Third-degree Tears Research Articles

Does Combining Warm Perineal Compresses with Perineal Massage During the Second Stage of Labor Reduce Perineal Trauma? A Randomized Controlled Trial: Warm compresses for reducing perineal trauma.

Various interventions have been applied to reduce perineal trauma and obstetric anal sphincter injuries (OASIS). The efficacy of warm compresses during the second stage of labor for reducing the occurrence of perineal tears is controversial. We aimed to compare rates of spontaneous perineal tears requiring suturing, between women who received warm compresses plus perineal massage vs. perineal massage alone. Women admitted to a single tertiary university-affiliated hospital between June 2023 and January 2024 were randomized to receive warm compresses and perineal massage (n=206) or perineal message only (n=206) during the second stage of labor. Excluded were women with a history of third-degree perineal tear, nut allergy, fetal death, Crohn's disease with perineal involvement, or delivery number >5. Participant allocation was concealed until the second stage of labor. The allocated perineal management was implemented at the time of active fetal descent and when the participant felt the need to push. During active maternal pushing, gentle perineal massage with almond oil was performed in both study groups. In one group, warm compresses were applied between contractions, for a minimum of 10 minutes and a maximum of 30. The temperature of the warm compresses was kept in the range of 45-59°C. The perineum was protected during delivery with a hands-on technique. After delivery, the perineum was assessed by an intervention-blinded senior midwife and rectal examination was performed for ruling out OASIS. The primary outcome was the rate of perineal tears requiring suturing. Secondary outcomes included the rates of OASIS and episiotomies. A sub-analysis according to parity and an intention-to-treat analysis were performed. Similar proportions of women treated and not treated with warm compresses had spontaneous perineal tears requiring suturing: 43.7% vs 45.1%, p-value=0.766. The groups did not differ in the proportions with first-degree tears, 22.8% vs 21.4%, p-value=0.722; second-degree tears, 21.4% vs 23.8%, p-value=0.566; and OASIS rates, 0.5% in each. In a sub-analysis according to parity, the proportion with perineal tears did not differ between the two groups. For women treated during the second stage of labor with warm compresses and perineal massage, compared to perineal massage alone, the rate of spontaneous perineal tears requiring suturing was similar. VIDEO ABSTRACT.

Retrospective Case-Control Study of Extended Birth Perineal Tears and Risk Factors.

A perineal tear is a rupture of the skin or muscle between the vagina and anus (perineum). A third-degree tear is one type of extended perineal tear (EPT), and it involves the penetration of the anal sphincter muscle.Another type of EPT is a fourth-degree laceration, which penetrates deeper into the lining of the anus or rectum. The stretching of the perineum during childbirth may result in perineal trauma. Invasive surgical interventions are required for the treatment of EPTs.For this reason, the reduction of their incidence can be achieved by fully comprehending the risk aspects associated with them. The aim of this study is to contribute to the body of knowledge by providing insight into the various risk factors that are associated with extended perineal trauma.By following this path, this study aims to contribute to and advance Saudi Arabia's development of evidence-oriented obstetric care recommendations. The current study is a case-control study where a review of 5000 vaginal delivery records was carried out between March 1, 2018, and March 19, 2023. For the study, cases (n = 71) were female patients who had documented greater than second-degree perineal injury.The control group (n = 238) was randomly chosen from women who had vaginal delivery but with less or equal to a second-degree perineal laceration. For each patient, we reviewed medical and obstetrics records for the following characteristics: age of diagnosis, gestational age, parity, labor induction, second-stage labor duration, mode of delivery, infant birth weight, epidural use and episiotomy indication, healthcare worker (HCW) experience,and APGAR (appearance, pulse, grimace, activity, and respiration) score. From the 5000 births analyzed, the cases were 71 patients (1.42% of 5000 births).The mean age at diagnosis in our sample was (28.05 ± 4.66 years).The study's results showed that the following variables significantly affected the occurrence of EPTs: birth weight, labor durations, parity, HCW experience, and mode of delivery.The odds for tears were 3.69 (95% CI: 0.156-0.469) higher in nulliparous patients relative to multiparous patients. Instrumental deliveries resulted in more tears than non-instrumental deliveries with an odds ratio (OR) of 5.901 (95% CI: 2.443-14.525). This study also found that prolonged second-stage labor seems to be associated with an increased risk of perineal damage. HCW experience was looked at in relation to the increased incidence of EPTs, which showed that midwives had a lower incidence rate than physicians with an ORof 2.25 (95% CI: 1.169-4.366). Epidural usage has also been significantly associated with a lesser incidence of perineal tears, which indicates that using epidural could protect against the occurrence of EPTs. In conclusion,the occurrence of perineal lacerations could be prevented during childbirth by taking preventative measures and having more precise judgments. Epidural was a protective factor in our study against the incidence of extensive perineal tearing.Furthermore, as compared to midwives, our study showed that the majority of EPTS occurred in cases of physicians (residents/consultants). Further research, proper documentation, and the development of evidence-based guidelines are needed to improve perineal care and reduce EPTincidence.

