Vaginal Tears Research Articles

The Effectiveness of Mostafa Maged Technique in Closure of the Episiotomy during Vaginal Delivery.

This study is done to assess the effectiveness of Mostafa Maged technique in suturing the episiotomy. At the time of delivery, this technique will be applied to all women with episiotomy or perineal or vaginal tears. The technique employs absorbable vicryl threads with 75 mm round needles. Mostafa Maged technique includes the continuous suturing of the vaginal epithelium and the muscle layer. Evaluation of the perineal region within the next twenty-four hours prior to discharge searching for (edema-hematoma-septic wound - continence - ecchymosis - dyspareunia). The current study included 50 patients. All patients had an episiotomy during delivery; 25 patients' episiotomies were sutured using Mostafa Maged technique, while the remaining patients' episiotomies were by regular traditional technique. Mostafa Maged technique has demonstrated efficacy in achieving adequate hemostasis and avoiding dead space formation during an episiotomy. It was found that 100 % of patients with Mostafa Maged technique have no dead space, and 95.8% of Mostafa Maged patients do not have vulval edema. The technique of Mostafa Maged has also proven effectiveness in achieving postoperative hemostasis. Unlike patients with regular maneuvers, 83.3% do not have dead space, and 83.3 % do not have vulval edema. Mostafa Maged technique is a simple technique and easy to apply when suturing episiotomy. Mostafa Maged technique is significantly superior to conventional maneuvers in preventing bleeding at the episiotomy site and preventing formation of dead space so achieving good hemostasis; therefore, it is highly recommended. I recommend more studies on efficacy of Mostafa Maged maneuver on large sample of patients.

Restrictive v/s Routine episiotomy in Primigravida

Introduction: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy is the most common surgical procedure experienced by women. In near past there were many studies pointed out its disadvantages like more post-delivery pain, wound complications and dyspareunia. So, this study was done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth. Aims and objectives: To assess the effects of restrictive use of episiotomy in comparison with routine episiotomy in primigravida during vaginal birth in terms of - (1) No. of episiotomies can be avoided (2) Perineal tear (3) Blood loss (4) Hematoma & Healing complications (5) Faecal & urinary incontinence (6) Dyspareunia. Material and methods: This study was descriptive analytic study conducted in the Department of Obstetrics and Gynecology, Surat municipal institute of medical education and research (SMIMER), Surat from January 2017 to June 2019 with sample size of 148 patients. Results: This study included total 148 patients, where 74 were selected randomly in each group. In Restrictive Episiotomy group, out of 74 patients, Episiotomy was required in 18 (24.32%) patients. Thus, Episiotomy was avoided in 56 (75.68%) patients. Mean duration of second stage of labour in Routine Episiotomy group was 31.88 ± 5.37min and in Restrictive Episiotomy group it was 32.35 ± 3.73min, which was suggestive of no statistically significant difference. (p value = 0.5375). Total 4.05% patients in Routine group and 13.51% patients in Restrictive group suffered from anterior vaginal tear which was statistically significant (p value = 0.021). There were 2 cases (18%) of 2nd degree perineal tear in routine episiotomy group which were 8(40%) in restrictive episiotomy group. The difference was statistically assessed by Chi-square and found to be significant (p value=0.2399). Not a single case of 3rd & 4th degree perineal tear in either group. In Routine Episiotomy group, suturing was done in 100% patients. While restricted episiotomy group only 44.59% needed suturing which was statistically significant (p value:<0.0001). Average blood loss in Routine group was 341.89 ± 49.33ml and in Restrictive group was 301.01 ± 52.41ml. So, there was significantly higher blood loss in Routine Episiotomy group. (p value= 0.000002). Complications rate in the form of episiotomy wound gap and hematoma was higher in routine group in 5.41% patients as compared to 1.35% patients in Restrictive group. Postpartum perineal pain at 1 week (14 v/s 5) and 2 weeks (5 v/s 1) was significantly higher in routine group as compared to the restrictive group. Postpartum perineal pain at 1 week and 2 weeks was significantly higher in routine group as compared to the restrictive group. Conclusion: In conclusion on the basis of our study, the immediate outcomes of routine episiotomy are no better than the restrictive use of episiotomy. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision. The routine use of episiotomy has higher incidence of peripartum blood loss, requirement of suturing, postpartum perineal pain and healing complications. The policy of restrictive use of episiotomy is not associated with any third and fourth degree perineal tear or adverse neonatal outcomes.

