Pelvic Floor Injury Research Articles

Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries.

Our primary objective was to evaluate parturition mode (PM) recommendations following obstetric anal sphincter injuries (OASIs) and adherence to these recommendations and to evaluate recurrence of OASIs in women who had a subsequent vaginal delivery (VD). The hypothesis was that adherence to the PM recommendations leads to a reasonable OASI recurrence rate. This was a retrospective observational cohort study of patients with previous OASIs between 2010 and 2016. After an outpatient visit including 3D transperineal ultrasound to screen for pelvic floor and anal sphincter injuries, all patients received recommendations for a subsequent PM. Patients were invited to complete validated questionnaires 2 to 5years post-OASIs. The majority of invited patients (265/320) attended follow-up, with 264 receiving a recommendation for PM. Only 5.6% did not adhere to the received recommendation. One hundred sixty-one patients delivered again, 58% had a VD, and 42% had a cesarean section (CS). Recurrence of OASIs was observed in 4.3% of the patients that had a VD. Fecal incontinence occurred in 4.9%, however any form of anal incontinence in 48% of patients. While dyspareunia was common in patients with residual external anal sphincter (EAS) injuries and levator ani muscle (LAM) avulsions, anal pain occurred more frequently in EAS injuries and fecal incontinence in LAM avulsions. This study showed that the vast majority of patients followed PM recommendations, and this resulted in a low recurrence of OASIs with a high CS rate. Fecal incontinence after OASIs was correlated with the degree of OASIs.

Defining "normal recovery" of pelvic floor function and appearance in a high-risk vaginal delivery cohort.

Childbirth pelvic floor trauma leads to pelvic floor disorders. Identification of significant injuries would facilitate intervention for recovery. Our objectives were to identify differences in pelvic floor appearance and function following delivery and patterns of normal recovery in women sustaining high-risk labor events. We completed a prospective cohort study comparing women undergoing vaginal births involving risk factors for pelvic floor injury with women undergoing cesareans. Data were collected on multidimensional factors including levator ani muscle (LA) tears. Descriptive and bivariate statistics were used to compare the groups. We identified potential markers of pelvic floor injury based on effect size. Eighty-two women post-vaginal delivery and 30 women post-cesarean enrolled. The vaginal group had decreased perineal body length between early postpartum, 6weeks (p < 0.001), and 6months (p = 0.001). POP-Q points did not change between any time point (all p > 0.05). Measures of strength improved between each time point (all p < 0.002). When compared with cesarean delivery, women post-vaginal birth had longer genital hiatus and lower anterior and posterior vaginal walls (all p < 0.05). Based on theoretical considerations and effect sizes, those with Bp ≥0cm, Kegel force ≤1.50N, and/or an LA tear on imaging were considered to have significant pelvic floor injury. Using this definition, at 6weeks, 27 (46.4%) women were classified as injured. At 6months, 13 (29.6%) remained injured. We propose that pelvic floor muscle strength, posterior vaginal wall support, and imaging consistent with LA tear are potential indicators of abnormal or prolonged recovery in this cohort with high-risk labor events.

Magnetomyographic Recordings of Pelvic Floor Activity During Pregnancy and Postpartum: A Novel Non-invasive Approach.

The levator ani muscles (LAM) are integral to pelvic floor support and injury to this muscle complex has been associated with pelvic floor disorders, but our ability to evaluate their neuromuscular integrity is limited. During pregnancy, gravidas undergo systemic functional and anatomic modifications, including pelvic floor muscular adaptations. Magnetomyography (MMG) is a novel and non-invasive tool to passively measure the magnetic fields generated by depolarization activity of muscles and offers a unique method to evaluate the LAM. We collected serial MMG data in a pregnant woman with singleton gestation. Pregnant woman performed LAM contractions (Kegels) with intervening rest periods. Kegel signals were isolated by using the frequency dependent subtraction (SUBTR) and independent component analysis (ICA) methods. Concurrent body-surface electromyography (EMG) was used to evaluate for accessory-muscle recruitment by placing bipolar electrodes on the perineum, abdomen, and thigh. Amplitude and spectral-related indicators were computed across moderate intensity MMG Kegel epochs: root-mean square (RMS) amplitude, power spectrum density (PSD) and relative PSD (rPSD) in three frequency bands. Indicators were extracted from two pregnancy recordings and one postpartum. Parameters were represented in terms of gestation and postpartum weeks. We observed that postpartum RMS Kegel amplitudes had lower values than seen in pregnancy. Changes in spectral indicators were observed between pregnancy and postpartum.

