Prevention and Management of Obstetric Perineal Lacerations

2018 ◽  
Author(s):  
Helai Hesham ◽  
Lori R Berkowitz
Keyword(s):  
Risk Factors ◽  
Pelvic Floor ◽  
Key Words ◽  
Evidence Based ◽  
Operative Delivery ◽  
Prevention Strategies ◽  
Perineal Lacerations ◽  
Vaginal Deliveries ◽  
Perineal Massage

Vaginal deliveries vary widely in the trauma they may introduce to the pelvic floor as does the management of such trauma. Labor, operative deliveries, lacerations, and episiotomies all present unique risk factors for both acute and long-term pelvic floor complications. Of these risk factors, perineal lacerations are the most commonly encountered event that women experience during vaginal childbirth. This review attempts to analyze obstetric perineal lacerations, their management, and potential prevention strategies to enhance pelvic floor health. With standardized management based on evidence based strategies and care during both delivery and postpartum, clinicians can decrease higher order lacerations and their possible sequela. This review contains 12 figures, 1 table and 36 references Key Words: episiotomy, laceration, laceration repair, obstetric, operative delivery, perineal massage, prevention, pudendal block

Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)

2020 ◽  
Author(s):  
Kyoung Ja Moon ◽  
Chang-Sik Son ◽  
Jong-Ha Lee ◽  
Mina Park
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Cloud System ◽  
Evidence Based ◽  
Methodological Study ◽  
Term Care ◽  
Web Based ◽  
Care Facilities ◽  
Delirium Prevention

BACKGROUND Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring. OBJECTIVE This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI). METHODS This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized. RESULTS We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool. CONCLUSIONS This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care. CLINICALTRIAL none

scholarly journals Adherence to Behavioral Interventions for Urge Incontinence When Combined With Drug Therapy: Adherence Rates, Barriers, and Predictors

2010 ◽  
Vol 90 (10) ◽  
pp. 1493-1505 ◽  
Author(s):  
Diane Borello-France ◽  
Kathryn L. Burgio ◽  
Patricia S. Goode ◽  
Alayne D. Markland ◽  
Kimberly Kenton ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Pelvic Floor ◽  
Behavioral Intervention ◽  
Behavioral Interventions ◽  
Pelvic Floor Muscle ◽  
Exercise Adherence ◽  
Secondary Data ◽  
Prevention Strategies ◽  
Exercise Barriers

Background Behavioral intervention outcomes for urinary incontinence (UI) depend on active patient participation. Objective The purpose of this study was to describe adherence to behavioral interventions (pelvic-floor muscle [PFM] exercises, UI prevention strategies, and delayed voiding), patient-perceived exercise barriers, and predictors of exercise adherence in women with urge-predominant UI. Design This was a prospectively planned secondary data analysis from a 2-stage, multicenter, randomized clinical trial. Patients and Intervention Three hundred seven women with urge-predominant UI were randomly assigned to receive either 10 weeks of drug therapy only or 10 weeks of drug therapy combined with a behavioral intervention for UI. One hundred fifty-four participants who received the combined intervention were included in this analysis. Measurements Pelvic-floor muscle exercise adherence and exercise barriers were assessed during the intervention phase and 1 year afterward. Adherence to UI prevention strategies and delayed voiding were assessed during the intervention only. Results During intervention, 81% of women exercised at least 5 to 6 days per week, and 87% performed at least 30 PFM contractions per day. Ninety-two percent of the women used the urge suppression strategy successfully. At the 12-month follow-up, only 32% of the women exercised at least 5 to 6 days per week, and 56% performed 15 or more PFM contractions on the days they exercised. The most persistent PFM exercise barriers were difficulty remembering to exercise and finding time to exercise. Similarly, difficulty finding time to exercise persisted as a predictor of PFM exercise adherence over time. Limitations Co-administration of medication for UI may have influenced adherence. Conclusions Most women adhered to exercise during supervised intervention; however, adherence declined over the long term. Interventions to help women remember to exercise and to integrate PFM exercises and UI prevention strategies into daily life may be useful to promote long-term adherence.

