Childbirth injuries encountered on outreach in remote RDCongo

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.

Download Full-text

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

Obstetrics and Gynecology International ◽

10.1155/2021/2621872 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Suskhan Djusad ◽

Yuditiya Purwosunu ◽

Fadil Hidayat

Keyword(s):

Multivariate Analysis ◽

Vaginal Delivery ◽

Body Length ◽

Head Circumference ◽

Power Calculation ◽

Perineal Body ◽

Fourth Degree ◽

Perineal Tears ◽

Good Ability ◽

Significant Difference

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.

Download Full-text

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.

Download Full-text

Atresia Ani in the Dog: A Retrospective Study

Journal of the American Animal Hospital Association ◽

10.5326/0410317 ◽

2005 ◽

Vol 41 (5) ◽

pp. 317-322 ◽

Cited By ~ 16

Author(s):

Maria L. Vianna ◽

Karen M. Tobias

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Fecal Incontinence ◽

Imperforate Anus ◽

Congenital Anomalies ◽

Surgical Repair ◽

Anal Stenosis ◽

Type I ◽

Type Ii ◽

Type Iv

Congenital anomalies of the rectum and anus are rare in dogs. The most frequently reported anomaly is atresia ani. Four types of atresia ani have been reported, including congenital anal stenosis (Type I); imperforate anus alone (Type II) or combined with more cranial termination of the rectum as a blind pouch (Type III); and discontinuity of the proximal rectum with normal anal and terminal rectal development (Type IV). An increased incidence was found in females and in several breeds, including miniature or toy poodles and Boston terriers. Surgical repair is the treatment of choice, but postoperative complications can occur, including fecal incontinence and colonic atony secondary to prolonged preoperative distension.

Download Full-text

Fourth degree perineal tears: surgical repair technique in 10 steps

Journal of Gynecology Obstetrics and Human Reproduction ◽

10.1016/j.jogoh.2021.102151 ◽

2021 ◽

pp. 102151

Author(s):

G. Lamblin ◽

M. de Boisredon ◽

L. Picard ◽

A. Atallah ◽

J. Massardier ◽

...

Keyword(s):

Surgical Repair ◽

Fourth Degree ◽

Repair Technique ◽

Perineal Tears

Download Full-text

Surgical Repair of Type I Truncus Arteriosus 7 Years After Pulmonary Artery Banding: A case Report.

The Kitakanto Medical Journal ◽

10.2974/kmj.48.215 ◽

1998 ◽

Vol 48 (3) ◽

pp. 215-218

Author(s):

Masao Suzuki ◽

Akio Ohtaki ◽

Shigeru Ohki ◽

Takashi Ibe ◽

Jun Murakami ◽

...

Keyword(s):

Case Report ◽

Pulmonary Artery ◽

Surgical Repair ◽

Pulmonary Artery Banding ◽

Truncus Arteriosus ◽

Type I

Download Full-text

Faculty Opinions recommendation of Urinary incontinence, but not fecal incontinence, is a risk factor for admission to aged residential care of older persons in New Zealand.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726884087.793527977 ◽

2017 ◽

Author(s):

Mary H Palmer

Keyword(s):

Risk Factor ◽

Urinary Incontinence ◽

New Zealand ◽

Fecal Incontinence ◽

Residential Care ◽

Older Persons

Download Full-text

Risk factors for third- and fourth-degree perineal tears during vaginal delivery

Urogynaecologia ◽

10.4081/uij.2011.e2 ◽

2011 ◽

Vol 25 (1) ◽

pp. 2

Author(s):

Leonard Juul ◽

Gerhard B. Theron

Keyword(s):

Risk Factors ◽

Shoulder Dystocia ◽

Control Group ◽

Study Group ◽

Tertiary Referral Hospital ◽

Retrospective Case ◽

Fourth Degree ◽

Perineal Tears ◽

Vaginal Deliveries ◽

Hiv Negative

Objective. To identify risk factors for thirdand fourth-degree perineal tears, so as to anticipate and intervene in order to prevent this complication that can severely affect a woman’s quality of life. The study design was a retrospective case control study. Method. Ninety-three cases of third- and fourth-degree perineal tears were identified from the birth register of a tertiary referral hospital (Tygerberg Hospital). One hundred and nine patients with normal vaginal deliveries in the same time period were used as control group. Results. An analysis of the results revealed that there were no significant differences between cases and controls with regards to age, body mass index (BMI), gestation at delivery, duration of second stage, episiotomy and birth weight. However, there were significantly more primigravidas, assisted deliveries (forceps and vacuum), occipitoposterior positions, HIV negative patients and shoulder dystocia in the study group. Conclusions. Antenatal risk factors for thirdand fourth-degree tears are difficult to identify. However, intrapartum occipitoposterior and assisted deliveries, especially in the primigravid patient, should warn the obstetrician/ midwife about the risk of a severe tear. A restrictive episiotomy policy should be practiced. Shoulder dystocia was invariably associated with third- and fourth-degree tears in this study. The higher incidence of HIV negative patients in the study group requires further research.

Download Full-text

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Obstetrics and Gynecology International ◽

10.1155/2020/6035974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Mahad Ali ◽

Richard Migisha ◽

Joseph Ngonzi ◽

Joy Muhumuza ◽

Ronald Mayanja ◽

...

Keyword(s):

Risk Factors ◽

Vaginal Delivery ◽

Anal Sphincter ◽

Tertiary Hospital ◽

Monthly Income ◽

Obstetric Anal Sphincter Injuries ◽

Perineal Tear ◽

Fourth Degree ◽

Anal Sphincter Injury ◽

Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

Download Full-text