The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis.

In order to reduce the complications of perineal damage and the pain caused by it for the mother, this study was conducted to determine the effect of warm perineal compress on perineal trauma (1st-, 2nd-, 3rd-, and 4th-degree perineal tears), postpartum pain, intact perineum (primary outcomes), episiotomy, length of the second stage, and APGAR score at 1 and 5min after childbirth (secondary outcome). PubMed, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, SID, Magiran, and ClinicalTrials.gov were searched to identify the relevant articles from inception to November 1, 2022, with language restriction (only English and Persian). A manual search was also performed. Risk of bias 2 (RoB2) and ROBIN-I were employed to evaluate the quality of the included papers. Meta-analysis was conducted using RevMan 5.3. Heterogeneity was assessed using I2. In cases with high heterogeneity, subgroup analysis was utilized based on the parity and ethnicity, and time of pain measurement after delivery also a random-effects model was used instead of a fixed-effects model. Trial sequential analysis (TSA) was performed for the primary outcomes. The certainty of evidence was assessed using the GRADE approach. A total number of 228 articles were found in databases. Of these articles, eighty-six were screened by title, 27 by abstract, and 21 by full text. Finally, 14 articles were included, of which ten were RCT and four were non-RCT. Meta-analysis results revealed that warm perineal compress significantly reduced perineal pain (RR 0.23, 95% CI 0.08-0.66; P = 0.0006), average pain (SMD -0.73, 95% CI 1.23 to -0.23; P = 0.004), second-degree perineal tear (RR 0.65, 95% CI 0.54-0.79; P˂0.00001), third-degree perineal tear (RR 0.32, 95% CI 0.15-0.67; P = 0.003), fourth-degree perineal tear (RR 0.11, 95% CI 0.01-0.87; P = 0.04), episiotomy (RR 0.63, 95% CI 0.46-0.86; P = 0.004), and intact perineum significantly increased (RR 3.06, 95% CI 1.79-5.22; P < 0.0001) compared to the control group. However, there was no statistically significant difference in terms of first-degree tear (RR 1.04, 95% CI 0.86-1.25; P = 0.72), length of the second stage of labor (MD -0.60, 95% CI -2.43 to 1.22; P = 0.52), the first minute (MD -0.03, 95% CI -0.07 to 0.02; P = 0.24) and the fifth minute Apgar score (MD -0.02, 95% CI -0.07 to 0.03; P = 0.46) between the two groups. Warm perineal compress administered during the second stage of laborreduce postpartum pain, second and third-degree perineal tears, andepisiotomy rate while it increases the incidence of intact perineum compared to the control group.

A91 INTERACTIONS BETWEEN PREGNANCY, DELIVERY, AND ILEAL POUCH-ANAL ANASTOMOSIS FOR INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE CHART REVIEW