scholarly journals Prevalence of Episiotomy and Perineal Lacerations in a University Teaching Hospital, North-Central Nigeria

2018 ◽  
Vol 1 (2) ◽  
pp. 142-147
Author(s):  
S K Hembah-Hilekaan ◽  
A O Ojabo ◽  
O Audu ◽  
P E Onche ◽  
M T Maanongun
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Teaching Hospital ◽  
Maternal Age ◽  
Fetal Weight ◽  
University Teaching ◽  
Warning Sign ◽  
Perineal Laceration ◽  
Perineal Lacerations ◽  
Vaginal Deliveries

Episiotomy is an incision on the introitus and the perineum to increase pelvic outlet to facilitate childbirth and prevent trauma to fetal and maternal tissues. Episiotomy and perineal laceration may predispose the woman to short and long term complications. The objective of this study was to determine the prevalence of episiotomy and perineal lacerations and their associated risks factors at Benue State University Teaching Hospital, Makurdi, Nigeria. Retrospective data of all women who had spontaneous vagina delivery over a 3 year period with perineal laceration/episiotomy were reviewed. Data was obtained from the records and information on the socio-demographic variables, episiotomies, lacerations and the birth weight of infants. The associated risk factors were recorded using Statistical Package for Social Sciences version 22.Of the 636 vaginal deliveries, 85(13.4%) had lacerations with 65(10.2%) first degree, 19(3.0%) second degree and 1(0.2%) major laceration. Episiotomy rate was 132(20.8%). The mean parity and birth weight of infants were 2.62(SD= ± 1.83) and 3.1 kg (SD= ± 0.767) respectively. The highest number of perineal tears 69(10.8%) were in the lower age group (≤ 30 years). A similar observation was noted in respect of episiotomies which rate however decreased with parity. The relationship between maternal age, parity, booking status, fetal weight and the perineal status at delivery was statistically significant (P≤ 0.05). Episiotomy and perineal laceration rates in our institution were low. The major risk factors were low parity, young maternal age and increasing fetal weight at birth and their presence should be an early warning sign. We advise perineal support for all women during delivery.

scholarly journals Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles

2016 ◽  
Vol 39 (01) ◽  
pp. 26-30 ◽  
Author(s):  
Ana Silva ◽  
Mary Montenegro ◽  
Maria Gurian ◽  
Andreia Mitidieri ◽  
Lucia Lara ◽  
...  
Keyword(s):  
Sexual Function ◽  
Pelvic Floor ◽  
Depression Scale ◽  
Pelvic Floor Muscles ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Pain Group ◽  
Perineal Massage ◽  
Pain Domain

Aim To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles. Methods A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group – 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group – 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks. Results All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain. Conclusion Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.

Performance-based specifications for pavements

1991 ◽  
Vol 18 (6) ◽  
pp. 1054-1061 ◽  
Author(s):  
P. Kuzyk ◽  
R. C. G. Haas ◽  
R. W. Cockfield
Keyword(s):  
Risk Factors ◽  
Key Words ◽  
Current Practice ◽  
Cost Effective ◽  
Pavement Performance ◽  
Substantial Portion ◽  
Actual Performance ◽  
Long Term Performance ◽  
Term Performance

Pavements represent a very substantial portion of the public's investment in infrastructure. It is essential that this investment be preserved through cost-effective planning, design, and maintenance. One way of achieving this is through the use of long-term performance-based specifications. This paper first describes the current practice for pavement specification. For the most part, these specifications are "recipe" orientated. Very specific requirements are set for procedures, such as compaction, or as constructed properties such as density. With the proposed system, the contractor would be required to warranty the actual performance of the pavement over an extended term. The paper describes the overall scope of the system, its key elements and advantages, and the major risk factors. As well, the measures that can be used to characterize performance and a model for estimating performance are identified. A stochastic formulation of the model is used to present a method of determining the risk to the contractor based on a design example. Finally, the paper explores some of the concerns associated with the implementation of the system and how these concerns might be addressed. Key words: long-term warranties, pavement contracting, pavement performance.