Frequency and Clinical Outcomes of Women with Postpartum Hemorrhage at a Tertiary Care Hospital

Background and aim: Postpartum hemorrhage (PPH) is still a leading cause of maternal morbidity and mortality globally. Postpartum hemorrhage is characterized as excessive bleeding (> 500 ml) from the vaginal tract following childbirth. The present study aimed to determine the frequency and clinical outcomes of women with postpartum hemorrhage. Materials and Methods: This cross-sectional study was conducted on 1346 patients who underwent vaginal delivery in the department of obstetrics and gynecology, Kausar Hospital, Khairpur Mirs from March 2021 to March 2022. The study included all the women who had postpartum hemorrhage following vaginal birth in the labor room or who were referred with primary postpartum hemorrhage. Patients with prior history of bleeding disorders and on warfarin were excluded from the study. SPSS version 26 was used for data analysis. Results: Of the total 1346 patients, the prevalence of postpartum hemorrhage was 12.6% (n=170). Out of 170 PPH cases, the incidence of primary and secondary PPH was 138 (81.2%) and 32 (18.8%) respectively. The age-wise distribution of patients were as follows: 26 (15.3%) had <20 years, 62 (36.4%) in 21-30 years, 68 (40.1%) in 31-40 years, and 14 (8.2%) in >40 years. The incidence of primiparas, multipara, and grand multipara were 34 (20%), 58 (34.1%), and 78 (45.9%) respectively. The booked and unbooked patients were 56 (32.9%) and 114 (67.1%) respectively. Among 170 PPH patients, the incidence of spontaneous vaginal delivery, instrumental delivery, and cesarean section were 52 (30.6%), 56 (32.9%), and 62 (36.5%) respectively. The major causes of PPH was uterine atony, perineal and vaginal tears, and prolong labor found in 112 (65.9%), 56 (32.9%), and 38 (22.4%) respectively. Conclusion: The present study concluded that the prevalence of PPH was 12.6% among total cases. Primary PPH was more prevalent than secondary PPH and uterine atony was the most common cause followed by perineal and vaginal tears and prolong labor. Additionally, unbooked patients were more susceptible to PPH. Risk factors assessment, unnecessary induction, and third stage labor active management can prevent the PPH. Keywords: Postpartum hemorrhage, Clinical outcomes, Uterine atony

Comparison of Fetomaternal Complications in Women of High Parity with Women of Low Parity among Saudi Women.

High parity is associated with the risk of fetomaternal complications such as gestational diabetes mellitus, hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, and perinatal and preterm mortality. The objective of the study was to compare fetomaternal complications in women of high parity with women of low parity. This involved a cohort study on a sample size of 500 women who had singleton births. Data were collected from the Maternity and Child Hospital, Ha'il, Kingdom of Saudi Arabia. Participants were classified into two groups according to parity, i.e., women of low parity and women of high parity. Socio-demographic data and pregnancy complications, such as gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, etc., were retrieved from participants' files. Participants were followed in the postnatal ward until their discharge. The results revealed that women of high parity mostly (49%) were married before 20 years of age, less educated, obese, and were of un-booked cases. Premature babies and fetal mortality are significantly high (0.000) in this group. There is a significant difference between the two groups with respect to maternal anemia, gestational diabetes mellitus, joint pain, perineal tear, miscarriage, postpartum hemorrhage, preeclampsia, vaginal tear, and cesarean section. Determinants responsible for high parity should be identified via evidence-based medicine. Public health education programs targeting couples, weight control, nutrition, and contraception would be a cost-effective strategy for reducing the risk of possible fetomaternal complications.

