Second-degree Perineal Trauma Research Articles

Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta-analysis.

To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour. Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent. A meta-analysis of randomized controlled trials. The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019. We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta-analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour. Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR]=0.74, 95% CI 0.59-0.93), shortened the active pushing phase (mean difference [MD]=-8.16min, 95% CI -16.29 to -0.02), decreased the rate of severe perineal trauma (RR=0.35, 95% CI 0.14-0.87) and episiotomy (RR=0.52, 95% CI 0.29-0.92), but significantly increased the rate of second-degree perineal trauma (RR=1.45, 95% CI 1.10-1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage. Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence. This meta-analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.

Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study.

To assess the association between superficial perineal muscle trauma and perineal pain and dyspareunia. Prospective cohort study of 405 women with a spontaneous vaginal birth comparing an intact perineum and first-degree perineal trauma group (n =205) with a second-degree perineal trauma and episiotomy group (n =200). Perineal pain was measured at 2days, 10days, 7weeks, 3months and 6months postpartum. Dyspareunia was assessed at 7weeks, 3months and 6months postpartum. All second-degree perineal traumas and episiotomies involved damage to the bulbospongiosus muscle (BSM), but not always to the superficial transverse perineal muscle (STPM). In case of second-degree trauma or episiotomy, the odds of pain at 10days and dyspareunia at 6 months postpartum were four- and five-fold greater, respectively, than if the perineum had remained intact or suffered a first-degree perineal trauma [OR 4.4 (95% CI: 2.8-6.9) and OR 5.5 (95% CI: 2.8-10.9), respectively]. When comparing injuries where > 50% BSM ± STPM against those with < 50% BSM torn, pain was significantly higher at 10days postpartum [OR 1.9 (95% CI: 1.1-3.6], with no difference at 7weeks, while dyspareunia was significantly higher at 6 months postpartum [OR 3.3 (95% CI: 1.4-7.8)]. There was no difference in perineal pain or dyspareunia when comparing first-degree with < 50% BSM traumas. When perineal muscle trauma encompasses > 50% BSM ± STPM, perineal pain and dyspareunia persisted until 10days and 6months postpartum, respectively.

Assessment of Perineal Trauma during Child Birth by Estimation of Striae Gravidarum Score among Post-natal Mothers at Selected Hospitals of New Delhi

Perineal trauma or injury to perineum is a contributing factor affecting the postpartum health. Striae gravidarum is thought to be one of such factors associated with the perineal outcome during normal vaginal delivery. In this study, an exploratory research design including 81 post-natal mothers via purposive sampling was used. Structured questionnaire was used to obtain background information and obstetrical data of the post-natal mothers. Striae gravidarum was assessed using Attwal numerical scoring system. Analysis and interpretation of data was done through Statistical Package for the Social Sciences (SPSS) version 16.0 by using both descriptive and inferential statistics. The range of striae gravidarum obtained score for the subjects was 0-18 with a mean score 6.85; 28 (34.6%) post-natal mothers were having no signi cant striae, 27 (34.6%) had mild striae, 22 (27.2%) had moderate striae and 4 (4.9%) post-natal mothers had signi cant striae. Also, 22 (27.2%) had intact perineum, 9 (11.1%) suffered rst degree perineal trauma and 50 (61.7%) post-natal mothers either had episiotomy or second-degree perineal trauma. Using Chi-square test it was found that there was no signi cant relationship between the total striae gravidarum score and perineal trauma during childbirth. Our results contradict the ndings of previous studies which found a signi cant relationship between the striae gravidarum and perineal trauma among post-natal mothers.

Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis.

Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy. Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception - December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB. Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4-10days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12months, women still experienced dyspareunia whether perineal trauma existed or not. Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.