Abstract Background Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects people in their reproductive years of life. Surgical treatment for medically refractory UC involves surgery over 2-3 stages, which includes a subtotal colectomy followed by creation of an ileal pouch-anal anastomosis (IPAA), known as a “J pouch”. The IPAA allows preservation of fecal continence and avoids the psychosocial impacts of a stoma. The IPAA procedure is a deep pelvic surgery, which may impact pregnancy outcomes. Caesarean section (C-section) delivery is often performed to avoid anal sphincter and J pouch damage from vaginal delivery. However, literature demonstrates conflicting results regarding the risks of C-section compared to vaginal delivery, including the impact on pouch function. Surveys of clinicians also report varying delivery recommendations. Purpose To describe the delivery methods, pregnancy outcomes and postpartum course of IBD patients with IPAA at Mount Sinai Hospital. Method A retrospective chart review is being performed for female patients at Mount Sinai Hospital (Toronto, Ontario) with a diagnosis of IBD and an IPAA. Eligible patients completed a pregnancy from January 1, 2002-February 1, 2021 post-IPAA surgery and had variables of interest accessible in their electronic medical record. Variables of interest include demographics, pregnancy history, IBD characteristics, IPAA surgery details, pregnancy outcomes, mode of delivery and characteristics, and postpartum complications. Clinical data will be presented as means, medians and frequencies. Differences between variables of interest will be evaluated with Student’s t-test or chi-squared test. Result(s) Three avenues of patient identification yielded 1113 patients to be screened. Inclusion criteria were met for 71 patients and chart review is complete for 36 patients who had a total of 53 pregnancies and delivered 56 babies. Most patients (49%) had a two-stage IPAA surgery, 21% required a three-stage surgery and 30% were undocumented. Most patients’ (55%) IPAA was created through laparotomy, while 13% was through laparoscopic procedure and 32% was undocumented. Seventy-four percent of deliveries were through C-section (75% of primiparous), 69% of which were indicated to protect the patient’s J pouch and 31% for an obstetrical indication. The remaining 26% of deliveries were vaginal, 29% of which were assisted with forceps or vacuum, 57% had tears (37.5% first-, 37.5% second-, and 25% third-degree) and 50% had an episiotomy. Conclusion(s) At Mount Sinai Hospital, most IBD patients with an IPAA who completed a pregnancy had a history of laparotomy to create their IPAA. Most patients (74%) with IBD and an IPAA are delivering through C-section, and mainly to protect their J pouch, which is in line with reports in the literature. Most patients had a tear or episiotomy during vaginal delivery. Rates of third-degree tears may be higher than in the general population. Trends will be further elucidated with advancement of the study. Disclosure of Interest None Declared

Obstetric rectal buttonhole tear and a successful three-layer repair: A case report

An obstetric rectal buttonhole tear (ORBT) is a rare obstetric complication with only 21 cases reported in the literature. The choice of two- or three-layer repair of ORBT is controversial. In this case, the author describes (with high-quality images) an ORBT repaired in three layers in order to provide clinical lessons to healthcare professionals involved in obstetrical care. The patient was a 26-year-old pregnant woman with a previous vertex delivery and 4 previous first-trimester miscarriages. In the index pregnancy, she had a spontaneous vertex vaginal birth of a 3095g male baby at 39weeks of gestation. During childbirth, she sustained an ORBT and a third-degree perineal tear involving <50% of the external anal sphincter. The ORBT was repaired in three layers using continuous 2-0 Vicryl to the rectal mucosa, and interrupted polydioxanone (PDS) 3-0 to the adjoining vagino-rectal fascia. Subsequently, the external anal sphincter was repaired end-to-end with interrupted PDS 3-0. Thereafter, the vagina was repaired with continuous Vicryl 2-0. The wound healed with no complications over the 12weeks of postnatal clinic visits. A three-layer repair is arguably preferable given that closure of the fascia between the rectal and vaginal mucosae (vagino-rectal fascia) may improve the tensile strength at the injury site. However, a two-layer repair may be undertaken in rare cases where the vagino-rectal fascia is not identifiable.

Substantial Obstetric Anal Sphincter Injury during Vacuum Assisted Delivery: An Obstetrical Issue or Device Related?

