FREQUENCY OF COMMON FACTORS INFLUENCING THE GRAFT UPTAKE IN MYRINGOPLASTY AMONG THE TERTIARY CARE HOSPITAL KPK

Introduction: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and /or the ossicular chain. Myringoplasty is a tympanoplasty without ossicular reconstruction. Over the years many methods have been used for closing perforations. Myringoplasty was introduced by Berthold in 1878 but the modern era began only in 1950s with the work of Wullstein and Zoellner. The study aims to analyse the common factors which are predictive of success of myringoplasty in adult patients and to construct and validate a prognostic index that could be used as tool to predict the success of myringoplasty in adults. Objectives: To determine the frequency of common factors influencing the graft uptake in myringoplasty. Materials and Method: In this study, a total sample size was 376, using 4.08% proportion of fourth degree perineal tear, 95% confidence level and 2% margin of error under WHO software for sample size determination. Moreover, consecutive non probability sampling technique was used. Results: The mean age was 40 years with standard deviation of ± 2.63. Sixty two percent of the patients were male while thirty eight percent patients were female. The success rate of myringoplasty was 90% while the failure rate was 15(10%) patients in which 4(25%) patients had medium perforation, 5(33%) patients had large perforation while 6(42%) patients had subtotal perforation. Regarding the causes of perforation among 15(10%) patients, 13(85%) patients had infection while only 2 patients had trauma. Conclusion: The study concludes that infection (85%) was the most common cause of perforation followed by trauma (15%) in the graft uptake in myringoplasty.

To Assess Social Demographic Characteristics of Women with Pelvic Organ Prolapse

Introduction: One of the prevalent clinical conditions in daily gynecological treatment is pelvic organ prolapses (POP), particularly in parous women. The entity comprises vaginal wall descent and/or uterine descent. Pelvic organ prolapse is a common pelvic disorder among women. Objective: To determine the social demographic characteristics and types of pelvic organ prolapse and to find out the association between social demographical characteristics with pelvic organ prolapse. Methods: The descriptive survey was used and the sampling technique was non probability convenient sampling technique and the sample size was 60. Results: Twenty six (43.3%) women were belongs to in the age group of 33-40 years. 54 (90%) of women were married.29 (48.3% ) of women never had abortion. 26 (43.3%) of women had normal delivery whereas 17(28.3) had instrumental delivery .19 (31.3%) of women had perineal tear, 20 (33.30%) of women had cervical tear in previous pregnancy . 21(35% ) of women had cystocele whereas 20(33.3) has rectocele . There is significance association between the of age of women, marital status, occupation, Place of previous delivery, type of previous delivery, complications during previous labour except the parity with pelvic organ prolapse. Conclusion: Pelvic organ prolapse is common gynecological condition .The patients are relatively middle age group. Parity, Occupation, Injuries to birth canal was may be contributory to severity of pelvic organ prolapse.

Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014–2019: a national population-based cross-sectional study

ObjectivesThe aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales.DesignCross-sectional analysis.Setting64 699 live births in Wales from 31 March 2014 to 16 September 2019.Primary outcome variableWe examined each of the following seven adverse pregnancy outcomes: (1) small for gestational age (SGA); (2) large for gestational age; (3) preterm birth; (4) third-degree or fourth-degree perineal tear; (5) major postpartum haemorrhage (MPPH); (6) a lower Apgar score at 5 min and (7) emergency caesarean section.ResultsThere was no significant association between increasing aggregate measures of area-level deprivation and the adverse pregnancy outcomes we studied. Women living in an area with greater access to services are more likely to have a baby that is SGA (1.27, 95% CI 1.11 to 1.49), have a greater likelihood of a perineal tear (1.74, 95% CI 1.15 to 2.61), are significantly less likely to have MPPH (0.79, 95% CI 0.64 to 0.96), have a baby with an Apgar score of 0.26 higher (95% CI 0.22 to 0.29) and are significantly less likely to have an emergency caesarean section (0.81, 95% CI 0.73 to 0.88). Women living in areas with higher employment (0.26, 95% CI 0.19 to 0.36) and better health (0.26, 95% CI 0.19 to 0.35) were less likely to experience perineal tear.ConclusionsThere was no clear social-spatial gradient in area-level deprivation and adverse pregnancy outcomes. We found a stronger association for individual-level behavioural risk factors than area-level factors. These findings support the benefits that accessible and holistic person-centred care may bring through addressing individual behavioural risk factors. There is a need for improved data completeness and further individual-level data on risk factors such as employment and income to better understand the role which may be played by population-level policies and their pathways to affecting outcomes.

