episiotomy, incidence of perineal laceration, or meconium-stained amniotic fluid when compared with participants in the other 2 groups (P>.05). Of all other maternal outcomes examined, no difference was reported among the 3 treatment groups with the exception of incidence of prolonged labor in the OMT group. Participants receiving OMT had longer durations of labor than participants in the other groups (P=.002). These results suggest that the OMT protocol given during the third trimester of pregnancy as applied in the PROMOTE study is safe with regard to labor and delivery outcomes. The increased duration in labor in the OMT group needs further study. (ClinicalTrials.gov number NCT00426244).

Birthing postures and birth canal lacerations

Objective: This study was performed to assess the differences in the birth canal lacerations following the lateral and fours posture deliveries compared with those following the supine posture deliveries.Methods: We examined the birth canal lacerations of our “low risk” pregnant women under the midwife-led delivery care at Japanese Red Cross Katsushika Maternity Hospital between April 2006 and March 2015.Results: There were 3826, 1754 and 719 women who delivered with supine, lateral and fours postures. The rate of no laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.630, 95% CI 0.56–0.71, p < 0.01); however, the incidence of perineal laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.856, 95% CI 0.76–0.90, p < 0.01). The incidence of perineal laceration of third- or fourth-degree in the women who delivered with fours posture was significant higher than that in the women who delivered with supine posture (OR 2.28, 95% CI 1.2–4.2, p < 0.01).Conclusion: The current results may be to help for self-determination of birthing postures in prenatal women.

A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced mifwives.

BackgroundMedical staff’s influence on patient outcomes has become a subject of interest. We evaluated experienced midwives and compared their performance concerning perineal lacerations (PL).MethodsIn a retrospective cohort study, 1937 women with singleton pregnancies who had delivered spontaneously with a cephalic presentation by experienced midwives in the Medical University of Vienna from January 2009 to April 2014 were included. As predictive parameters, we included basic patient-, pregnancy- and delivery-related characteristics including the individual midwife who delivered the child. The incidence of PL was the main outcome measure.ResultsOverall PL and severe PL were found in 508/1937 (26.2 %) and 19/1937 women (1.0 %), respectively. In a multivariate analysis for PL of any degree, maternal age (ß = 0.170 ± 0.080), gestational age at delivery (ß = 0.190 ± 0.320), and birth weight (ß = 0.002 ± 0.000) significantly increased the risk, whereas multiparity (ß = −0.379 ± 0.141) and mediolateral episiotomy (ß = −1.514 ± 0.284) decreased it (p < 0.05). In addition, the individual midwife who delivered the child was a significant influencing factor, with ß-values ranging from −0.028 to 0.899 compared to the reference midwife. For severe PL, the midwife was not of significant influence.ConclusionsThe individual midwife is an independent factor that influences the risk for overall PL, not for severe PL. Other risk factors include maternal age, gestational age at delivery, birth weight, parity and episiotomy.

Risk factors for severe obstetric perineal lacerations.

The aim of this study was to assess the occurrence of severe perineal lacerations in vaginal delivery and its relationship with predisposing clinical and obstetric factors. A retrospective cohort analysis using an electronic clinical database at a University Referral Center for high-risk pregnancies was performed. A total of 941 vaginal deliveries were analyzed, over 10 consecutive months in 2013 and 2014. The relationship between obstetric and clinical characteristics and lacerations, especially severe forms, was analyzed. The frequency and severity of birth canal lacerations were compiled and classified as mild (unintentional laceration grades I and II, and mediolateral episiotomy) and severe (grades III and IV). The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models. The overall incidence of perineal lacerations in vaginal delivery was 78.2% (n = 731). Lacerations were considered mild in 708 women (75.7%) and severe in 23 women (2.5%). Maternal age, parity, use of forceps, mediolateral episiotomy, and birth weight influenced the occurrence of some degree of tear. The chance of severe lacerations increased 1.77-fold per week with the gestational age (1.03-3.03, P = 0.025), while primiparity increased the chance of laceration 5.32-fold. Episiotomy did not show a protective effect against severe laceration occurrence (P = 0.999). Severe perineal lacerations were associated with operative delivery, primiparity, gestational age, and epidural anesthesia. Episiotomy was not protective.

