Third-degree Perineal Lacerations Research Articles

LACERAÇÃO PERINEAL DE TERCEIRO GRAU: RELATO DE CASO EM UMA ÉGUA

The present work aims to report the case of a mare that had a third-degree perineal laceration. The cause was due to fetal distortion, which was noticed after being passed on to another owner. She was taken to the veterinary hospital to resolve the case months after the incident, with the laceration classified as serious, as it had already affected the animal's entire reproductive system, being sent for treatment and then repair surgery was chosen. The technique used was Modified Pouret by Papa et al. in three stages; the animal went to the chute to be restrained, then sedated, to begin the operative process, highlighting that throughout the time the animal behaved appropriately. After the postoperative period, the animal was kept in a separate stall in order to keep it calm, being kept on a specific diet so that the feces remained soft, avoiding complications from the condition, and medications and dressings were also administered for its good recovery. It was noted that the chosen technique resulted in an absolute recovery without any physical consequences.

Application of the PDCA cycle for implementing the WHO Safe Childbirth Checklist in women with vaginal deliveries.

The World Health Organization Safe Childbirth Checklist (SCC) has been recommended globally. However, the results are inconsistent. The aim of this study was to investigate the effectiveness of implementing the SCC based on plan-do-check-act (PDCA) cycle management. From November 2019 to October 2020, women who were hospitalized and had vaginal deliveries were enrolled in this study. Before October 2020, the PDCA cycle was not applied for the SCC, and women who had vaginal deliveries were included in the pre-intervention group. From January 2021 to December 2021, the PDCA cycle was applied for the SCC, and women who had vaginal deliveries were included in the post-intervention group. The SCC utilization rate and the incidence of maternal and neonatal complications were compared between the 2 groups. The SCC utilization rate in the post-intervention group was higher than that in the pre-intervention group (P < .01). The postpartum infection rate in the post-intervention group was lower than that in the pre-intervention group, and the difference was statistically significant (P < .05). After the intervention, postpartum hemorrhage, neonatal mortality, and neonatal asphyxia rates were also reduced, although no significant differences were observed between the 2 groups. There was no significant difference in the third-degree perineal laceration or neonatal intensive care unit hospitalization rate between the 2 groups (P > .05). Application of the PDCA cycle can improve the SCC utilization rate, and the SCC combined with the PDCA cycle can effectively reduce the postpartum infection rate.

Associations between the Safe Prevention of Primary Cesarean Delivery Care Consensus and Maternal/Neonatal Outcomes.

This study aimed to compare cesarean delivery (CD) rates and maternal/neonatal outcomes before and after the 2014 ACOG/SMFM Obstetric Care Consensus for Safe Prevention of Primary CD. This retrospective study compared unscheduled CD rates and outcomes of singleton, cephalic, term pregnancies at a tertiary-care teaching maternity hospital. Births 5 years before (March 2009-February 2014) and after (June 2014-May 2019) release of the consensus were included. Chi-square and t-test were used to compare outcomes and logistic regression to adjust for confounders. In this study, 44,001 pregnancies were included, 20,887 before and 23,114 after the consensus. Unscheduled CD rates increased after the consensus (12.9 vs. 14.3%, p < 0.001); however, there was no difference after adjustment (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.91-1.03). Vaginal birth after cesarean (VBAC) deliveries increased among multiparas (4.8 vs. 7.2%, p < 0.001), which remained significant after adjustment (aOR, 1.51; 95% CI, 1.37-1.66). Postpartum hemorrhage, blood transfusion, and chorioamnionitis were modestly increased, while third-degree perineal lacerations decreased. Uterine rupture and neonatal outcomes were unchanged after adjustment. At our tertiary-care maternity hospital, the Safe Prevention of Primary CD Care Consensus was not associated with a change in unscheduled CD, though VBAC deliveries increased. We did not demonstrate improved neonatal outcomes and showed increased maternal morbidity that warrants further study. · Consensus did not change unscheduled cesarean rates.. · Consensus associated with increased hemorrhage.. · Institutional outcomes can assist implementing changes..

Impact of peripartum antibiotics on wound complications in women with obstetric anal sphincter injury.