Comparison the Effectiveness of Oxytocin and Misoprostol in Prevention of Primary Post-Partum Haemorrhage

Introduction: Postpartum haemorrhage is one of the leading causes of maternal mortality. Maternal Mortality globally is estimated as 599.00 deaths per year, a ratio of 400 maternal deaths per 10,000 live births. The aim of this study was to compare the effectiveness of oxytocin and misoprostol in prevention of primary post-partum haemorrhage Material and Method: It was Randomized Controlled Trial, which was conducted in the department of Obstetrics and Gynaecology, Hospital, Peshawar, between 14th March 2020 to 22 April 2022). The sample size was 100(50 in each group) Using 4% of PPH in misoprostol group, 24% of PPH in oxytocin group, 95% confidence level and 90% power of test under WHO software for sample size determination. Results: A total of 100 patients of primary post-partum haemorrhage were observed, which were divided in two equal groups A & B. Patients in Group A were managed with misoprostol while patients in group B will be subjected to oxytocin. Gravida wise distribution shows that out of 50 patients 22(44%) were gravid less than or equal to one,18(36) patient have 2-5 and 10(20%) were more than 5 while group B contains 25(50%) less than or equal to one, 17(34%) patients 2-5 and 8(16%) have gravid more than 5. Gravida distribution among the groups was insignificant with p-value=0.802. Average age was 27.82 years+4.56SD with range of 20-36 years. Group A contained 13(26%) patients in less than or equal to 25 years, 30(60%) patients 26-35 years and 7(14%) patients having ages of more than 35 years. While group B contained 18(36%) patients in less than or equal to 25 years, 28(56%) in 26-35 years and 4(8%) patients with age more than 35 years. The age distribution among the group was also insignificant with p-value 0.429. Efficacy wise distribution was significant with p-value = 0.021. Group A showed 47(94%) efficacy while non-effective in 3(6%) patients. Similarly, Group B showed 39 (78%) efficacy while non effective in 11(22%) patients. The misoprostol has greater efficacy than oxytocin. Age wise distribution of drug-efficacy shows that efficacy was almost same in all age groups. The patients having less than or equal to 25 years of age have shown efficacy in 12(92.3%) patients while 1(7.7%) patients being non-effective. Patients with 26-35 years of age have shown efficacy in 28(93.3%) of patients and 2(6.7%) have shown no efficacy. Similarly, 7(100%) patients have shown efficacy and no patients have no efficacy, with age more than 36 years of age. The same pattern was followed in group B, although age wise efficacy was insignificant in both the groups with p-value=0.765 and 0.987 respectively. The prevention of PPH, particularly in resource poor settings, where PPH is the leading cause of maternal mortality The enormity of postpartum haemorrhage and the limitations in the use of oxytocin for the adequate preventive therapy were the basic rationales behind this study. Secondarily, our cultural setups of home deliveries have a marked role in grave morbidity as well as lack a consensus protocol for the choice of adequate preventive treatment of haemorrhage. Keeping in view the above mentioned factors, this study was conducted to compare the effectiveness of the per rectal misoprostol medication to the intramuscular oxytocin to control the blood loss as adequate preventive therapy. Conclusion: Misoprostol is more effective as compared to oxytocin in prevention of primary postpartum hemorrhage. Keywords: Primary Postpartum haemorrhage, Cervical tears, Vaginal tears, oxytocin, Misoprostol, efficacy

Risk factors of pelvic organ prolapse at Asella Teaching and Referral Hospital: Unmatched case control study.