Obstetric anal sphincter injuries (OASIS) might be associated with long-term urinary and anorectal morbidities. The aim of the study was to investigate the risk factors and clinical implications of OASIS associated with vacuum-assisted deliveries versus normal vaginal deliveries. A series of 413 consecutive OASIS cases were retrospectively analyzed. A comparison was made between OASIS cases diagnosed following vacuum-assisted deliveries versus OASIS cases diagnosed following normal vaginal deliveries. Multivariable analysis was used to study the association between vacuum-assisted deliveries and superficial (3A and 3B) versus deep (3C and 4) perineal tears. The study population comprised 88,123 singleton vaginal deliveries. Diagnosis of OASIS was made in 413 women (0.47% of the total cohort), 379 (91.8%) of whom had third-degree tears and 34 (8.2%) of whom had fourth-degree tears. Among the 7410 vacuum-assisted deliveries, 102 (1.37%) had OASIS, whereas, among the 80,713 normal vaginal deliveries, only 311 (0.39%) had OASIS. In a multivariate analysis, only vacuum-assisted delivery was found to be associated with a significant risk of deeper (3C or 4) perineal tears (OR = 1.72; 95% CI 1.02-2.91; p = 0.043). Vacuum-assisted instrumental intervention is a significant risk factor for OASIS and especially for deeper tears, independent of other maternal and obstetric risk factors.

Examining the Association Between Episiotomy and Severe Perineal Tears in a Tertiary Care Center Implementing a Restrictive Episiotomy Policy.

Background Perineal lacerations are feared complications of vaginal delivery, especially the severe types (third- and fourth-degree tears). World Health Organization (WHO) recommended restrictive episiotomy practice after alarming literature linked the increase in severe tears with routine episiotomy. Therefore, this study aimed to measure the association between episiotomy and the incidence of third- and fourth-degree perineal tears and infections in women who underwent episiotomy versus those who did not at a tertiary care center implementing the restrictive episiotomy policy in Jeddah, Saudi Arabia. Methods This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology at King Abdulaziz Medical City (KAMC), Western Region, between May 2016 and May 2018, targeting all pregnant women who underwent normal spontaneous vaginal delivery. The nonprobability convenient sampling technique was used for women who underwent episiotomy. Women without episiotomy (control group)were randomly selected in a 1:1 ratio. The prevalence (incidence) of episiotomy and its association with severe perineal tears were measured. Statistical data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY). A p-value of less than 0.05 was considered significant. Result A total of 7436 deliveries were recorded. At KAMC, episiotomy had a prevalence of 10% and was more common in primipara. The incidence of third-degree tears was 3.3% in the episiotomy group and 0.8% in the control group (odds ratio, 4.1; p = 0.03). None had fourth-degree tears. Furthermore, the infection rate was not significantly different between the two groups (0.1% vs. 0.1%). Using Firth's logistic regression model, primipara emerged as an independent significant risk factor (OR, 3.5 [1.1-11.2]; p = 0.035)while the trend toward increased risk for tear development in the episiotomy group became statistically insignificant (OR, 2.3 [0.7-8.0]; p = 0.19). A post hoc examination to observe the association between episiotomy exposure and BMI using a stepwise logistic regression model showed that parity and age were independent risk factors for episiotomy, with OR values of 2.2 (1.6-3.2) and 0.9 (0.88-0.94), respectively (p < 0.001). The BMI became insignificant, with an OR of 1.0 (0.7-1.4) (p = 0.96). Conclusion The development of severe perineal tears in acenter with a restrictive episiotomy policy is rare. Parity has emerged as an independent risk factor for severe perineal tears.Prospective multicenter research with a larger sample size is recommended to validate this study's findings further and investigate other obstetric measures to reduce severe tears in primi mothers.

The clinical characteristics of perineal tears: A study carried out on 14 pregnant women in a tertiary center: Case series

BackgroundThe sheer quality of the female genital tract is not always respected at the time of childbirth because no protocol for the management of perineal tears exists in our services these days. The management remains dependent on a gynecologist and obstetrician. The study aimed to describe the characteristics of perineal tears. MethodsOur cross-sectional, retrospective, and descriptive study focused on patients admitted for childbirth and hospitalized in the obstetrics department of the Saint Luc Tertiary Clinic for a period from March 2021 to March 2022. During this period, we recorded 111 deliveries with 14 perineal tears. ResultsA total of 111 deliveries were recorded with a 12.6% frequency of perineal tears. 64.3% of women aged between 26 and 35 and 71.4% of primiparous women were affected by perineal tears. For delivery, 64.3% of births were eutocic deliveries, with 42.9% of children born with a birth weight greater than 4 kg, and the cephalic presentation delivered 86% of children. For degrees of perineal tears, 64.3% of patients had first-degree perineal tears. For postpartum treatment of perineal tears, analgesics help calm the pain, and antibiotic therapy has been considered. For fourth and third-degree tears, episiotomy was performed as a surgical procedure. ConclusionPerineal tears are the trauma often encountered in obstetrics; the first few suffer from it essentially. The high birth weight of children is often the cause. They require immediate management to prevent or avoid infections.