Fetomaternal outcome in operative vaginal delivery

Background: Operative vaginal deliveries (OVD) were performed with the help of vacuum or forceps in the second stage of labor when mother and foetus condition is threatening. A successful assisted vaginal delivery avoids caesarean section and its associated morbidity and implications for future pregnancy. The aim of the study was to assess the maternal and neonatal outcome of vacuum and forceps assisted vaginal deliveries.Methods: It was a retrospective comparative cross sectional study done in VMKVMCH, Salem in obstetrics and gynecology department, from the period of April to June 2021. All the mothers delivered by operative vaginal delivery were included. Mothers with multiple pregnancies, preterm and breech presentation were excluded. Data collected using patients information sheet and analysis was done using SPSS 23. P value <0.05 was considered significant.Results: The most common age group was 21-25 years of age in both groups and most commonly used in primigravida. The most common indication for forceps assisted delivery in our study was the prolonged second stage labour and in vacuum delivery was poor maternal effort. In our study, common complication noted was extended episiotomy followed by perineal tear in forceps group and vice versa in vacuum group. Cephalhematoma was found to be more common in vacuum and scalp and instrumental injuries were more common in forceps assisted vaginal deliveries.Conclusions: Operative vaginal deliveries helps in improving both maternal and foetal outcomes and reduces the caesarean delivery rate and vacuum significantly reduces maternal trauma than forceps. No difference noted in neonatal outcome.

Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial

Perineal massage increases elasticity of myofascial perineal tissue and decreases the burning and perineal pain during labour, thus optimising child birth, although an application protocol has not been standardised yet. The objective of this study is to determine the efficiency of massage in perineal tear prevention and identification of possible differences in massage application. Total of 90 pregnant participants were divided into three groups: perineal massage and EPI-NO® device group, applied by an expert physiotherapist, self-massage group, where women were instructed to apply perineal massage in domestic household, and a control group, which received ordinary obstetric attention. Results: The results showed significant differences among the control group and the two perineal massage groups in perineal postpartum pain. Correlations in perineal postpartum pain, labour duration and the baby’s weight were not statistically significant. Lithotomy posture was significantly less prevalent in the massage group than in the other two; this variable is known to have a direct effect on episiotomy incidence and could act as a causal covariate of the different incidence of episiotomy in the groups. Perineal massage reduces postpartum perineal pain, prevalence and severity of perineal tear during delivery.

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

Background Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and ≥ 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43–27.84] and in single mothers (AOR 2.57, 95%CI 1.14–5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05–0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09–0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31–4.08). Conclusions Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

PREGNANCY EXERCISE IMPACT TO PERINEAL TEAR IN NORMAL LABOR

Background: Perineal tear is the tearing of the pelvic floor muscles. Based on the literature review and previous research, perineal tear often occur in labor, especially in primigravida. Pregnancy exercise is a physical activity that carried out by pregnant women. This study aims to determine the relationship between pregnancy exercise and perineal tear in normal labor at the Pratama Anugrah Clinic in Surabaya. Methods: This study uses an observational analytic method with a retrospective time approach. The number of samples was 34 case groups (perineal tears) and 34 control groups (no perineal tears) in normal delivery using purposive sampling. The instruments used are medical records, written interviews, cameras and checklists. Data analysis used chi square statistical test with a significance level of 0.05. Results: The results showed that there were still many mothers who did not do pregnancy exercise during their pregnancy as many as 43 (63.2%). Mothers who did not practice pregnancy exercise experienced more perineal tears as much as 27 (79.4%), while mothers who did practice pregnancy exercise experience perineal tear in normal labor that is 18 (53%). Result of chi square statistical tests obtained p value 0.006 (p<0.05). Conclusion: Pregnancy exercise minimizes perineal tear in normal delivery.