BackgroundProlapse is one of the sub-types of pelvic floor dysfunction (PFD) which occurs due to abnormal fall of the pelvic organs from their normal anatomic positions. Although the cause of prolapse is multifactorial, it primarily occurs due to pregnancy and vaginal delivery. Hence, the present study aimed to identify risk factors of prolapse among women who undergo gynecological surgery.Materials and methodsFacility-based-unmatched case–control design was employed. Cases were all gynecological women who were diagnosed with pelvic organ prolapse (POP) at Asella teaching referral hospital (ATRH) while controls were all charts of gynecological women who were diagnosed with other gynecological problems rather than POP at ATRH. For each case, two controls were selected using a simple random sampling technique. The data were entered into Epidata version 4.3.1 and finally exported to SPSS version 25 for further analysis. Then variables that had an association in the bivariate model (p < 0.25) were entered and analyzed by a multivariable conditional logistic regression model to identify the independent effect of different factors. Statistical significance was declared at p < 0.05.ResultsA total of 147 cases and 293 controls were included in this study. Women who had a history of chronic cough, previous pelvic floor surgery, constipation, and vaginal tear during delivery, history of pelvic trauma, age of the women, rural resident, and maternal gravidity were strongly associated with prolapse at p-value of < 0.05. Multigravida [adjusted odds ratio (AOR) 2.987 (95% CI 1.237–6.853), p = 0.014], age >50 years [AOR: 2.496 (95% CI 1.372–4.539), p = 0.003], women with a history of pelvic floor surgery [AOR: 0.3.666 (95% CI 1.328–10.124), p = 0.012], women who had diabetes mellitus [AOR: 4.676 (95% CI 0.908–24.075), p = 0.065], and resided in rural areas [AOR = 1.878; (95% CI: 0.984–3.585), I2 = 47.5%, p = 0.056] were the independent predictors were of prolapse.ConclusionsIn this study, women with diabetes mellitus, previous pelvic floor surgery, rural residents, being multigravida, and age >40 were independent predictors of prolapse. Therefore, delivering health education by focusing on the identified risk factors was strongly recommended.

Trend Changes in the individual contribution of risk factors for postpartum hemorrhage over more than two decades.

Postpartum hemorrhage is an obstetric emergency with a rising incidence. The aim of this study was to identify trends in the specific contribution of various risk factors for postpartum hemorrhage by observing their odds ratios throughout different time periods. In this population-based retrospective cohort study trends of change in odds ratios for known risk factors for postpartum hemorrhage occurring in three consecutive eight-year intervals between 1988 and 2014 were compared. Two multivariable logistic regression models were used in order to identify independent risk factors for postpartum hemorrhage in our population. Trends of various risk factors were compared along the time period of the study. The incidence of postpartum hemorrhage increased from 0.5% to 1988 to 0.6%. Using logistic regression models, preeclampsia, vacuum extraction delivery, retained placenta, perineal or vaginal tears and delivery of a large for gestational age neonate were recognized as independent risk factors for postpartum hemorrhage. While the odds ratios for perineal or vaginal tears significantly increased, odds ratios for delivery of a large for gestational age neonate significantly decreased. Odds ratios for the other risk factors did not change significantly. In our study, not only did the rates of statistically significant risk factors for postpartum hemorrhage change during the study period, the specific contribution of each risk factor changed as well. Having a better understanding of these trends might augment our ability to predict this grave obstetric complication and improve maternal outcomes in the future.

Comparison of Safety and Efficacy of Intrauterine Foley’s Catheter Balloon and Uterovaginal Packing in Patients with Excessive Vaginal Bleeding after Vaginal Delivery

Objectives: To compare the safety and efficacy of uterovaginal packing and Foley’s catheter balloon tamponade in patients with excessive vaginal bleeding following vaginal delivery. Design : RCT ( Randomized Controlled Trial). Setting : Obstetrics &amp; Gynaecology Deptt. , HFH ( holy family hospital) , RWP. Duration: Six Months. Materials &amp; Methodology: 94 females who presented with excessive vaginal bleeding ( &gt; 500 ml) following vaginal delivery, 18 to 40 years of age , gestational age (GA) ≥37 weeks were included. Patients with retained products of conception, PPH due to perineal, cervical or vaginal tear and coagulation disorders were excluded. The patients were distributed equally into 2 groups ; a and b based on the lottery method. Group a was managed with uterine packing and Group b was managed by the Foley’s catheter balloon tamponade. Efficacy and safety in both groups was measured. Results: In my study, efficacy was significantly high in uterine packing group (Group a) compared to Foley’s catheter balloon tamponade (group b) (89.36% versus 68.09%; respectively) with p-value of 0.012. In my study, safety was significantly high in uterovaginal packing group (Group a) compared to Foley’s catheter balloon tamponade (group b) (72.34% versus 31.91%; respectively) with p-value of 0.0001. Conclusion: Uterovaginal packing is more secure, prompt and efficient procedure to manage excessive hemorrhage after delivery compared to Foley’s catheter balloon tamponade. Keywords: Hemorrhage, uterovaginal packing ,foley’s balloon tamponade.

Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada.

IntroductionRacial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada.MethodsWe conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates.ResultsAmong 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people.ConclusionThere are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.

Covert postpartum urinary retention: causes and consequences (PAREZ study)

Introduction and hypothesisIncreased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum.MethodsWe carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined.ResultsA total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups.ConclusionsWe have found a few significant obstetrical–pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.

Immediate unfavorable birth outcomes and determinants of operative vaginal delivery among mothers delivered in East Gojjam Zone Public Hospitals, North West Ethiopia: A cross-sectional study.

Operative vaginal delivery is the use of forceps or vacuum devices to assist the eligible laboring mother to avoid poor birth outcomes. It is associated with increased maternal, neonatal morbidity and perinatal complications if it is not used appropriately. Instrumental delivery use needs health care providers' skills, knowledge, and decision-making ability for good maternal outcomes. This study aimed to assess immediate unfavorable birth outcomes and associated factors of operative vaginal delivery among women delivered in East Gojjam Zone Public Hospitals, North West Ethiopia. The study design was institution based cross-sectional and consecutive sampling procedure was used to select 313 mothers in the study, from March 1, 2019, to April 30, 2019. We used Epi data version 3.1 for data entry and SPSS version 25 software for cleaning and analysis. A Bivariable logistic regression analysis was used to identify the association between each outcome variable and each factor. Again, a multivariable logistic regression analysis was employed to identify factors associated with each outcome variable, and variables with a p-value less than 0.05 were taken as significant variables. The overall unfavorable maternal outcomes of operative vaginal delivery were found to be 32.9% [95% CI: 27.8, 38.3]. No formal education (AOR = 8.36; 95% CI: 1.01, 69.2), rural residence (AOR: 11.77; 95% CI: 2.02, 68.41), male sex of the neonate (AOR: 2.87; 95% CI: 1.08, 7.61) and zero station during instrumental application (AOR: 6.93; 95% CI: 1.75, 27.5) were factors associated with unfavorable maternal outcomes. The study also showed that the magnitude of unfavorable neonatal outcomes was 34.8% (95% CI: 29.7, 40.3). Vaginal first-degree tear (AOR = 0.03, 95% CI: 0.001, 0.951) and blood transfusion (AOR = 7.38, 95% CI: 1.18-46.15) was statistically significant factors associated with unfavorable neonatal outcomes. The overall unfavorable maternal and neonatal outcomes of operative vaginal delivery were high compared with some other studies done in Ethiopia.

Postpartum maternal wellbeing

The 6-to-8 week postnatal check marks an important face-to-face review for a new mother and her newborn. The approach to this review, with a focus on the mother’s physical and mental wellbeing, has relevance to primary care doctors’ training in obstetrics and gynaecology. A typical review will routinely consider aspects of physical and psychological wellbeing, including coping as a new parent, for example with newborn feeding. The physical review includes aspects of recovery after delivery including lochia, wound healing after caesarian section, pelvic floor health (including vaginal tears) and assessment for urinary and faecal incontinence. Physiological changes in blood pressure and blood test results occur and interpretation demands experience to ensure appropriate reassurance. Chronic and any new medical conditions diagnosed in pregnancy (including gestational diabetes mellitus and pregnancy-induced hypertension) require review, discussion and follow-up as they can impact on short and longer term health. This article explores common postnatal themes and medical conditions including early recognition and management.