Obstetric anal sphincter injuries (OASIS): using transperineal ultrasound (TPUS) for detecting, visualizing and monitoring the healing process

PurposeThe aim of this study was to examine whether OASIS, and its extent, can be confirmed or excluded using transperineal ultrasound (TPUS). A further objective of this study was to monitor the healing process over a period of 6 months and to establish a connection between the sonographic appearance of obstetric anal sphincter injury (OASIS) and anal incontinence.Materials and methodsIn this retrospective clinical study, women with OASIS who gave birth between March 2014 and August 2019 were enrolled. All the patients underwent TPUS 3 days and 6 months after delivery. A GE E8 Voluson ultrasound system with a 3.5–5 MHz ultrasound probe was used. The ultrasound images showed a third-degree injury, with the measurement of the width of the tear and its extent (superficial, partial, complete, EAS and IAS involvement). A positive contraction effect, a sign of sufficient contraction, was documented. Six months after delivery, a sonographic assessment of the healing (healed, scar or still fully present) was performed. A Wexner score was obtained from each patient. The patients’ medical histories, including age, parity, episiotomy and child’s weight, were added.ResultsThirty-one of the 55 recruited patients were included in the statistical evaluation. Three patients were excluded from the statistical evaluation because OASIS was excluded on TPUS 3 days after delivery. One patient underwent revision surgery for anal incontinence and an inadequately repaired anal sphincter injury, as shown sonographic assessment, 9 days after delivery. Twenty patients were excluded for other reasons. The results suggest that a tear that appears smaller (in mm) after 3 days implies better healing after 6 months. This effect was statistically significant, with a significance level of alpha = 5% (p = 0.0328). Regarding anal incontinence, women who received an episiotomy had fewer anal incontinence symptoms after 6 months. The effect of episiotomy was statistically significant, with a significance level of alpha = 5% (p = 0.0367).ConclusionTPUS is an accessible, non-invasive method for detecting, quantifying, following-up and monitoring OASIS in patients with third-degree perineal tears. The width, as obtained by sonography, is important with regard to the healing of OASIS. A mediolateral episiotomy seems to prevent anal incontinence after 6 months.

Labor interventions in low- and high-risk parturients in a university hospital.

The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.

Perineal Injury with Vaginal Delivery; What are the Risks

Objective: To observe the severity of the perineal trauma and its risk factors among women who developed perineal tears during vaginal delivery. Material and methods: This descriptive cross-sectional study was conducted at the Obstetrics and genecology department of LUMHS, Hyderabad, Pakistan, from September 2016 to August 2017. All the women who developed perineal trauma during vaginal delivers, age 18–40 years, singleton pregnancy, both primiparous and multiparous were included. After delivery, patients who had developed perineal tears were assessed for its severity and risk factors. Perineal tears were categorized as per severity in four categories All the data were collected via study proforma and for the analysis of data, the 26 versions of SPSS were employed. Results: A total of 100 cases were studied in the study and most of the patients 45.0% were in the age group of 15–25 years. The average gestational age was 38.2+4.1 weeks. Primiparous cases were 65.0%. Un-booked women were 65.0%. 30.0% underwent mediolateral episiotomy and 19.0% with a midline cut extension. Most of the women 41.0% were delivered by NVD, followed by 26.0% by assist vaginal delivery and while 33.0% women underwent instrumental vaginal delivery. According to the birth weight the 40.0% babies weighing more than 2.5 kg. 40.0% females had a first-degree perineal tear, followed by 32.0 percent had a second-degree tear, 19.0 percent had third-degree tear, and 10.0 percent had a fourth-degree perineal tear. Conclusion: Perineal trauma of 3rd and 4th degree were observed to be 19% and 10%, respectively. Maternal age less than 25 years, primiparity, un-booked status, use of the oxytocin, previous history of the vaginal surgeries and fetal weight &gt;2.5 kg were observed the risk factors of the perineal tear. Key words: NVD, Severity of perineal tears, risk factors.

