Healing of disrupted perineal wounds after vaginal delivery: a poorly understood condition

Perineal injury following childbirth can result in complications such as wound infection and dehiscence. The reported incidence of these complications in the literature range between 0.1-23.6% and 0.2-24.6%, respectively. However, the healing of disrupted perineal wounds is poorly understood. In addition, it is a neglected area in maternity services. In this review, the authors explore the process of wound healing in the context of infected perineal wounds following childbirth. In addition, the authors describe the management of complications including hypergranulation, perineal pain and dyspareunia.

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.

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

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.

Magnitude and outcomes of complex perineal injury – A retrospective analysis of five years’ data from a Level 1 trauma centre

Complex perineal injuries pose a major diagnostic and therapeutic challenge to trauma surgeons. A retrospective review of the hospital records of 29 patients with complex perineal injury following blunt trauma was done. Demographic profile, management and outcomes were collected. Quality of life analysis was conducted for patients with complex perineal injuries who were discharged. The most predominant mode of injury was a road crash: being a pedestrian run over by a heavy motor vehicle. Pelvic fracture was seen in 20, anorectal involvement in 22 and urogenital injuries in 14. Urgent surgical debridement was done in all patients, faecal diversion in 27 and urinary diversion in 14. There were nine deaths, three from haemorrhage, and the remainder from sepsis and multi-organ dysfunction. Complex perineal injury remains a major cause of morbidity and mortality in trauma patients. There is a need to ensure adequate rehabilitation services for such patients.

Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study

Background: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. Methods: A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016–2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.

Perilaku Perawatan Luka Perinium, Pola Hidup Sehat dan Kondisi Kesehatan Ibu Post Partum Masa Pandemi Covid-19

The pandemic covid-19 needs to be an effort to handle infection prevention for mothers and infants. Infection in pregnancy accounts for 11% of the causes maternal morbidity, the most vulnerable period for infection is in the puerperium or after delivery. One of the factors that facilitate infection is wound the birth canal. It can be a pathway for microorganisms. A healthy lifestyle is also a factor influencing the healing of perineal wounds. There is a relationship between of knowledge, nutrition, exercise and personal hygiene. Perineal injury requires time to heal for 2-3 weeks and it takes good care of the perineal wound to avoid infection. The purpose of the study was to identify the behavior of perineal Wound Care, Healthy Lifestyle and post partum maternal health conditions during the Covid-19 Pandemic at BPM Islah Wahyuni. The sample of 30 respondents were post partum on March 10 to June 25, 2020. The results obtained from the Behavioral Care of Perineal Injury both 27 respondents 90%, Healing Time <3 weeks 20 respondents (80%), PerinealInfection 0%, conditions physically healthy (96.7%). Post partum mothers should maintain perineal wound care, promote health and preventing transmission of post partum infection during this pandemic covid-19.

Paediatric perineal injury following explosive blast: A Case Report

Perineal injury in children is uncommon. Injuries range from minor perineal skin laceration to severe injury to the genitourinary tract, anorectal region and the pelvic bone. The mechanisms of injury are usually attributed to blunt trauma, penetrating injuries like impalement injury, or sexual abuse. Perineal injury resulting from explosive blast in children is rare. The management depends on the time and mode of presentation and examination findings. Early presentation (a few hours after injury) with 1st or 2nd-degree perineal injury may benefit from debridement with primary repair of soft tissues and/or sphincters. Late presentation (days after injury) with 3rd or 4th-degree injury will require diverting colostomy or urinary diversion and wound drainage. This is a report of an unusual case of severe perineal injury in a child following explosive blast sustained while squatting close to packed explosives that got detonated. The perineal injury was initially managed with colostomy and wound drainage. The colostomy was closed after the wound had healed with good faecal continence achieved and without perineal soft tissue or anal sphincteric repair. It is concluded that severe isolated paediatric explosive blast perineal injury is rare but is amenable to surgical care.