Biaxial Murine Vaginal Remodeling With Reproductive Aging.

Higher reproductive age is associated with an increased risk of gestational diabetes, pre-eclampsia, and severe vaginal tearing during delivery. Further, menopause is associated with vaginal stiffening. However, the mechanical properties of the vagina during reproductive aging before the onset of menopause are unknown. Therefore, the first objective of this study was to quantify the biaxial mechanical properties of the nulliparous murine vagina with reproductive aging. Menopause is further associated with a decrease in elastic fiber content, which may contribute to vaginal stiffening. Hence, our second objective was to determine the effect of elastic fiber disruption on the biaxial vaginal mechanical properties. To accomplish this, vaginal samples from CD-1 mice aged 2-14 months underwent extension-inflation testing protocols (n = 64 total; n = 16/age group). Then, half of the samples were randomly allocated to undergo elastic fiber fragmentation via elastase digestion (n = 32 total; 8/age group) to evaluate the role of elastic fibers. The material stiffness increased with reproductive age in both the circumferential and axial directions within the control and elastase-treated vaginas. The vagina demonstrated anisotropic mechanical behavior, and anisotropy increased with age. In summary, vaginal remodeling with reproductive age included increased direction-dependent material stiffness, which further increased following elastic fiber disruption. Further work is needed to quantify vaginal remodeling during pregnancy and postpartum with reproductive aging to better understand how age-related vaginal remodeling may contribute to an increased risk of vaginal tearing.

Prevention of perineal laceration in vaginal birth: review

Background: The vaginal tear in vaginal delivery is a recurring and worrying factor for the health of parturients, so, this necessary to know the most effective prevention strategies, so that perineal traumas are minimized. Aims: to investigate in the literature what evidence is available on strategies to prevent the occurrence of perineum tears. Method: Narrative review of the literature was made out from March to April 2020, in the LILACS, MEDLINE and SCIELO databases using the keywords “vaginal delivery”, “perineum” and “episiotomy”. Results: Initially, 86 articles were found, 54 were excluded because they did not fit the theme, 32 remained, and after the inclusion and exclusion criteria were applied, leaving 7 productions. Conclusion: it was possible to observe that the most used strategies to obtain perineal integrity after vaginal deliveries are: peri-neal massage and Epi-no during pregnancy, favorable position during childbirth, manual protection of the perineum, hands on and hands off during delivery.

Trans-fistula Anorectoplasty (TFARP) in the Management of Anorectal Malformation (ARM) with Recto Vestibular Fistula (RVF) in Females: A Retrospective Study

Aim: To determine the outcome of trans-fistula anorectoplasty (TFARP) in female children having anorectal malformation with recto-vestibular fistula.&#x0D; Study Design: A retrospective study.&#x0D; Place and Duration: Department of pediatric surgery during the period of February 2018 to February 2020.&#x0D; Methodology: A total of 87 female children who have imperforate anus with recto-vestibular fistula from the age of 3 months to 6 years were included in this study. Initially, we have started this technique with the covering sigmoid colostomy, then TFARP after 12 weeks interval &amp; once new anus healed and hegar dilatation achieved then sigmoid colostomy closed after 24 weeks of the first procedure. When we were experienced then we start TFARP as a single-stage procedure. Post-operative data regarding early complications of local wound infections, prolapse of the rectal mucosa, and late complications for anal stenosis, rectal prolapse, and scarring in the perineal body were collected up to 2-3 months respectively.&#x0D; Results: A total of 87 patients were included in this study. The average operative time was 40 minutes. The total days of hospital stay were 3 to 5 days. Regarding early complications, skin excoriation was present in 21 (24%) followed by vaginal tear in 17 (19%) cases. Mucosal prolapse was a late complication observed in 17 (20%) cases. Continence was good (Score 0) in 33 (38%) cases, while it was fair (score 1) in 36 (41%) cases.&#x0D; Conclusion: Primary repair of recto-vestibular fistula by Trans-fistula anorectoplasty in children is a feasible procedure that has a good cosmetic appearance and anal continence. Single-stage reconstruction is possible in children with satisfactory results. It produces less morbidity and is a more efficient procedure.