To evaluate the role of antibiotics on preventing wound complications following obstetric anal sphincter injuries (OASI). This is a cohort study with retrospective and prospective components of women who sustained an OASI at vaginal delivery. The primary objective of this study was to assess the impact of prophylactic antibiotics at the time of delivery on perineal wound complications. Women were grouped based on peripartum antibiotic administration: no antibiotics (NABX), antibiotics for OASI wound complication prophylaxis (PABX), antibiotics for therapeutic indications (TABX), and antibiotics for any indication (AABX, PABX + TABX). Four hundred and twenty-five women with OASI were included in this analysis. Most women experienced a third-degree perineal laceration (358, 84.2%). One hundred and sixteen (27.3%) women received NABX, 195 (45.9%) women received PABX, and 114 (26.8%) women received TABX. Cefazolin was the most common antibiotic in the PABX group. Perineal wound complications occurred in 51 (12.0%) women: 14 (12.4%) in NABX, 26 (13.3%) in PABX, 11 (9.6%) in TABX, and 37 (12.0%) in AABX. The incidence of perineal wound complications did not differ between groups. In this cohort study, peripartum antibiotics did not reduce wound complication incidence following OASI. It is likely that a first-generation cephalosporin is not the ideal antibiotic in this clinical setting.

Delivery in water, experience in a population of Mexican women in Mexico City

Background: Labor is a physiological process during which the fetus, the membranes, the umbilical cord, and the placenta are expelled from the uterus and water delivery has become popular, although its prevalence is unknown, it is supported by healthy women with full-term pregnancies, without complications; although there is insufficient evidence to support or discourage it. Objective : To identify obstetric and neonatal outcomes and complications in women who delivered in water and to compare them with traditional deliveries. Material and methods: It is a retrospective, observational and cross-sectional study, where 2486 women were included from a database of 4223 women assisted from 2004 to 2020 in private hospitals; Of the 2486 patients included, 1025 had a water delivery and 1461 had a conventional delivery, discarding 1737 women who underwent caesarean section from the study. The information obtained from the patients, their data obtained for this study were kept in the anonymity of the patients, where they were analyzed: non-parametric data reported in percentages using Chi-square ; Parametric, perinatal and neonatal data are reported as mean plus Standard Deviation (± SD) and analyzed using Student’s T, using the SPSS version 25 statistical package. Results: A total of 2486 women were included in this study, the birth in 1025 was water delivery (24%) and 1461 was conventional delivery (35%), 1737 caesarean section (41%) were excluded from the study, no difference was observed maternal age; unlike weight, height, body mass index; they were higher in women with water birth compared to conventional. No difference was demonstrated between nulliparous (45.99%) and multiparous (53.86%) when comparing both births in water and conventional; only increase in previous cesarean sections (9.36 vs 6.5%, p = 0.008) and decrease in previous abortions (16.19 vs 20.94%, p = 0.002) in water delivery with the conventional one; complications were not different: administration of oxytocin (3.2 vs 3.1) or postpartum hemorrhage (0.29 vs 0.13) in both deliveries; no differences in first degree perineal tears (21.4 vs 18.5%); Only for the second and third-degree was it greater in conventional delivery than in water delivery (6.6 vs 11.4%, p = 0.00), (0 vs 2.8%) respectively, only 1.9% of deliveries in water that required epidural block ended in delivery conventional. Conclusion : Water birth reduces stress, pain sensation, second and third-degree perineal lacerations and contributes to better newborn outcomes; the selection and inclusion of patients with low-risk pregnancies allow better perinatal results than conventional delivery; but, further studies are required to use it routinely.

Reconstruction of third-degree perineal lacerations in female camels (Camelus dromedarius) using a modified Goetz one-stage repair technique.