Early-career midwives' experiences of perineal assessment and repair after normal vaginal birth

Background It falls within the midwife's scope of practice to assess and repair first- and second-degree perineal trauma. Failure to accurately do so can lead to significant maternal morbidities. Evidence suggests that this can be a source of anxiety for midwives. Aims To explore early-career midwives' experiences of performing perineal assessment and repair after normal vaginal birth. Methods A qualitative semi-structured interview study analysed via interpretative phenomenological analysis. Six purposively-selected midwives, qualified for fewer than 5 years, were interviewed. Findings The study identified two superordinate themes. ‘Working and learning in an imperfect environment’ highlighted inadequacies in pre-registration midwifery education in preparing midwives for suturing, and a lack of support for developing their clinical skills once qualified. ‘Knowing myself, understanding my women’, highlighted midwives' understanding of suturing in terms of professional identity, responsibility for women's wellbeing and promotion of continuity. Conclusions Midwives often experience their pre-registration training as poor preparation for suturing in practice. Once qualified, preceptorship programmes can be variable and support for skills development is often lacking. Time constraints and structural hierarchies can inhibit the ability of midwives to articulate and advance their learning needs.

Effectiveness and Acceptability of Lidocaine Spray in Reducing Perineal Pain During Spontaneous Vaginal Delivery: Randomized Controlled Trial

Women planning spontaneous vaginal delivery often are not offered analgesia for perineal pain while in the second stage of labor. Midwives, however, sometimes apply various substances, including lidocaine, in an attempt to limit postpartum perineal pain. This study was a randomized, controlled trial comparing a topically applied local anesthetic spray with a placebo spray in 185 women having spontaneous vaginal delivery without epidural analgesia. The active and placebo solutions looked and smelled alike. The anesthetic solution was formulated to be equivalent to Xylocaine spray. Midwives were asked to apply 5 0.1-mL sprays to the perineum and the inside of the labia when birth appeared imminent but preferably at least 3 minutes beforehand. The actively treated and placebo-treated women were similar in most obstetric and sociodemographic characteristics. Women in both groups received 4.8 sprays on average. The intervals between treatment and delivery also were similar, approximating 11 to 12 minutes. Approximately 80% of women in each group delivered within 15 minutes of spraying. Pain scores, estimated using a 0 to 100 scale, were high and similar in the 2 groups. There was no evidence that the lidocaine spray lessened perineal pain, and it may even have increased it slightly. Fewer women in the active treatment group incurred second-degree perineal injuries. There were no third- or fourth-degree injuries. Women sprayed with lidocaine less often described dyspareunia when resuming sexual activity. Although acceptable to parturients, spraying the perineal region with a local anesthetic solution did not decrease postpartum pain. Further studies are needed to explore the reductions in second-degree perineal trauma and dyspareunia observed in women sprayed with lidocaine solution.

Postpartum sexual functioning and its relationship to perineal trauma: A retrospective cohort study of primiparous women

Objective: Our goal was to evaluate the relationship between obstetric perineal trauma and postpartum sexual functioning. Study Design: Our study was carried out with a retrospective cohort design in 3 groups of primiparous women after vaginal birth: Group 1 (n = 211) had an intact perineum or first-degree perineal tear; group 2 (n = 336) had second-degree perineal trauma; group 3 (n = 68) had third- or fourth-degree perineal trauma. These sample sizes reflect a 70% response rate. Outcomes were time to resuming sexual intercourse, dyspareunia, sexual satisfaction, sexual sensation, and likelihood of achieving orgasm. Results: At 6 months post partum about one quarter of all primiparous women reported lessened sexual sensation, worsened sexual satisfaction, and less ability to achieve orgasm, as compared with these parameters before they gave birth. At 3 and 6 months post partum 41% and 22%, respectively, reported dyspareunia. Relative to women with an intact perineum, women with second-degree perineal trauma were 80% more likely (95% confidence interval, 1.2-2.8) and those with third- or fourth-degree perineal trauma were 270% more likely (95% confidence interval, 1.7-7.7) to report dyspareunia at 3 months post partum. At 6 months post partum, the use of vacuum extraction or forceps was significantly associated with dyspareunia (odds ratio, 2.5; 95% confidence interval, 1.3-4.8), and women who breast-fed were ≥4 times as likely to report dyspareunia as those who did not breast-feed (odds ratio, 4.4; 95% confidence interval, 2.7-7.0). Episiotomy conferred the same profile of sexual outcomes as did spontaneous perineal lacerations. Conclusions: Women whose infants were delivered over an intact perineum reported the best outcomes overall, whereas perineal trauma and the use of obstetric instrumentation were factors related to the frequency or severity of postpartum dyspareunia, indicating that it is important to minimize the extent of perineal damage incurred during childbirth. (Am J Obstet Gynecol 2001;184:881-90.)