Second Stage Intervention (Vacuum Versus Forceps) and Maternal Outcome

Objective: To determine the frequency of the second stage intervention and maternal outcome among those undergoing 2nd stage intervention (forceps versus vacuum) at Liaqat University hospital Hyderabad. Material and methods: This cross-sectional comparative study was conducted at the gynecology and obstetrics department of Liaquat University Hospital Hyderabad during one year from October 2014 to September 2015. Cases having a singleton pregnancy with cephalic presentation as per fresh fetal well-being ultrasound, gestational age 36 weeks or more, undergoing instrumental vaginal deliveries (vacuum or forceps) of either age or parity were included. The position of the head and pelvis and the status of the cervical dilatation were assessed. In the Labor Room, all instrumental forceps and vacuum-assisted deliveries were performed. The time of instrument application, the time of delivery, the type of instrument used, the number of pulls, the number of detachments in the case of ventouse, and the analgesia/anaesthetic provided were all recorded. The consultants who delivered the patient assessed the level of maternal trauma right away. Perineal tears, extension of episiotomy, ulceration of the vagina, cervical tears, and other maternal outcomes were measured. The data were entered and analyzed in the statistical program SPSS version 26.0. Results: During the study period, 2135 pregnant women were identified, with 265 receiving second-stage intervention (14.70%). These women were 27.84+5.13 years old on average. 52.83% women received ventouse/vacuum extraction and 47.16% received forceps assistance. The majority of females 73.58% were un booked. The interval decision-to-delivery was substantially shorter in patients of the forceps group than in the vacuum patient’s group (p-0.0001). Maternal trauma of soft tissues was the most common complication among 58 cases and out of them vaginal tears were significantly higher 18.4% in the Forcep group compared to vacuum group 7.14%, while cervical tear 4% in the Forcep group and 3.57% in the vacuum group and 3rd degree perineal in 8% of the Forcep group and 3.57% in the vacuum group. Findings regarding cervical tear, 3rd degree perineal, PPH, LSCS and other maternal complications were statistically insignificant according to both procedures (p-&gt;0.05). Conclusion: It was concluded from this study that maternal outcomes in assisted vaginal deliveries suggested that ventouse application is associated with less maternal complications than with forceps. The frequency of the second stage interventions was observed to be 14.70% and no adverse maternal outcomes were observed. Keywords: Vacuum extractor, Obstetric forceps, maternal morbidity

Risk factors and management of postpartum urinary retention: A scoping review

AbstractThis study aimed to identify the risk factors for the onset of postpartum urinary retention (PUR), to locate the most effective prevention, treatment interventions, and how to improve its management. The research questions were the following: ‘In postpartum women, what are the risk factors for PUR? In postpartum women, what are the interventions aimed to manage the urinary retention?’ PUR is defined as an inability to void spontaneously or adequately during the postpartum period. PUR is a common disease that can lead to different consequences and the necessity of its management is indisputable. It is necessary to work on the prevention of the onset of PUR by promptly recognizing the risk factors and acting on them, with the aim of developing guidelines and protocols that help in clinical practice. A scoping review was performed. PubMed, CINAHL, Cochrane Library, Scopus, clinicaltrials.gov, Medline (Journals@Ovid Full Text, YourJournals@Ovid, Ovid MEDLINE[R] ALL) were systematically searched from 2014 until 2019. A total of 17 articles were included. Several studies have shown the presence of risk factors for the onset of PUR including mode and duration of labour, post‐void residual bladder volume, episiotomy, vaginal tears, instrumental delivery, method of anaesthesia or analgesia, peripartum micturition, catheterization during labour, birth weight and parity. In addition, the duration of PUR is influenced by other factors, such as the number of fluids administered in the delivery room. Based on the current literature, PUR is a common condition that can lead to different consequences and the necessity of its management is indisputable. Although the risk factors are quite clear, there is still no definite way of treatment. Future research should focus on the PUR treatment.