Perineal Management and Episiotomy Practice in Chile

Episiotomy is a common intervention used during the second stage of delivery. Current use of this procedure is restricted to certain births due to several complications. Almost all births in Chile are delivered by a gynecologist or a midwife in the public or private health system where episiotomy is performed. The objective of this study is to identify strengths and weakness in aspects of perineal management and episiotomy practice among obstetric health care providers with the purpose of promoting practice assessment and updating skills and competencies. Design: Questionnaire-based-cross-sectional study. Method: Anonymous questionnaire applied to gynecologists and midwives of public and private hospitals, between October and December 2019 using the Instrument designed by Cornet et al. addressing questions such as affiliation, number of births/year, knowledge of anatomy, knowledge of episiotomy, knowledge of perineal tear, competence in perineal repair, and presence of expert in perineal trauma at their unit. Results: 189 surveys responded, 51% from midwives and 37.6% from doctors. 71% of total were trained at their medical or midwifery schools and 69% during postgraduate internships. Episiotomy practice criteria: 19% always in primigravida patients and 14,3% always in premature deliveries. Majority of professionals, 79.4% with less than 100 deliveries a year had incorrect answers about depth or sphincter tear prevention technique. Conclusions: The majority of professionals indicated insufficient training capacities in relation to episiotomy techniques. Undergraduate programs should strength training on this intervention, national guidelines must include routine episiotomy performance in order to unify criteria.

Perineal outcomes after delivery in 179 mothers with IBD compared to 31,258 controls - a single centre cohort study

Background Patients with IBD have an increased risk for caesarean section (CS) in women but perineal obstetric outcomes, which may have significant consequences for women with IBD, have not been previously studied. Method Maternal outcomes in singleton pregnancies of IBD and non-IBD patients (2014-2018) in a single centre were studied. Results In 31,528 Non-IBD and 179 IBD patients delivery by CS was more likely in IBD patients (p=0.0021, RR 1.45, CI 1.16-1.81). Elective CS in IBD patients occurred in 40% for IBD indications, all in accordance with current international guidelines. Perineal trauma, including tears involving the anal sphincter, were equally uncommon in IBD (2.23%) and Non-IBD patients (3.40%; p=0.35, RR 0.64, CI 0.24-1.68). Of the four IBD patients with clinically significant tears, none had pelvic floor dysfunction or incontinence at follow-up in a specialist postnatal perineal trauma clinic. One IBD patient who had a clinically non-significant second degree perineal tear reported incontinence a year after giving birth. Previous perianal disease was not associated with significant perineal trauma. Conclusion The low rate of perineal trauma is reassuring for promotion of vaginal delivery in most IBD patients. In those who experienced tears involving the anal sphincter no continence issues occurred. Women with IBD had greater incidence of delivery by CS only partially explained by IBD indications.

Efeitos da massagem perineal durante o trabalho de parto

Durante o trabalho de parto o traumatismo do períneo é frequente. A massagem perineal é considerada uma técnica que promove a integridade do períneo. Como objetivo pretende-se identificar os efeitos da massagem perineal durante o trabalho de parto. Foi realizada uma revisão integrativa da literatura, com pesquisa a 18 de janeiro de 2021. Foram considerados artigos de estudos primários e revisões sistemáticas da literatura, publicados em Português, Inglês e Espanhol, disponíveis nas bases B-ON, PubMed e CINAHL, em texto integral e de livre acesso, no ano de 2016 a 2020. A questão de pesquisa “Quais os efeitos da massagem perineal durante o trabalho de parto?” teve por base o método de PI[C]OD. Aquando a pesquisa nas bases de dados com a expressão -“(injury) AND (massage) AND (perineum) AND (labor) obteve-se 53 artigos na Pubmed; já com a expressão – “( perineal trauma OR perineal injury OR perineal tear OR perineal laceration ) AND massage AND ( labor OR delivery ) obteve-se 278 artigos na B-on e 41 na Cinahl, ficando no total com 372 artigos. Após aplicação dos critérios de inclusão do tempo, língua e livre acesso ficaram 110 artigos. De seguida, considerou-se a repetição dos artigos ficando com 85 artigos. Após leitura do título e resumo foram selecionados 11 artigos. Foram assim encontrados 6 artigos agrupados em função do método de pesquisa. Dos resultados encontrados verificou-se que existem benefícios na utilização da massagem perineal durante o trabalho de parto. Conclui-se que a realização de massagem perineal durante o trabalho de parto reduz o número de lacerações no períneo, a necessidade de episiotomia, a duração do trabalho de parto, bem como, a dor após o parto. No entanto, é necessário realizar mais estudos.