A multicentre study on the effect of moderate perineal protection technique: a new technique for perineal management in labour

We conducted a large-sample study in six midwifery centres to estimate the effectiveness of Moderate Perineal Protection technique during spontaneous delivery. 31,249 women accepted the traditional technique were selected as control group, and 57,056 women accepted the Moderate Perineal Protection technique as the observation group. There was no significant difference in demographic characteristics between the two groups. The perineal episiotomy rate decreased (22.913% vs. 32.161%, p < .05), the perineal integrity significantly increased (43.505% vs. 36.384%, p < .05) and perineal trauma reduced in the observation group when compared to the control group (54.630% vs. 61.239% in first degree tears, and 1.826% vs. 2.340% in second degree tears, p < .05). The neonatal asphyxia rate in the observation group was lower than that in the control group (p < .05). The observation group also had a higher rate of total satisfaction, lower VAS score for perineal pain, shorter postpartum hospitalisation days, lower rate of postpartum urinary retention and postpartum incontinence (p < .05). We concluded that the Moderate Perineal Protection technique is safe, effective and worth promoting widely.Impact statementWhat is already known on this subject? In order to reduce the episiotomy rate and reduce perineal injury, some researches have been carried out and some perineal techniques have been evaluated, but there are still many aspects to improve.What the results of this study add? Moderate Perineal Protection technique can effectively reduce episiotomy rate, protect perineal integrity, improve neonatal outcomes and increase maternal satisfaction.What the implications are of these findings for clinical practice and/or further research? The Moderate Perineal Protection technique is an effective and safe technique worth clinical promoting widely. Further research could focus on the long-term effects of Moderate Perineal Protection technique, such as pelvic floor injury and long-term mother–child outcomes.

Correlation between pelvic floor pain and pelvic floor injury in female patients with lower urinary tract disease

Objective To investigate the relationship between pelvic floor pain and pelvic floor injury in female patients with lower urinary tract disease. Methods Transvaginal and rectal pelvic floor acupressure was used to perform pelvic floor pain point examination in women with lower urinary tract disease. The number of tender points and the pain point of tenderness were recorded. Results The positive rate of pelvic pain points was 61.5% (3 507 checkpoints, 2 156 checkpoints had tenderness); there was a difference in the degree of pain caused by pain points in different regions (H=159.144, P<0.01). There was no difference in pain level between the P3 area, P4 and P5 areas and P2 (adjust P=1), and the pain points of the other areas were statistically different from the pain level (adjust P<0.01). Conclusions The density of tender points and degree of pain in pain points in female pelvic floor are related to the pelvic floor injury. It is of clinical significance to evaluate the degree of pelvic floor injury by taking the pelvic floor pain point. Key words: Lower urinary tract symptoms; Female urogenital diseases; Pelvic floor; Pain; Wounds and injuries

Research progress of bladder urethral dysfunction associated with pelvic floor injury in women

Female pelvic floor dysfunction is caused by pelvic floor dysfunction due to pelvic, pelvic organs and lumbosacral tissue lessions, deformities, tumors, trauma, surgery, pregnancy and dystocia. It is called bladder-urethral dysfunction associated with pelvic floor injury. Early diagnosis and targeted treatment of bladder-urethral dysfunction are the key to prevent upper urinary tract damage and obtain good curative effect. Nervous system and urodynamic monitoring are prerequisites for accurate diagnosis and reasonable treatment. Key words: Pelvic floor; Wounds and injuries; Urinary bladder diseases; Urethral diseases; Female urogenital diseases; Review