Prevalence, Associated Risk Factors and Maternal Outcomes of Lower Genital Tract Injuries in the Bamenda Regional Hospital

BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if severe, poorly managed or delayed in repair. It is a frequent complication of vaginal delivery. This study was aimed at determining the prevalence, demographic characteristics, risk factors, patterns and the t-term maternal outcomes of lower genital tract injuries in the labour room and the post-natal ward of the Bamenda Regional Hospital. METHODS: This was a hospital-based cross-sectional study of women managed for genital tract injuries following vaginal birth in the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A non-probabilistic, consecutive and exhaustive sampling technique was used to select participants (sample size estimated at 237). Among those selected were women who had a vaginal birth. However, the researchers’ interest was particularly centered on the women who had genital tract injuries. Data was collected using a pretested questionnaire and analyzed using the SPSS version 22 software. RESULTS: In total, 310 participants were included in this study. The mean age of the participants was 26.1 years (SD = 5.2), while the median age was 25 years (interquartile range = 22 - 29). Of the 310 participants included in the study, 128 developed a birth tract injury giving a prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We did not have any cases of fourth-degree perineal tears. We also encountered a few cases of cervical tears (0.6%). The factors associated with birth tract injury were assessed using bivariate and multiple logistic regression analysis. On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 - 5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002), being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were statistically significantly associated with birth tract injuries. The majority of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc and above. Also, the severity of genital pain lasting beyond 24 hours postpartum was mostly less than 5/10 (50.6%) followed by genital pains > 7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no maternal death from injury was recorded. CONCLUSION: The prevalence of lower genital tract injuries in the Bamenda Regional hospital is high. First-degree tears were the most common followed by episiotomies. The perineal outcome in the BRH is poor and should be improved upon.

Obstetric Perineal Tears in Pregnant Adolescents and the Influencing Factors

The incidence and risk factors of obstetric perineal tear occurrence in vaginal delivery of adolescent pregnant patients are not well established. We aimed to describe the incidence of obstetric perineal tears in adolescents and the maternal obstetric risk factors associated with this situation. Retrospective cohort study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Adolescent pregnant patients (≤19 years) who delivered vaginally in our institution between January 2014 and January 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: The main outcome measures were the incidence of perineal tears, the degree of perineal tears, and the risk factors associated with severe perineal tears in adolescents. Severe perineal tears include third- and fourth-degree lacerations. A third-degree tear is defined as partial or complete disruption of the anal sphincter muscles, and a fourth-degree tear is defined as lacerations involving the rectal mucosa. A total of 3441 adolescents who had a vaginal delivery were included in the study. The rate of severe perineal tear was 5.8% (200/3441). Risk factors associated with obstetric laceration in adolescents in multivariate analysis were nulliparity (OR=1.72; 95% CI, 1.14-2.41; P=0.007), high birth weight (OR=4.1; 95% CI, 2.71-6.21; P < 0.001), and labor induction (OR=1.36; 95% CI, 1.01-1.85; P=0.02). Spontaneous onset of labor and previous delivery reduced the risk of severe perineal tear in adolescent pregnant patients (respectively, OR=0.68; 95% CI, 0.51-0.94; P=0.02 and OR=0.51; 95% CI, 0.33-0.79; P=0.007). In adolescents, the risk of severe perineal tear was associated with nulliparity, birth weight, and labor induction. The only possible modifiable risk factor was labor induction.

Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014–2019: a national population-based cross-sectional study

ObjectivesThe aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales.DesignCross-sectional analysis.Setting64 699 live births in Wales from 31...