This study was designed to evaluate the modified Goetz-one-stage repair technique for reconstruction of third-degree perineal lacerations (TDPLs) in female camels. Fifteen female dromedary camels with TDPL were surgically reconstructed using the modified Goetz one-stage repair using the three-line closure technique. The surgical outcomes, the interval between repair and breeding, and the postoperative conception of the operated female camels were recorded and analyzed. During the 12-month postoperative follow-up period, TDPLs in 14 female camels (93.33%) healed completely by the first intention with mild inflammatory edema and infection in 2 female camels. One camel (6.67%) had a rectovaginal fistula, which was successfully repaired with suturing through the vaginal approach. Of the 15 female camels, 13 (86.67%) subsequently became pregnant through natural mating within 3 to 6 months postoperatively; however, 2 (13.33%) were one was immature and the other was barren which referred for gynecological treatment. The modified Goetz one-stage repair technique was successful in 14 of the 15 female camels after a single surgery, with a low incidence of postoperative complications. This technique is efficient for the repair of TDPLs in female camels, with promising results for subsequent fertility.

Single-stage reconstruction of third-degree perineal lacerations in horses under general anesthesia: Utrecht repair method.

To describe perioperative management, surgical procedure, and outcome in mares with third-degree perineal lacerations (TDPL) treated with a single-stage repair, the Utrecht repair method (URM). Retrospective study. Twenty mares with TDPL. Medical records of mares with TDPL reconstructed with a URM were reviewed for perioperative management; surgical outcome; and postoperative fertility, athletic performance, and complications. Mares ranged in age from 3.5 to 11 years. Long-term follow-up was available for 13 mares. Mean duration of follow-up was 9 years (median, 9.5; range, 2-215 months (17.9 years)). Standardized perioperative fasting and postoperative refeeding protocols were used. Only five mares received supportive gastric medication. Reconstruction of the rectovestibular shelf was successful in 18 of 20 mares. Two of 20 mares developed a small rectovestibular fistula after the initial repair, which was successfully repaired with a second surgery. Other postoperative complications were observed in 13 mares and consisted of mild postanesthetic myositis, facial nerve paralysis, esophageal obstruction, rectal obstipation, partial perineal dehiscence, and rectal or vestibular wind-sucking. Six of seven mares that were subsequently bred became pregnant. One mare was successfully used for embryo recovery, and five of six mares foaled without recurrence of a TDPL. Nine of 13 mares were used for riding at various levels. The alternative single-stage reconstruction for TDPL was successful in 18 of 20 mares after a single surgery. No major complications related directly to the technique were noted. The URM is a valid alternative surgical technique for repairing TDPL in mares.

New frontiers in chromosome elimination-mediated doubled haploidy breeding: Focus on speed breeding in bread and durum wheat

Rectovaginal lacerations in the mare occur during parturition when the foal’s limb(s) or head are forced caudal and dorsal. The injury is seen predominantly in primiparous mares and is usually due to violent expulsive efforts by the mare (Colbern et al., 1985; Turner and McIlwraith, 1989). The injury is also seen following forced extraction of a large fetus or extraction before full dilation of the birth canal. Third-degree perineal lacerations occur when there is tearing through the rectovaginal septum, the musculature of the rectum and vagina, and the perineal body.

One Stage Surgical Management for Third Degree Recto-vaginal Laceration in Mares: A Report of Two Cases

Rectovaginal lacerations in the mare occur during parturition when the foal’s limb(s) or head are forced caudal and dorsal. The injury is seen predominantly in primiparous mares and is usually due to violent expulsive efforts by the mare (Colbern et al., 1985; Turner and McIlwraith, 1989). The injury is also seen following forced extraction of a large fetus or extraction before full dilation of the birth canal. Third-degree perineal lacerations occur when there is tearing through the rectovaginal septum, the musculature of the rectum and vagina, and the perineal body.

End-to-End Compared With Overlap Repair of Third-Degree Perineal Lacerations

End-to-End Compared With Overlap Repair of Third-Degree Perineal Lacerations

Inside-Out Continuous Suturing Technique for the Repair of Third-Degree Perineal Laceration in Mares

Seven mares with third-degree perineal laceration were treated by a two-stage surgical technique. The rectovestibular shelf was corrected with two layers of inside-out continuous suture technique distributed along the longitudinal axis of the vestibule, vagina, and rectum simultaneously obliterating perivestibular and perirectal space with poly-p-dioxanone. Perineal body was reconstructed in the second stage with simple continuous pattern and the skin using a horizontal mattress suture pattern. All mares completed the two-stage surgery, and healing occurred in all of them. Three mares had foaled once without any subsequent injury, one mare was in foal, and others were in regular heat. The results of the present study indicate that the inside-out continuous suturing technique appeared to be effective for repair of third-degree perineal laceration.