Relation between Epidural Analgesia and severe perineal laceration in childbearing women in Catalonia

ObjectiveOur objectives were to study the association between epidural analgesia and risk of severe perineal laceration (SPL), and identify additional risk factors for SPL. This multicentre study consisted of an analysis of data from the MidconBirth Phase I Database, on the use of EA and perineal results during childbirth. (World Health Organization, International Clinical Trials Registry Platform, 2016: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN17833269). MethodsWe conducted a prospective study of pregnant women at term between July 2016 and July 2017 in 30 public maternity hospitals in Catalonia, Spain. Inclusion criteria were an uncomplicated singleton pregnancy, in cephalic presentation and vaginal birth. Data was analysed separately for instrumental births and spontaneous vaginal births, as the former is more frequently associated with episiotomy and more perineal lacerations. Risk factors as well as protective factors in each cohort of women (instrumental and spontaneous vaginal birth), were identified. Multivariate logistic regression model was performed to study the association between epidural analgesia and SPL to identify potential confounders. Odds ratios (OR), using 95% confidence intervals (CI) were constructed. FindingsDuring the study period, 5497 eligible women gave birth, 77.46% of them received epidural analgesia. SPL occurred in 1.63% of births. The univariate analysis showed births with epidural analgesia had significantly higher rates of inductions, augmentation of labour, lithotomy position for birth and episiotomy. However, this association disappeared when the variable "type of vaginal birth" was introduced. In multivariate logistic regression, nulliparity was the major predictor for SPL (OR: 0.17; CI 95%: 0.08–0.34, p: 0.000). Key conclusionsEpidural analgesia was not associated with SPL once confounding factors were included. Other interesting factors associated with SPL were identified. Implications for practiceThis paper identifies important practice areas which contribute to SPL and which have the potential to be rectified. It offers evidence on the role that EA plays on pelvic floor injuries and it adds to existing evidence about the disadvantages of using the lithotomy position for birth, especially in relation to SPL. It highlights the need for practice change in Catalonia from what can be considered a medical model of care to one more aligned with the midwifery philosophy of care through the development of clinical guidelines. It also signals the need to provide women with evidence base upon which to make informed choices on the use of EA, specifically in relation to SPL.

Percepção de dor no parto normal em gestantes

A gestação é um período em que o corpo feminino sofre variadas alterações, sendo elas físicas e psíquicas. O parto é um evento que desperta nos gestantes sentimentos de angústia, medo, ansiedade e dor. O presente artigo foi realizado através de um levantamento bibliográfico realizado por meio de uma revisão de literatura de caráter qualitativo, considerando a relevância do tema. Notou-se uma grande rejeição por parte das mulheres em optarem pelo parto normal, devido às dores sentidas no trabalho de parto e no parto. Porém, perceberam-se também pontos relevantes na optação pelo parto normal; ele traz benefícios para a mãe e para o bebê, pois minimiza os riscos para a saúde de ambos os envolvidos em gestações de baixo risco, além de o parto natural ser recomendado pela Organização Mundial de Saúde (OMS). Notou-se, com esta pesquisa, que a fisioterapia pode auxiliar para a qualidade do trabalho de parto, facilitando em todas as suas fases, com técnicas que podem ajudar aliviando a dor, permitindo que a parturiente tenha melhor consciência corporal, prevenindo lesões no assoalho pélvico, e auxiliando na recuperação no pós-parto. É papel do fisioterapeuta esclarecer às gestantes quanto aos tipos de parto e todas as possibilidades existentes. Percebeu-se também que o fisioterapeuta pode ser especializado em saúde da mulher, trabalhando com gestantes, auxiliando e orientando para que a mesma estimule a potencialidade do seu corpo no trabalho de parto e parto prevenindo complicações. A abordagem fisioterapêutica terá resultados benéficos sobre o bem-estar da gestante, ajudando e prevenindo maiores lesões na musculatura do assoalho pélvico nos partos normais.

ACOG Practice Bulletin No. 198 Summary: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.

Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth. The purpose of this document is to provide evidence-based guidelines for the prevention, identification, and repair of obstetric lacerations and for episiotomy.

ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.

Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth. The purpose of this document is to provide evidence-based guidelines for the prevention, identification, and repair of obstetric lacerations and for episiotomy.

Análise crítica sobre a utilização do Epi-No na gestação e parto

Atualmente são reportados métodos que poderiam favorecer o alongamento e prevenir as lesões do assoalho pélvico no parto vaginal, como a massagem perineal e o balão Epi-No. Esse dispositivo é bem aceito pelas pacientes, mas seus resultados para prevenção de episiotomias e lesões perineais são controversos. O objetivo desse estudo foi avaliar o propósito, método, frequência, ensino/orientação e resultados da utilização do Epi-No durante a gestação e parto. Foi elaborada uma revisão narrativa com levantamento de bibliografia disponível sobre o uso do Epi-No nas bases de dados PUBMED, BVS e SciELO em português e inglês. 837 artigos foram encontrados, nos quais apenas 9 atenderam aos critérios de inclusão. Informações desses artigos foram sintetizadas em quadros que contemplaram os aspectos considerados pertinentes. Fatores como o tempo, período, posicionamento e processo de ensino/orientação devem ser melhor descritos e padronizados para que seja possível investigar a eficácia de seu uso nos desfechos perineais no parto vaginal.

971: Diabetes mellitus in pregnancy does not delay postpartum pelvic floor recovery

Pelvic floor dysfunction (PFD) symptoms are prevalent during pregnancy, however they are mostly reversible postpartum. Diabetes mellitus (DM) and pre-diabetic conditions, such as insulin resistance and impaired fasting glucose, have been found to be a risk factor for PFD in non-pregnant women. Therefore, it has been hypothesized that PFD symptoms may be more prevalent in women with gestational or pre-gestational DM and that there may be a slower spontaneous postpartum recovery of PFD symptoms. We aimed to determine the impact of DM on PFD symptoms recovery. We conducted a prospective cohort study of women who gave birth at a tertiary medical center in Israel. Women who have consented completed the “Pelvic Floor Distress Inventory-20” (PFDI-20), a condition specific questionnaire developed to measure quality-of-life and the extent of pelvic floor injury. The PFDI-20 was completed during the third trimester of pregnancy or immediately after delivery, and again three months postpartum. Clinical and obstetrical characteristics were retrieved from the participants' medical records. A total of 192 women have completed both questionnaires and were divided into DM group (n=66) and control group (n=126). We found a significant difference between PFD during pregnancy, and PFD three months postpartum (P<0.001). This difference remained consistent in all components of the PFDI-20: pelvic organ prolapse distress (P<0.001), colorectal and anal dysfunction (P=0.01) and urinary dysfunction (P<0.001). No significant difference was noted in the extent of recovery of PFD symptoms between women with DM and the control group (P=0.31). There is a clinical and statistically significant spontaneous recovery of PFD symptoms in the postpartum period. Diabetes mellitus in pregnancy does not delay the pelvic floor recovery postpartum.

Gastrointestinal manifestations of pelvic floor disorders in adolescents: a diagnostic framework for the general practitioner.

Pelvic floor disorders (PFDs) can present with gastrointestinal complaints in the adolescent patient, and identification of PFDs is aided by clues in the history and physical examination apparent to the knowledgeable clinician. The aim of this article is to provide a framework for the diagnostic evaluation of the adolescent patient with a PFD and introduce management strategies. Patients with PFDs can present with gastrointestinal symptoms, including abdominal pain, constipation, incomplete evacuation, and fecal incontinence or nongastrointestinal complaints around genitourinary symptoms or sexual health. Although such symptoms can be attributed to a variety of diagnoses, PFDs should be considered in the adolescent patient based on history and physical examination findings, including a careful digital rectal examination. Adolescent patients in high-risk groups may be especially susceptible to PFDs. Such groups include postpartum women, victims of sexual abuse, those with congenital anorectal malformations, or acquired spinal cord or pelvic floor injuries. Biofeedback can be beneficial in patients with PFDs. PFDs may present with a spectrum of symptoms, but a familiarity with the clinical characteristics and understanding of the digital rectal examination may guide the skillful clinician in diagnosis, initial management, and subspecialist referral if needed.