scholarly journals Case Report of Ectopic Ovarian Pregnancy following Fresh Embryo Transfer

2016 ◽  
Vol 10 ◽  
pp. CMRH.S40593
Author(s):  
Nivin Samara ◽  
Yaakov Bentov
Keyword(s):  
Risk Factors ◽  
Embryo Transfer ◽  
Prevention Strategies ◽  
Fresh Embryo Transfer ◽  
Vitro Fertilization ◽  
Extrauterine Pregnancy ◽  
Ovarian Pregnancy ◽  
Clinical Phenomenon

Background Ovarian pregnancy is a rare and challenging clinical phenomenon. Recent studies have identified assisted reproductive treatments and infertility as risk factors. However, neither a definite mechanism nor clear risk factors were identified and therefore prevention strategies are yet unavailable. Clinical Case In this article, we present a case of ovarian pregnancy occurring following in vitro fertilization treatment and a fresh embryo transfer. The couple was diagnosed with unexplained infertility and no identifiable risk factors for extrauterine pregnancy. The diagnosis of ovarian pregnancy was made during explorative laparoscopy performed due to suspected extrauterine pregnancy. The patient had normal intra- and postoperative course. Conclusion Ovarian pregnancy is an infrequent and a challenging diagnosis. Yet, late diagnosis and lack of appropriate intervention may have long-term implications. Several mechanisms and risk factors are proposed, and their acknowledgment may improve early diagnosis and prevention of complications.

scholarly journals Use of Transabdominal Ultrasound Imaging in Retraining the Pelvic-Floor Muscles of a Woman Postpartum

2008 ◽  
Vol 88 (10) ◽  
pp. 1208-1217 ◽  
Author(s):  
Allison Ariail ◽  
Trace Sears ◽  
Elizabeth Hampton
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Transabdominal Ultrasound ◽  
Motor Tasks ◽  
Daily Routines ◽  
Vaginal Deliveries ◽  
History Of ◽  
Postpartum Stress

Background and PurposePostpartum stress urinary incontinence (SUI) often compromises a woman's ability to participate in normal daily routines or physical activities. Pelvic-floor muscle (PFM) training has been shown to be effective in improving urinary incontinence. Transabdominal ultrasound (TAUS) imaging is a new, noninvasive method for assessing the function of the PFMs. This case report describes the use of TAUS imaging in the strengthening of a patient's PFMs.Case DescriptionThe patient was a 29-year-old woman experiencing SUI with high-impact activities following a history of 2 vaginal deliveries, 1 resulting in a grade III perineal laceration. Intervention included PFM training with the use of TAUS imaging. A 1-year follow-up examination was performed to assess the long-term functional outcomes experienced by the patient. The patient's ability to maintain a PFM contraction during motor tasks was documented throughout the course of treatment to demonstrate her gain in PFM control.OutcomesThe patient gained strength in her PFMs, enabling her to maintain a PFM contraction during various motor tasks. She was able to return to a running program with no SUI symptoms. Her satisfaction level was high at 1 year.DiscussionThe use of TAUS imaging was a helpful assessment and biofeedback tool for re-education and rehabilitation of the PFMs for this patient.

scholarly journals An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise Associated Muscle Cramps

2021 ◽  
Author(s):  
Kevin C. Miller ◽  
Brendon P. McDermott ◽  
Susan W. Yeargin ◽  
Aidan Fiol ◽  
Martin P. Schwellnus
Keyword(s):  
Risk Factors ◽  
Patient Specific ◽  
Evidence Based ◽  
Prevention Strategies ◽  
Extrinsic Factors ◽  
Physically Active ◽  
Muscle Cramps ◽  
Evidence Based Treatment ◽  
Treatment And Prevention ◽  
Exercise Associated Muscle Cramps

