Relationship between Perineal Body Length and Degree of Perineal Tears in Primigravidas Undergoing Vaginal Delivery with Episiotomy

Background. Perineal tears are one of the most common complications of vaginal delivery. Severe perineal tears can cause various morbidities. There are many factors that affect the occurrence of perineal tears. One of the major factors related to the occurrence of perineal tears is the length of the perineal body. However, until now, no research in Indonesia has concluded that the length of perineal body can predict the perineal tears. Objective. To find the relationship between perineal body length and perineal tears, so it can provide a reference on the use of perineal body length to predict severe perineal tears in vaginal delivery with episiotomy. Methods. This nested case-control study was conducted at RSUD Tangerang and RSUD Karawang in Indonesia from February to September 2017. A total of 126 primigravida patients participated in the study consecutively. The length of the perineal body was then measured and followed until the start of the second stage of labor. Afterwards, the perineal length and degree of perineal tears were assessed using unpaired T-test for bivariate analysis, multivariate analysis, and scoring test to predict the occurrence of third- and fourth-degree of perineal tears with power calculation (β) 80% and Zβ 0.842. Results. There was a significant difference in mean length of the perineal body between the group with first- and second-degree perineal tears and the group with third- and fourth-degree perineal tears ( p < 0.001 ). From the multivariate analysis, adjusted OR was 5.26 (95% CI 1.52–18.17). Score test was performed to predict the occurrence of third- and fourth-grade perineal tears. Perineal body length and head circumference could be used as predicting factors of perineal tears. Perineum length ≤ 3.0 cm and head circumference ≥ 33.5 cm posed a risk of perineal tears of third and fourth degrees (70.52%). Conclusion. The length of the perineal body has a good ability to predict the occurrence of perineal tears.

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Optimalisasi Pertumbuhan Bayi dengan Baby Massage and Spa

Jurnal Kesehatan ◽

10.26630/jk.v10i2.1416 ◽

2019 ◽

Vol 10 (2) ◽

pp. 276

Author(s):

Yusari Asih ◽

I Gusti Ayu Mirah WS

Keyword(s):

Body Length ◽

Head Circumference ◽

Intervention Group ◽

Sampling Technique ◽

Holistic Approach ◽

The Body ◽

Control Group ◽

P Value ◽

Control Group Design ◽

Significant Difference

Baby Massage and Spa was a traditional effort that uses a holistic approach through comprehensive care using a combination of massage and water therapy methods that are carried out in an integrated manner to balance the body, mind, and feelings. Age 3-6 months is the right time for babies to do massage and spa. The purpose of this study was to determine the effect of baby massage and spa on the growth of infants aged 3-5 months in Pringsewu District in 2018. This study uses a quasi-experimental approach with research design pre and post-test with control group design. The purposive sampling technique was taken with a sample of 30 infants as the intervention group and 30 infants as the control group. Data were processed using computerization and analyzed using the T-Test. The results showed that there were significant differences between body weight, body length and baby head circumference in the pre and post-treatment. There was no significant difference in the average increase in infant weight between babies who were carried out by baby massage and spa with babies who were not carried out by baby massage and spa with p-value 0.116. There is a significant difference in the baby's body length and head circumference performed by baby massage and spa with those not carried out by baby massage and spa with p-value 0.000. Baby Massage and Spa has a significant effect on increasing the growth of babies aged 3-5 months.

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Effect of episiotomy on perineal lacerations in spontaneous vertex deliveries

Annals of King Edward Medical University ◽

10.21649/akemu.v11i4.1079 ◽

2016 ◽

Vol 11 (4) ◽

Author(s):

Meherun Nisa

Keyword(s):

Vaginal Delivery ◽

Local Anaesthesia ◽

Analytical Study ◽

Study Groups ◽

Perineal Laceration ◽

Cross Sectional ◽

Fourth Degree ◽

Mediolateral Episiotomy ◽

Perineal Tears ◽

Perineal Lacerations

Objectives: To evaluate the effects of episiotomy on the frequency of perineal lacerations. Design: Cross-Sectional analytical study. Place & duration of study: Department of Gynae Obstetrics unit III. Lady willingdon Hospital Lahore. From April 1994 to March 1996. Patients & methods: 2918 women who delivered vaginally were included in the study. Only right mediolateral episiotomy incision was used in these cases. Local anaesthesia in the form of 2% Lignocain was used in all cases to infiltrate the area before episiotomy cut. The delivery was conducted in most cases by a resident. The rate of perineal lacerations with or without episiotomy in both primiparae and multiparae groups was noted. Results 2918 women of term singleton babies were entered into this study. Episiotomy was performed in 1419 (48.63%) of these women. There were 1095(37.53%) primiparae and 1823 (62.47%) multiparae in the study groups. The rate of episiotomy in primiparae and multiparae were 93.42% and 21.72% respectively. A total of 267 (9.2%) perineal tears were sustained by these women during vaginal delivery . Episiotomy was associated with 151 (10.6%) perineal tears compared to 116(7.7%) without episiotomy. The incidence of fourth degree perineal laceration was 0.4% without episiotomy but increased to 1% with the use of episiotomy. This difference is statistically significant. Conclusion: Episiotomy is not protective against severe perineal lacerations. A selective use of episiotomy is recommended for appropriate indications.

