Background: Perineal trauma and vaginal laceration are considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologis...Background: Perineal trauma and vaginal laceration are considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg persistent occipital posterior position, null parity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature, but data are conflicting, such as prolonged second stage of labor, episiotomy and obesity. Objective: To evaluate third- and fourth-degree perineal rears rates and the impact of related risk factors on perineal tears in Ministry of health in Bahrain over 5 years (which includes Salmanyia Medical complex (SMC) and Jidhafs maternity hospital (JMH)). Methods: This retrospective descriptive cross-sectional study analyzed all vaginal deliveries from January 2015 to December 2019 in Obstetrics and Gynecology department in Salmanyia Medical Complex (the main hospital in Kingdom of Bahrain which received all kinds of cases including low and high risks) and Jidhafs Maternity Hospital (tertiary hospital which received only low risk cases), Kingdom of Bahrain. During the period of interest 33,694 records were identified. Data were extracted from observational recording from SMC and JMH labour registry books. Results: There was no statistically significant difference between groups according to age (p = 0.199). On the other hand, there was statistically significant higher cases of >40 weeks at gestational age, obesity > 35 kg/mr, vacuum delivery, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm, episiotomy and lower cases of nulliparity in study group compared to control group 16 (66.7%) vs. 13,805 (41.0%), 3 (12.5%) vs. 1448 (4.3%), 3 (12.5%) vs. 1414 (4.2%), 4 (16.7%) vs. 1751 (5.2%), 3 (12.5%) vs. 1751 (5.2%), 12 (50.0%) vs. 15,926 (47.3%), 15 (62.5%) vs. 20,135 (59.8%) and 17 (70.8%) vs. 29,024 (86.2%);(p = 0.027, 0.009, Conclusion: Gestational age > 40 weeks, obesity > 35 kg/mr, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm and using of vacuum increase incidence of 3rd and 4th degree perineal tears with vaginal delivery however maternal age and nulliparity have no significant role. Finally, episiotomy did not represent as protective factor for perineal damage. .展开更多
Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are...Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman’s preference during delivery.展开更多
Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routi...Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.展开更多
文摘Background: Perineal trauma and vaginal laceration are considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg persistent occipital posterior position, null parity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature, but data are conflicting, such as prolonged second stage of labor, episiotomy and obesity. Objective: To evaluate third- and fourth-degree perineal rears rates and the impact of related risk factors on perineal tears in Ministry of health in Bahrain over 5 years (which includes Salmanyia Medical complex (SMC) and Jidhafs maternity hospital (JMH)). Methods: This retrospective descriptive cross-sectional study analyzed all vaginal deliveries from January 2015 to December 2019 in Obstetrics and Gynecology department in Salmanyia Medical Complex (the main hospital in Kingdom of Bahrain which received all kinds of cases including low and high risks) and Jidhafs Maternity Hospital (tertiary hospital which received only low risk cases), Kingdom of Bahrain. During the period of interest 33,694 records were identified. Data were extracted from observational recording from SMC and JMH labour registry books. Results: There was no statistically significant difference between groups according to age (p = 0.199). On the other hand, there was statistically significant higher cases of >40 weeks at gestational age, obesity > 35 kg/mr, vacuum delivery, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm, episiotomy and lower cases of nulliparity in study group compared to control group 16 (66.7%) vs. 13,805 (41.0%), 3 (12.5%) vs. 1448 (4.3%), 3 (12.5%) vs. 1414 (4.2%), 4 (16.7%) vs. 1751 (5.2%), 3 (12.5%) vs. 1751 (5.2%), 12 (50.0%) vs. 15,926 (47.3%), 15 (62.5%) vs. 20,135 (59.8%) and 17 (70.8%) vs. 29,024 (86.2%);(p = 0.027, 0.009, Conclusion: Gestational age > 40 weeks, obesity > 35 kg/mr, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm and using of vacuum increase incidence of 3rd and 4th degree perineal tears with vaginal delivery however maternal age and nulliparity have no significant role. Finally, episiotomy did not represent as protective factor for perineal damage. .
文摘Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman’s preference during delivery.
文摘Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.