Vacuum-assisted vaginal deliveries among parturients with congenital uterine anomalies; risk factors and outcomes

ObjectiveTo evaluate the maternal and neonatal outcomes associated with vacuum-assisted vaginal delivery (VAVD) in a subset of parturients with congenital uterine anomalies. Study DesignA retrospective database study was conducted at a single tertiary center between 2005 and 2019. Parturients with known congenital uterine anomalies who had vaginal deliveries were enrolled, whereas parturients with failed VAVD, didelphic uterus, and delivery after intrauterine fetal death were excluded. Various maternal and neonatal outcomes were compared between parturients who achieved spontaneous vaginal delivery (SVD) and those who delivered via VAVD. The maternal composite outcome was calculated for each group and included one or more of the following: post-partum hemorrhage, hemoglobin drop ≥ 4 gr/dL, blood transfusions, retained placental products, and obstetric anal sphincter injuries. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. ResultsAfter the application of the exclusion criteria, 332 parturients were found eligible. Of those, 289 (87%) had SVD and 43 (13%) had VAVD. VAVD was more common among primiparous parturients and epidural analgesia users. Parturients with VAVD had higher rates of third-degree perineal tear, postpartum hemorrhage, and blood transfusions. The maternal composite outcome was significantly more prevalent in the VAVD group (44.2% vs. 20.8%, p < 0.01). After controlling for potential confounders, the maternal composite outcome was found to be independently associated with VAVD (aOR 2.3, 95% CI 1.10–4.60). The neonatal results were overall comparable, except for scalp trauma and Erb’s palsy/clavicular fracture, which were more prevalent in the VAVD group. ConclusionIn a special population of parturients with congenital uterine anomalies, VAVD was found to be associated with significantly higher rates of adverse maternal outcomes and perinatal birth trauma. These findings should be presented to parturients during consultations about modes of delivery.

The effect of warm compresses on perineal tear and pain intensity during the second stage of labor: A randomized controlled trial.

Warm compress is believed to reduce perineal tear occurrence and decrease pain intensity during the second stage of childbirth. This study aimed to determine the effect of warm compresses on perineal tear and pain intensity during the second stage of labor. A randomized controlled trial was conducted between 28 September 2018 to 30 October 2018 in King Khaled Hospital (KKH), affiliated with the Ministry of National Guard Hospital Affairs, King Abdul-Aziz Medical City Western Region, Saudi Arabia. According to eligibility criteria, the sample randomly recruited through lottery included 100 primigravida pregnant women, with 50 in each intervention and control group. Data were presented in the form of frequency and percentages, standard deviation, and mean. Chi-square test was used for data analysis, with p-value significance at ˂ 0.05. Sociodemographic data revealed no statistically significant difference in the age, education, occupation, and residence of both the control and experimental group. The perineum area's pain intensity after birth showed a statistically significant difference between the intervention and the control groups (p = 0.001). The perineal tear was also significantly different between both groups (p = 0.001). The applied warm compresses on the perineum area positively reduce second and third-degree perineal tear and pain intensity during the second stage of labor and after childbirth. Therefore, midwives and nurses are expected to actively provide effective planned in-service training programs regarding warm compresses' advantages in the second stage of labor and apply this procedure actively.

Enhancing the identification of anal incontinence in women of reproductive age

Anal incontinence is an unpredictable and debilitating condition that can significantly reduce quality of life. Symptoms include the involuntary loss of solid and/or liquid stool, flatus incontinence and rectal urgency. Pregnancy and childbirth are two major factors that increase the risk of anal incontinence in women of reproductive age. Women at high risk of anal incontinence include those with a known history of the condition and those who have experienced severe perineal trauma, particularly after injury to the anal sphincters (third-degree and fourth-degree tears). Routine screening for anal incontinence of women in high-risk groups during pregnancy and after childbirth appears to be limited in clinical practice. This article discusses the potential benefits of screening for anal incontinence, outlines the factors that inhibit and enable screening, describes current bowel screening tools and their limitations, and explores how the identification of anal incontinence in women of reproductive age could be improved.