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Childbirth injuries encountered on outreach in remote RDCongo

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i2.21878 ◽

2018 ◽

Vol 13 (2) ◽

Author(s):

Justin Paluku Lussy ◽

Esther Kahambu Kitambala ◽

Eugénie Kamabu Mukekulu

Keyword(s):

Urinary Incontinence ◽

Fecal Incontinence ◽

Vaginal Delivery ◽

Surgical Repair ◽

Type I ◽

Success Rates ◽

Dr Congo ◽

Fourth Degree ◽

Patients Âgés ◽

Perineal Tears

Aims: This paper describes childbirth injuries encountered in remote DR Congo. Causes of identified injuries and their surgical repair outcomes are outlined. Methods: Through community awareness activities, patients with urinary or fecal incontinence were mobilized to report for care. Records from patients examined during outreach surgical camps in the Nord-Ubangi province from January to June 2018 were reviewed. Results: A total of 151 patients, ages 16-72 years, were attended for urinary and/or fecal incontinence after childbirth. Among 105patients who reported with urinary incontinence, 103 had vesico-vaginal fistulae that were classified as type I or type II (77 (77/103, 74.8%) patients) and type III of Waaldjik (26 (25.2%) patients). Two patients had urinary incontinence secondary to a small bladder.Among 46 patients who came complaining of fecal incontinence, 15 (15/46, 32.6%) patients had recto-vaginal fistulae while 31 (31/46, 67.4%) patients had third or fourth degree perineal tears. Vaginal delivery (79.2%), caesarean section (16.1%) and hysterectomy (4.7%) caused observed injuries.84.2% of the urinary incontinence group and 86.7% of the fecal incontinence group were dry and continent after repair. Conclusions: Genito-urinary fistulae were predominant among childbirth injuries encountered in remote DRCongo. Vaginal delivery was the leading cause of childbirth injuries. Surgical repair success rates were high.

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A comparative evaluation of post placental intrauterine contraceptive device (IUCD) insertion between normal delivery and caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183802 ◽

2018 ◽

Vol 7 (9) ◽

pp. 3826

Author(s):

Sharmistha Sarkar ◽

Dhruba Prasad Paul ◽

Jayanta Ray

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Comparative Evaluation ◽

P Value ◽

Contraceptive Device ◽

Government Medical College ◽

Expulsion Rate ◽

Medical College ◽

Significant Difference ◽

Post Placental

Background: Adverse maternal and perinatal outcomes are related to pregnancies spaced too closely together. Objective of present study was to compare the expulsion rate and complications between post placental IUCD insertion between caesarean section and vaginal delivery.Methods: This study was a prospective comparative study conducted in the department of Obstetrics and Gynecology, at Agartala Government Medical College over 1.5 Years (January 2016-June2017) All cases at term pregnancy delivering by caesarean section and vaginal delivery were divided into two different groups. Sample size of 105 in each group. Subjects recruited from-obstetrics OPD and casualty of Agartala Government Medical College (AGMC) and GB Pant Hospital expulsion rate and complications. Comparative evaluation of Expulsion rate and complications following post placental IUCD insertion between caesarean section and vaginal delivery at the end of six months, one year and one and half year.Results: There was no significant difference in either complications between the two groups (P value-.913) or outcomes (p value-.035). Expulsion rate 18.2% following vaginal delivery compared to those with intracaesarean insertion i.e 3.8%.Conclusions: The complications associated with postplacental Intrauterine device insertion is insignificant, still the awareness, acceptance and continuation are very low. Therefore Information, education Communication activity by the field workers must be enhanced to overcome this knowledge gap.