Obstetric outcomes of low-risk labors at ‘Japanese tatami’ mat delivery room: a preliminary study

We examined the obstetric outcomes of low-risk labors at the 'Japanese tatami' mat compared with Western-style delivery room. A retrospective cohort study was performed on 201 deliveries at the 'Japanese tatami' delivery room and 360 deliveries at the standard Western-style delivery room. There were no measurable differences in the duration of labor, the incidence of perineal laceration, total maternal blood loss and the incidence of low Apgar score and umbilical artery pH between the two groups. We found no evidence that the Japanese room is unsafe for low-risk infants and mothers in comparison with the standard Western-style delivery room.

Prenatal Perineal Massage: Preventing Lacerations During Delivery

To investigate the associations between perineal lacerations and 13 variables associated with the incidence of perineal lacerations. Of particular interest was the variable of prenatal preparation of the perineum. This retrospective descriptive study used a convenience sample of 368 women whose delivery was attended by at least one of two midwives practicing in the Northwest between 1979 and 1995. All births in the study occurred in a home-based midwifery practice in the Northwest. The sample was primarily white and included 307 multiparous and 61 primiparous women. The initial chi squares indicated that five of the 13 factors investigated were significantly associated with the degree of laceration: parity, maternal age, maternal position at delivery, length of second stage of labor, and prenatal perineal massage. However, further analyses showed that when parity was controlled, the only factors independently associated with the seriousness of lacerations were parity and prenatal perineal massage. This study supports the conclusion that teaching perineal massage to primiparous women and multiparae who had episiotomies with their previous births is a useful intervention. It suggests that further study may help clarify the optimum frequency, timing, and technique of massage.

A ballooning accident with multiple fatalities

On 13 August 1989 a fully laden commercially operated balloon carrying 12 passengers and a pilot was involved in a midair collision with another balloon, just north of Alice Springs. The collision resulted in the balloon sustaining a major tear of the envelope. Rapid deflation of the envelope led to an approximately 600 metre fall to the desert floor, with the basket partially disintegrating on impact. With one exception, the occupants were found still within the basket at the accident site. Full autopsies were performed on all occupants. The autopsies revealed a marked similarity in the injury patterns. Facial soft tissue and skeletal trauma was severe, associated with anterior third skull base fracture. A high incidence of perineal lacerations and pelvic burst fractures were present with relatively few spinal fractures. An unusual form of brain stem and spinal cord trauma was identified. The injuries sustained to feet, ankles, and legs were of the pattern associated with vertical decelerative force. The injury pattern is described and interpreted with reference to the basket of the balloon and the form of impact.

Episiotomy and its role in the incidence of perineal lacerations in a maternity center and a tertiary hospital obstetric service

Abstract This study examines the use of episiotomy and the frequency of perineal lacerations in a primary care maternity center staffed by certified nurse-midwives (Booth Maternity Center) and a tertiary care teaching hospital where deliveries were performed by physicians (Thomas Jefferson University Hospital). The study sample (1262 women) was a stratified random selection of singleton live births in 1977 and 1978 at Booth Maternity Center and Thomas Jefferson University Hospital, with the demographic characteristics of women at Booth Maternity Center used as the sampling frame. Data were abstracted from medical records. Clinical and demographic factors that might be associated with the likelihood of having an episiotomy or experiencing a perineal laceration were examined using logistic regression. After controlling for other significant factors, women at Thomas Jefferson University Hospital were twice as likely to have an episiotomy as women at Booth Maternity Center. Use of an episiotomy was associated with a decrease in perineal lacerations of first- or second-degree, but a fourfold increase in the incidence of third-degree lacerations. (Am J Obstet Gynecol 1989;160:1047-52.)

Episiotomy and its role in the incidence of perineal lacerations in a maternity center and a tertiary hospital obstetric service

This study examines the use of episiotomy and the frequency of perineal lacerations in a primary care maternity center staffed by certified nurse-midwives (Booth Maternity Center) and a tertiary care teaching hospital where deliveries were performed by physicians (Thomas Jefferson University Hospital). The study sample (1262 women) was a stratified random selection of singleton live births in 1977 and 1978 at Booth Maternity Center and Thomas Jefferson University Hospital, with the demographic characteristics of women at Booth Maternity Center used as the sampling frame. Data were abstracted from medical records. Clinical and demographic factors that might be associated with the likelihood of having an episiotomy or experiencing a perineal laceration were examined using logistic regression. After controlling for other significant factors, women at Thomas Jefferson University Hospital were twice as likely to have an episiotomy as women at Booth Maternity Center. Use of an episiotomy was associated with a decrease in perineal lacerations of first- or second-degree, but a fourfold increase in the incidence of third-degree lacerations. (Am J Obstet Gynecol 1989;160:1047-52.)