The 3D Pelvic Inclination Correction System (PICS): A universally applicable coordinate system for isovolumetric imaging measurements, tested in women with pelvic organ prolapse (POP)

In pelvic organ prolapse (POP), the organs are pushed downward along the lines of gravity, so measurements along this longitudinal body axis are desirable. We propose a universally applicable 3D coordinate system that corrects for changes in pelvic inclination and that allows the localization of any point in the pelvis at rest or under dynamic conditions on magnetic resonance images (MRI) of pelvic floor disorders in a scanner- and software independent manner.The proposed 3D coordinate system called 3D Pelvic Inclination Correction System (PICS) is constructed utilizing four bony landmark points, with the origin set at the inferior pubic point, and three additional points at the sacrum (sacrococcygeal joint) and both ischial spines, which are clearly visible on MRI images. The feasibility and applicability of the moving frame was evaluated using MRI datasets from five women with pelvic organ prolapse, three undergoing static MRI and two undergoing dynamic MRI of the pelvic floor in a supine position.The construction of the coordinate system was performed utilizing the selected landmarks, with an initial implementation completed in MATLAB. In all cases the selected landmarks were clearly visible, with the construction of the 3D PICS and measurement of pelvic organ positions performed without difficulty. The resulting distance from the organ position to the horizontal PICS plane was compared to a traditional measure based on standard measurements in 2D slices. The two approaches demonstrated good agreement in each of the cases.The developed approach makes quantitative assessment of pelvic organ position in a physiologically relevant 3D coordinate system possible independent of pelvic movement relative to the scanner. It allows the accurate study of the physiologic range of organ location along the body axis (“up or down”) as well as defects of the pelvic sidewall or birth-related pelvic floor injuries outside the midsagittal plane, not possible before in a 2D reference line system. Measures in 3D can be monitored over time and may reveal pathology before bothersome symptoms appear, as well as allowing comparison of outcomes between different patient pools after different surgical approaches.

Pelvic Floor Injury - Gymnastics

HISTORY: A 16-year-old female gymnast sustained a gymnastic injury resulting in left hip and pelvic pain. She was on the uneven bars and had to straddle in the air and then catch the bar coming from the abducted hip position to an adducted hip position. She felt the outside of her bilateral hips “pop”. She rested for 6 weeks and underwent physical therapy. She returned to competition and reinjured the same area 2 weeks later. She underwent additional physical therapy and again returned to gymnastics but subsequently noticed many activities within her sport now caused “stabbing” pain. When landing from a trick she reported a shock up her left leg into her pubic bone. She was referred to a physiatrist for consideration of pelvic floor involvement given limited improvement in her symptoms with previous treatments and therapies. PHYSICAL EXAMINATION: Bilateral active and passive ROM at the hip was WNL. There was tenderness to palpation (TTP) of the piriformis, glutes, ITB and trochanteric bursa on the left. Special tests including Scour’s, FABER’s, Ober’s and Ely’s were negative. There was TTP of the adductors bilaterally. Pelvic floor examination revealed normal labia with external inspection with intact sensation. Palpation revealed no pain in the introitus or urogenital diaphragm. Obturator internus was tender to touch and with resisted motion L>R. Abdominal exam revealed TTP of the psoas bilaterally L>R, pubic symphysis, and at the attachment of the rectus abdominis on the pubic bone bilaterally L>R. DIFFERENTIAL DIAGNOSIS: 1. High Tone Pelvic Floor Muscle Dysfunction 2. Abdominal Wall Strain 3. Osteitis Pubis TEST AND RESULTS: MRI Abdomen Pelvis -osteitis pubis, questionable pubic symphysis abnormality, and possible sports hernia FINAL WORKING DIAGNOSIS: High-Tone Pelvic Floor Muscle Dysfunction TREATMENT AND OUTCOMES: 1. Manual therapy for pelvic alignment correction 2. Abdominal and pelvic girdle myofascial release 3. Pelvic stability with Kinesio Taping 4. Internal vaginal muscle myofascial release and neuro re-education 5. Padding in leotard to reduce impact at pubic tubercle 6. Trigger point injections of obturator internus muscles 7. Trial of Lyrica 8. Reduction of high-impact & high-speed repetitive sport-related activities 9. Discharge from PT with successful return to gymnastic competition