Massive Traumatic Postpartum Haemorrhage with Co-incidental Atypical Eclampsia and Abdominal Koch’s- A Maternal Near Miss

Obstetric haemorrhage is related with augmented risk of maternal morbidity and mortality and continues to be the second greatest direct cause of near miss and maternal death. Postpartum Haemorrhage (PPH) is the most common form of obstetric haemorrhage, atonic PPH being responsible for 80% cases. Traumatic PPH with massive vulval haematoma, an infrequent but possibly fatal condition if left undiagnosed and untreated. Hence, prompt recognition and management with simultaneous resuscitation and operative procedure is vital to save life of mother. A 24-year-old P1L1 female with traumatic haemorrhage with the formation of massive vulval haematoma, periurethral tears, extensive cervical and vaginal wall tears with hypovolemic shock with severe anaemia admitted to the tertiary care hospital. Immediate resuscitation measures were taken followed by vaginal exploration for the vulvovaginal haematoma and a multispeciality approach for the better outcome. However, postvaginal exploration after 24 hours, there was progression in vulvo vaginal haematoma size, with haemodynamic instability. Re-exploration under anaesthesia via abdominal approach was performed. The patient required a longer hospital stay. Thus, early diagnosis and treatment of puerperal haematomas can prevent significant complications.

The Importance of Continuity of Care Women with Obstetric Trauma

Around 50% of women who give birth naturally have trauma to the birthing tract requiring soft tissue suturing. In Lithuania, women spend an average of 2-3 days in hospital after an uncomplicated natural delivery, which is not always enough time to acquire the skills to take care of the new-born as well as to care for the delivery wound. Continuity of care after the return of the mother from hospital is particularly important to avoid complications in the postnatal period such as fever, wound infections, resolution of wound edges, incontinence of gases or faeces, formation of fistulae, painful sexual intercourse, and delay of future family planning.&#x0D; Aim of the study: to assess the importance of continuity of care for women with obstetric trauma.&#x0D; Methods: A quantitative study, an anonymous survey of women who have given birth naturally in the last two years and who have experienced various soft tissue injuries of the birthing tract between November 2020 and January 2021, following an analysis of the scientific literature, was conducted.The survey data were analysed using Microsoft Office Excel 2016 data processing software. The study was carried out in accordance with ethical principles.&#x0D; Results: 110 women participated in the study. Most of the respondents were first-time mothers with grade I-II perineal or vaginal tears. More than half of the women highlighted the lack of information from professionals about home care of the birth canal, postnatal sexuality, and family planning.&#x0D; Conclusions: Women with natural childbirth who have suffered soft tissue injuries to the birthing tract experience pain in the wound area in the postnatal period, which limits movement when walking, sitting, getting up from a lying position, and feel anxiety and fear of soft tissue injury when defecating. Mothers are not sufficiently informed about home care of the obstetric wound and would prefer follow-up care in primary care.

Combined Mastectomy and Laparoscopic Hysterectomy with Salpingo-Oophorectomy in Transgender Men: a Cohort Study

There are few data on complications with gender affirming surgery. The aim of this study was to assess peri- and postoperative complications of laparoscopic hysterectomy and mastectomy performed in a single sitting in transgender men. Assessment of intra- and postoperative complications in a series of 65 transgender men (mean age 27, range 18–47) undergoing concomitant mastectomy and laparoscopic hysterectomy with salpingo-oophorectomy. Mean operating time was 292 ± 47 min. Thirty-four (52%) patients experienced complications: 28 (41%) DINDO grade I, 0 DINDO grade 2, 6 (11%) DINDO grade III. The six grade 3 complications consisted of 5 hematomas requiring evacuation after mastectomy and 2 vaginal tears requiring transvaginal repair. Three patients were readmitted within 30 days, all for postoperative bleeding/hematoma. In transgender men, performing laparoscopic hysterectomy and mastectomy at a single sitting has a modest rate of perioperative complications, and may improve resource utilization.