Maternal Body Mass Index and Risk of Obstetric Anal Sphincter Injury

Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5–24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third- or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28–0.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.

Clinical Significance of Deliveries With Uterine Fundal Pressure Maneuver at a Single Perinatal Center in Japan

Background: We examined the patient characteristics and obstetrical outcomes of deliveries with uterine fundal pressure maneuver (UFPM) to identify their clinical significance at a single perinatal center in Japan. Methods: Subjects were women with vertex singleton pregnancy who delivered at Japanese Red Cross Katsushika Maternity Hospital between April 2008 and September 2012. Results: A total of 6,317 cases were evaluated for the statistical analyses. Of these, UFPM was performed in 634 cases (10.0%). Using multiple logistic regression, UFPM was independently associated with nulliparity (P < 0.001), presence of oligohydramnios (P = 0.023), non-reassuring fetal status (P < 0.001), oxytocin use (P < 0.001), vacuum extraction (P < 0.001), Cesarean delivery (P = 0.021), postpartum hemorrhage (P < 0.001), mid-lateral episiotomy (P < 0.001), third-degree perineal laceration (P = 0.0042) and cervical laceration (P = 0.022). Conclusion: UFPM remains a controversial maneuver. Therefore, the physician should make the decision about the appropriate use of UFPM based on the patient ’ s individual clinical circumstances. doi: http://dx.doi.org/10.4021/jcgo87w

Surgical repair of third-degree perineal laceration by Goetz technique in the mare: 7 cases (2000-2005)

Summary Third-degree perineal lacerations in 7 mares were repaired surgically by a one-stage method (Goetz technique). Primary healing occurred in all of them without any complication. The conception rate obtained after surgery was 70.1%. Five horses out of seven got pregnant after surgery and no further injury was seen at subsequent foaling. Three mares have produced several healthy foals without any subsequent injury. According to the results of the present study, single-stage surgical repair of third-degree perineal laceration (Goetz technique) appeared to have a good prognosis for subsequent fertility in mares.

Neonatal Coagulopathy Presents as Unusual and Severe Subgaleal Hematomas After Vacuum Delivery

Neonatal subgaleal hematomas (SGHs) are infrequent but may be underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock have caused death in 20–60% of newborn infants [1]. SGHs are mostly caused by vacuum delivery, and sometimes by neonatal coagulopathy. We report a case of a newborn who suffered from severe SGHs and anemia on the third day after delivery. A 26-year-old, gravida 1, para 0, mother, who had regular prenatal care at our hospital with no abnormal laboratory data or abnormal sonographic findings, was admitted to our delivery room at 38 weeks’ gestation for labor. The first and second stages of labor took about 15 hours and 6 hours, respectively. Vacuum extraction was used because of maternal exhaustion and prolonged second stage. Third-degree perineal laceration was found after delivery. The male baby was active and irritable after delivery, with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. A small caput succedaneum occurred as usual, on the posterior fontanel. Unfortunately, the caput succedaneum seemed to progress until a big cephalohematoma was noted on the third day of delivery. It crossed the midline (sagittal suture) and covered the whole occipital area down towards the posterior neck, even though we packed it with an elastic cap. It continued to grow toward the anterior neck region and then the cheek. Patches of ecchymosis were noted over the eyelids (Figure), anterior neck, and ears. Because of this unusual appearance,

Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women

The purpose of this study was to determine whether selective midline episiotomy contributes to the prevention of third- or fourth-degree perineal lacerations. A randomized controlled clinical trial was performed with 446 nulliparous women with deliveries after 28 weeks of pregnancy. Patients were randomized to undergo either routine episiotomy or selective episiotomy. In the selective episiotomy group, episiotomies were performed only in cases of imminent lacerations, fetal distress, or forceps delivery. In the group of 223 patients who underwent routine episiotomy, 32 (14.3%) had third- or fourth-degree perineal lacerations, as compared to 15 (6.8%) in the group of 222 patients undergoing selective episiotomy (relative risk, 2.12; 95% confidence interval, 1.18-3.81). Only reduction in third-degree lacerations was significant when analyzed separately. Moreover, periurethral, labia minora, and superficial vaginal lacerations were significantly more frequent in the selective episiotomy group. The policy of performing selective midline episiotomy in nulliparous patients results in a reduction in the risk of third-degree perineal lacerations.