Effect of episiotomy on pelvic floor injuries and urogynecological complaints

Effect of episiotomy on pelvic floor injuries and urogynecological complaints

Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength.

This study aimed to determine factors associated with decreased pelvic floor strength (PFS) after the first vaginal delivery (VD) in a cohort of low-risk women. This is a secondary analysis of a prospective study examining the risk of pelvic floor injury in a cohort of primiparous women. All recruited participants underwent an examination, three-dimensional ultrasound and measurement of PFS in the third trimester and repeated at 4 weeks to 6 months postpartum using a perineometer. There were 84 women recruited for the study, and 70 completed the postpartum assessment. Average age was 28.4 years (standard deviation, 4.8). There were 46 (66%) subjects with a VD and 24 (34%) with a cesarean delivery who labored. Decreased PFS was observed more frequently in the VD group compared with the cesarean delivery group (68% vs 42%, P = 0.03).In modified Poisson regression models controlling for mode of delivery and time of postpartum assessment, women who were aged 25 to 29 years (risk ratio = 2.80, 95% confidence interval, 1.03-7.57) and 30 years and older (risk ratio = 2.53, 95% confidence interval, 0.93-6.86) were over 2.5 times more likely to have decreased postpartum PFS compared with women younger than 25 years. In this population, women aged 25 years and older were more than twice as likely to have a decrease in postpartum PFS.

Evaluation of isolated urinary stress incontinence according to the type of levator ani muscle lesion using 3/4D transperineal ultrasound 36months post-partum.

Vaginal delivery can lead to pelvic floor disorders. Many authors have described pelvic floor injuries that can predict future defects such as urinary incontinence and pelvic organ prolapse. We propose the assessment of urinary stress incontinence and its association with levator ani muscle (LAM) microtrauma (>20% in the levator hiatus area during Valsalva) and macrotraumas (avulsion) identified by 3/4D transperineal ultrasound (3D-TpUS) 36months post-partum. This was a prospective observational study including 168 nulliparous women. All patients included were nulliparous with singleton gestation in cephalic presentation, at ≥37weeks and were recruited on the first day after delivery. Thirty-sixmonths after delivery, 3D-TpUS was carried out to identify LAM lesions (macro or micro). Clinical assessment of urinary stress incontinence (USI) was based on the ICIQ-UI-SF test; a simple stress test and urodynamic test were carried out in the same visit. A total of 105 nulliparous women were studied (51 spontaneous deliveries [SpD] and 54 vacuum-assisted deliveries [VD]). Microtraumas were identified in 35.3% of SpD and 20.4% of VD. Macrotraumas (avulsion) were identified in 9.8% of SpD and 35.2% of VD (p=0.006). No differences were found in USI between study groups or in relation to the identification of LAM defects (19.2% in the no lesion group, 25% in the macrotrauma and 13.8% in the microtrauma groups; p=not significant). Nor were significant differences found in the results from the different study groups in the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) test (12.7±2.2 in the no lesion group, 12.5±4.2 in the macrotrauma and 13.25±4.8 in the microtrauma groups; p=NS). No difference was observed in USI between patients with and without LAM lesions (microtrauma or macrotrauma) 36months post-delivery.

Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.

Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth. The purpose of this document is to provide evidence-based guidelines for the prevention, identification, and repair of obstetric lacerations and for episiotomy.

Practice Bulletin No. 165 Summary: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.

Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth. The purpose of this document is to provide evidence-based guidelines for the prevention, identification, and repair of obstetric lacerations and for episiotomy.