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Prediction accuracy of standard and total keratometry by swept-source optical biometer for multifocal intraocular lens power calculation

Scientific Reports ◽

10.1038/s41598-021-84238-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hun Lee ◽

Jae Lim Chung ◽

Young Jun Kim ◽

Jae Yong Kim ◽

Hungwon Tchah

Keyword(s):

Cataract Surgery ◽

Case Series ◽

Intraocular Lenses ◽

Power Calculation ◽

Neutral Position ◽

Swept Source ◽

Refractive Outcomes ◽

Case Series Study ◽

Significant Difference ◽

Optical Biometer

AbstractWe aimed to compare the refractive outcomes of cataract surgery with diffractive multifocal intraocular lenses (IOLs) using standard keratometry (K) and total keratometry (TK). In this retrospective observational case series study, a total of 302 patients who underwent cataract surgery with multifocal IOL implantation were included. Predicted refractive outcomes were calculated based on the current standard formulas and a new formula developed for TK using K and TK, which were obtained from a swept-source optical biometer. At 2-month postoperatively, median absolute prediction errors (MedAEs) and proportion of eyes within ± 0.50 diopters (D) of predicted postoperative spherical equivalent (SE) refraction were analyzed. There was no significant difference between MedAEs or proportion of eyes within ± 0.50D of predicted refraction from K and TK in each formula. In TFNT00 and 839MP IOL cases, there was no difference between MedAEs from K and TK using any formula. In 829MP IOL cases, MedAE from TK was significantly larger than that from K in Barrett Universal II/Barrett TK Universal II (P = 0.033). In 677MY IOL cases, MedAE from TK was significantly larger than that from K in Haigis (P = 0.020) and Holladay 2 (P = 0.006) formulas. In the subgroup analysis for IOL, there was no difference between the proportion of eyes within ± 0.50 D of predicted refraction from K and TK using any formula. TFNT00 and 839MP IOLs were favorable with TK, with 677MY IOL with K and 829MP IOL being in a neutral position, which necessitates the study that investigates the accuracy of the new TK technology.

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Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study

Clinical Oral Investigations ◽

10.1007/s00784-021-03826-7 ◽

2021 ◽

Author(s):

W. Leontiev ◽

E. Magni ◽

C. Dettwiler ◽

C. Meller ◽

R. Weiger ◽

...

Keyword(s):

Multivariate Analysis ◽

Ex Vivo ◽

Predictive Values ◽

Composite Restorations ◽

Significant Difference ◽

Identification Technique ◽

Illumination Method ◽

Sensitivity Specificity ◽

Entire Procedure ◽

Higher Sensitivity

Abstract Objectives The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. Materials and methods Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. Results The sensitivity (84%, CI 81–86%), specificity (94%, CI 93–96%), PPV (92%, CI 90–94%), and NPV (90%, CI 88–91%) of FIT was significantly higher than that of CONV (47%, CI 44–50%; 82%, CI 79–84%; 66%, CI 62–69%, and 69%, CI 68–71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. Conclusions FIT is more reliable for detecting composite restorations than the conventional illumination method. Clinical relevance FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

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DIAGNOSIS OF IMPAIRED FETAL GROWTH IN NEWBORN INFANTS

PEDIATRICS ◽

10.1542/peds.48.4.511 ◽

1971 ◽

Vol 48 (4) ◽

pp. 511-522 ◽

Cited By ~ 1

Author(s):

Herbert C. Miller ◽

Khatab Hassanein

Keyword(s):

Birth Weight ◽

Soft Tissue ◽

Body Length ◽

Fetal Growth ◽

Head Circumference ◽

Soft Tissue Mass ◽

Newborn Infants ◽

Tissue Mass ◽

Growth Impairment ◽

Short Body

Measurements of crown-heel length, head circumference, and birth weight were made on a large number of newborn infants. Birth weight by itself was frequently not a valid measure of fetal growth impairment. By including measurements of body length and head size along with birth weight, four distinct patterns of fetal growth impairment were identified. The four patterns included infants who had abnormally short body lengths for dates, infants who had evidence of disproportionate growth between body length and head circumference, infants who accumulated excessive amounts of soft-tissue mass, and infants who accumulated too little soft-tissue mass. Criteria for diagnosing each pattern were obtained prospectively and have been presented with allowances made for the effects of race, sex, fetal age, and parity on each pattern. The separate identification of the four patterns provided a more precise description of fetal growth impairment than could be obtained from birth weight and calculated gestational age.

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Perineal Injury and Its Association with Postpartum Sexual Dysfunction among First Delivery Women

European Journal of Clinical Medicine ◽

10.24018/clinicmed.2021.2.3.74 ◽

2021 ◽

Vol 2 (3) ◽

pp. 34-39

Author(s):

Z. Nusee ◽

M. N. Ainy ◽

P. Hafizah

Keyword(s):