The Effect of Extended Preoperative Fasting in Mares Undergoing Surgery of the Perineal Region

Horses with third-degree perineal lacerations require surgical treatment. To reduce the risk of postoperative dehiscence of the surgical site caused by tension, bacterial contamination, and mechanical abrasion, a preoperative and postoperative fasting up to 14 days was performed. A complete blood cell count, concentrations of electrolytes, urea, creatinine, glucose, lactate, cholesterol, triglycerides, total protein, and the activities of aspartate aminotransferase, glutamate dehydrogenase, γ-glutamyl transferase, creatine kinase, and alkaline phosphatase were determined. Fasting resulted in a marked decrease in intestinal motility and an increase in the concentrations of triglycerides and cholesterol. The activity of the glutamate dehydrogenase increased three-fold during the presurgical period. The other biochemical values showed few fluctuations. Based on these data, we concluded that presurgical and postsurgical fasting causes no severe imbalances in the metabolism in mares.

Risk factors for sonographic internal anal sphincter gaps 6-12 months after delivery complicated by anal sphincter tear

The objective of the study was to identify risk factors for internal anal sphincter (IAS) gaps on postpartum endoanal ultrasound in women with obstetric anal sphincter tear. This prospective study included 106 women from the Childbirth and Pelvic Symptoms Imaging Supplementary Study who had third- or fourth-degree perineal laceration at delivery and endoanal ultrasound 6-12 months postpartum. Data were analyzed using Fisher's exact and t tests and logistic regression. Mean (+/- SD) age was 27.7 (+/- 6.2) years. Seventy-nine women (76%) were white and 22 (21%) black. Thirty-seven (35%) had sonographic IAS gaps. Risk factors for gaps included fourth- vs third-degree perineal laceration (odds ratio [OR] 15.4, 95% confidence interval [CI] 4.8, 50) and episiotomy (OR 3.3, 95% CI 1.2, 9.1). Black race (OR 0.23, 95% CI 0.05, 0.96) was protective. In women with obstetric anal sphincter repairs, fourth-degree tears and episiotomy are associated with more frequent sonographic IAS gaps.

Anal incontinence among women with one versus two complete third-degree perineal lacerations

Objective: To compare the rate of anal incontinence and severe incontinence among women who had 0, 1, and ≥ 2 additional vaginal deliveries after sustaining a third-degree perineal laceration and between subjects with one versus two third-degree tears. Method: A telephone survey was done to assess the anal function of all subjects who sustained a complete third-degree tear as a nullipara. Result: The rate of anal incontinence and severe incontinence was similar among women who had 0, 1, and ≥ 2 additional deliveries (11/65, 11/67, and 12/40, p = 0.179; 2/65, 1/67, and 2/40, p = 0.811) and between women who had one sphincter tear and no additional delivery versus those with two tears and ≥ 2 subsequent deliveries (11/65 and 10/37, p = 0.225. 2/65 and 2/37, p = 0.460). Conclusion: Additional vaginal deliveries and a repeat sphincter tear after the initial third-degree laceration were not associated with a higher rate or severity of anal incontinence.

A modified surgical technique for repairing third-degree perineal lacerations in mares

A modified surgical technique has been developed for repairing third-degree perineal lacerations in mares. Complications of the currently used methods include rectovaginal fistula formation, urine pooling, complete dehiscence of the repair, constipation, tenesmus and difficulty of performance in the practice. The modified method is simpler and more practical. This method was performed on eight Thoroughbred mares with third-degree perineal lacerations after delivery. The rectovestibular septum was reconstructed by three lines of sutures in a transverse direction in relation to the longitudinal axis of the rectum. In one of the eight cases pneumorectum was observed after using the new method. The conception rate obtained after using the new surgical technique was 62.5%. Pregnant mares delivered normally without any new lacerations at the subsequent parturition. It can be concluded that this new surgical technique can be used successfully for repairing third-degree perineal lacerations in mares.