ABSTRACT Exercise-associated muscle cramps (EAMC) are common and frustrating for athletes and the physically active. We critically-appraised the EAMC literature to provide evidence-based treatment and prevention recommendations. While the pathophysiology of EAMC appears controversial, recent evidence suggests EAMC are due to a confluence of unique intrinsic and extrinsic factors rather than a singular etiology. The treatment of acute EAMC continues to include self-application or clinician-guided gentle static stretching until EAMC abatement. Once the painful EAMC are alleviated, clinicians can continue treatment on the sidelines by focusing on patient-specific risk factors that the clinician believes may have contributed to the genesis of EAMC. For EAMC prevention, clinicians should first perform a thorough medical history followed by identification of the patients' unique risk factors that could have coalesced to elicit EAMC. Individualizing EAMC prevention strategies will likely be more effective than generalized advice (e.g., drink more fluids).

scholarly journals Perineal Outcome after Restrictive use of Episiotomy in Primi-gravidas

2009 ◽  
Vol 48 (176) ◽  
Author(s):  
A Joshi ◽  
R Acharya
Keyword(s):  
Risk Factors ◽  
Prospective Observational Study ◽  
Evidence Based ◽  
Perineal Tear ◽  
Factors Associated ◽  
Mission Hospital ◽  
The Mean ◽  
Clinically Significant ◽  
Based Medicine

Introduction: Episiotomy is a common obstetrical practice that is believed to prevent severe lacerations. Principles of evidence based medicine raises questions on the utility of routine episiotomy. Methods: A prospective observational study was conducted in primi gravidas coming to Tansen Mission Hospital for delivery who were not offered episiotomy sticking to the protocol of restrictive use of episiotomy and the subsequent perineal tear was evaluated in terms of its length, degree and complications. Risk factors associated with significant degrees of perineal tear was investigated. Results: The episiotomy rate during the time of study was only 22%. Among those included in the study, 16.2% of women had intact perineum and majority of women (43.2%) had first degree of tear. Only one (1.4%) had third degree tear without any long term complications. Having a baby weighing 2.5 kg increases the mean tear length significantly (P=0.019) and increases the risk of having second or third degree of tear by almost two times (Relative Risk=1.95). No clinically significant complications were observed in any of the women after the delivery. Conclusions: This study provides some evidence that the principle of restrictive use of episiotomy with a total episiotomy rate being around 20% can be carried out successfully even in an under¬resourced setting of our country.

Piercing associated perichondritis of the pinna: are we treating it correctly?

2013 ◽  
Vol 127 (5) ◽  
pp. 505-508 ◽  
Author(s):  
Z W Liu ◽  
P Chokkalingam
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Literature Review ◽  
Key Words ◽  
Retrospective Analysis ◽  
Persistent Infection ◽  
District General Hospital ◽  
Antibiotic Use ◽  
Causative Organism

AbstractObjective:This paper reports a series of patients with sporadic pinna perichondritis who presented to a district general hospital over a period of 10 years. The data examined included the causative organism, risk factors and pattern of antibiotic use.Method:A retrospective analysis of diagnosed cases of pinna perichondritis from 2001 to 2012 was performed. A literature review of pinna perichondritis was carried out using Pubmed with the key words ‘pinna perichondritis’, ‘pinna abscess’, ‘pinna infection’ and ‘piercing’.Results:Pinna perichondritis was more likely to result from chondral than lobe piercings. The majority of cases were caused byPseudomonas aeruginosa.Conclusion:Most patients were not prescribed anti-pseudomonal antibiotics on presentation. This may result in persistent infection and long-term cosmetic defects.

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