Perineal tears sustained during vaginal birth: a cross-sectional study

Aim: To analyse the type, location, degree, shape and size of perineal tears sustained during normal birth. Design: Cross-sectional study. Methods: The sample was composed of 100 women with perineal tears whose length and depth were measured using the tool Peri-Rule&#8482;. Bivariate and multivariate analyses were carried out using a significance level of 5% (p = 0.05). Results: Similar numbers of women sustained single or multiple tears (51% vs 49%). Perineal tears occurred more frequently in the posterior than anterior region of the perineum (80% vs 58%). In 77.5%, 20.0% and 2.5% of the women, first-, second- and third-degree tears, respectively, occurred in the posterior region of the perineum, with over half of them having straight-line tears (62.5%), approximately one third having U-shaped tears (35.0%) and a minority having star-shaped tears (2.5%). Perineal oedema during labour (OR = 5.31) remained an independent predictor of second-degree tears. Infant birth weight (RCÂ = -1.32), perineal body length (RC = 0.41) and oxytocin use (RC = -6.44) were statistically significantly associated with the size of perineal tears sustained. Conclusion: Perineal tears following normal birth were most likely of the first degree, straight-line and occurred mainly in the posterior region of the perineum. The degree, length and depth of the tears varied according to the location.

446 Risk factors and outcomes of vacuum assisted vaginal deliveries among parturients with congenital uterine anomalies

To evaluate the maternal and neonatal outcomes associated with vacuum-assisted vaginal delivery (VAVD) in a subset of parturients with congenital uterine anomalies. A retrospective cohort study was conducted at a single tertiary center between 2005 and 2019. Parturients with known congenital uterine anomalies who had vaginal deliveries were included; we excluded parturients with failed VAVD, didelphic uterus, and delivery after intrauterine fetal death. Maternal and neonatal outcomes were compared between parturients who achieved spontaneous vaginal delivery (SVD) and those delivered via VAVD. A maternal adverse composite outcome was calculated for each group and included one or more of the following: hemoglobin drop > 3 gr/Dl, blood transfusions, retained placental products, and obstetric anal sphincter injuries. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. After the application of the exclusion criteria, 332 parturients were identified; of those, 289 (87%) had SVD and 43 (13%) had VAVD. VAVD was more common among primiparous parturients and epidural analgesia users. Parturients with VAVD had higher rates of third-degree perineal tear, postpartum hemorrhage, and blood transfusions. The maternal composite outcome was significantly more prevalent in the VAVD group (44.2% vs. 20.8%, p < 0.01). After controlling for potential confounders, the maternal adverse composite outcome was found to be independently associated with VAVD (aOR 2.3, 95% CI 1.10–4.60). The neonatal outcomes were comparable among groups, except for scalp trauma and Erb’s palsy/clavicular fracture, which were more prevalent in the VAVD group. In a population of parturients with known congenital uterine anomalies, VAVD was found to be associated with significantly higher rates of adverse maternal outcomes and perinatal birth trauma. These findings should be accounted for at consult sessions towards delivery plan.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Residual Defects of the Anal Sphincter Complex Following Primary Repair of Obstetrical Anal Sphincter Injuries at a Large Canadian Obstetrical Centre.

To determine the rates of residual anal sphincter defect following primary repair of obstetrical anal sphincter injury (OASIS), and to assess symptomatology in these patients. A retrospective observational study of patients who underwent primary repair of an OASIS sustained at Mount Sinai Hospital from January 2016 to June 2017. Records were reviewed for demographic and obstetrical data, symptoms of anal incontinence (AI), and the results of endoanal ultrasonography (EA-US). Onehundred andone women sustained an OASIS during the study period, of whom 53 had EA-US performed at Mount Sinai Hospital; 4 women were excluded from this analysis. There were 42 third-degree tears and 7 fourth-degree tears. EA-US revealed residual defects in 22 patients with third-degree tears and 5 patients with fourth-degree tears (52% vs. 71%; P = 0.44). Twelve patients with third-degree tears and 4 patients with fourth-degree tears reported AI(29% vs. 57%; P = 0.20). EA-US revealed no evidence of a tear in 14 patients clinically diagnosed with third-degree tears and 1 patientclinically diagnosed with a fourth-degree tear(33% vs. 14%). These data demonstratedeficiencies indiagnosis and repair of OASIS. Continued training for health care providers on identification and effective repair of OASIS may improve outcomes for women who experience this complication.