Sexual Dysfunction ◽

Vaginal Delivery ◽

Female Sexual Dysfunction ◽

Family Income ◽

Mode Of Delivery ◽

Sexually Active ◽

Perineal Tear ◽

Health Clinics ◽

Perineal Injury ◽

Significant Difference

Background: Female sexual dysfunction (FSD) following childbirth imposes significant burden to the marital institution around the world. The perineal injury may potentially be one of the main risk factors contributing to postpartum female sexual dysfunction (PPFSD). The study aimed to determine the effect of perineal injury and patients’ characteristics on PPFSD. Methodology: This cross-sectional questionnaire study was conducted in six different health clinics in the district of Kuantan from April 2019 to October 2019. Eligible women who came to the family health clinics at 6 months postpartum were recruited as study population. The participants completed their biodata and socio-demographic form and the Malay-validated Female Sexual Function Index (MVFSFI) questionnaire given. A cut-off point of 26.55 and below on MVFSFI scoring system was used as a measure of the primary outcome of sexual dysfunction. Results: Out of 240 women who delivered vaginally, 34 (14%) had intact perineum, 107 (44.6%) sustained 1st degree perineal tear, 96 (40%) 2nd degree tear and three (1.25%) 3rd degree tear. Among the respondents, 60.9% of the sexually active respondents who had vaginal delivery, reported to have PPFSD. The timing of sexual resumption does not correlate with the severity of perineal tear. The severity of perineal tear is significantly associated with age (p=0.018), duration of marriage (p=0.008), body mass index (BMI) (p=0.019) and instrumental delivery (p=0.025). The level of personnel skill whom performed the repair were also found to have a significant relationship to PPFSD (p= 0.001). The relationship of participants’ mean age (p=0.271), marriage duration (p=0.903), race (p=0.928), religion (p=0.852), education level (p=0.549), employment status (p=0.102), family income (p=0.460) and BMI(p=0.159) with presence of PPFSD were all found to be statistically not significant. Conclusion: Occurrence of PPFSD is high among sexually active women who had vaginal delivery complicated by perineal tear, especially among those requiring instrumentation. The severity of perineal tear is associated with age, duration of marriage, BMI and mode of delivery. However, PPFSD does not significantly relate to the severity of perineal tear. None of the socio-demographic factors show a significant difference to sexual dysfunction.

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SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival

British Journal of Surgery ◽

10.1093/bjs/znab361.138 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Kalaiyarasi Arujunan ◽

Abdulwarith Shugaba ◽

Harmony Uwadiae ◽

Joel Lambert ◽

Georgios Sgourakis ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Postoperative Complications ◽

Liver Surgery ◽

Patient Survival ◽

Enhanced Recovery ◽

Readmission Rates ◽

Term Survival ◽

Significant Difference

Abstract Aims The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival. Methods This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival. Results There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (>3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival. Conclusions ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.

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The effect of Hyoscine Butylbromide on the rate of vaginal delivery in cases of secondary arrest of cervical dilatation: A rondomized controlled clinical trial

QJM ◽

10.1093/qjmed/hcab115.006 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Ahmed Elkady ◽

Dina Yahia Mansour ◽

Alyaa Mostafa Elshamy

Keyword(s):

Vaginal Delivery ◽

Statistical Difference ◽

Saline Group ◽

Cervical Dilatation ◽

Control Group ◽

Controlled Clinical Trial ◽

Hyoscine Butylbromide ◽

Labor Time ◽

Significant Statistical Difference ◽

Significant Difference

Abstract Background For decades, health providers have worked to manage labor actively and safely, with the goal of shortening the duration of painful labor. Reduction of cesarean sections and maternal complication is also an important aspect of labor management. Antispasmodic are commonly administrating during labor in both developing and developed countries, although there is a paucity of scientific reports validating this. Hyoscine butylbromide is an effective antispasmodic drug. Therefore, We aim to assess efficacy of Hyoscine butylbromide on rate of vaginal delivery in cases of 2ry arrest of cervical dilatation. Objective To assess whether the intravenous injection of hyoscine butylbromide is effective in progress of labor in which cases with 2ry arrest of cervical dilatation. Patients and Methods The study included 100 pregnant women (PG, P1, P2, P3) conducted at Ain Shams University Maternity Hospital, the inclusion Criteria were: term uncomplicated singleton pregnancy in a spontaneous active labor, with cephalic presentation. The patient must be free from any medical disorder associated with pregnancy and free from any obstetric complication. Cases were subdivided into 2 groups: Study group: 50 patients received 40mg iv Hyoscine Butylbromide (as Buscopan 20mg\mrl) when the cervix >4cm dilated and was >50% effaced. Control group: 50 patients received 2ml saline as placebo. Results Significant increase in vaginal delivery rate (72%) in Hyoscine group; compared to Saline group (52%); with significant statistical difference (p = 0.04). Highly significant decrease in 1st and 2nd stage labor time in Hyoscine group; compared to Saline group; with highly significant statistical difference (p < 0.05 respectively). These results observed without significant difference as regards 3rd stage labor time and postpartum hemorrhage (p > 0.05), APGAR score and NICU admission (p > 0.05). Conclusion From the current study we can conclude that HBB 40 mg is safe and effective in increasing vaginal delivary rate in cases of 2ry arrest of 12 dilatation. It is effective in decreasing first and second stage of labor. It has no maternal or neonatal adverse effect. It is easy and available.

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