Z Geburtshilfe Neonatol 2019; 223(06): 359-368
DOI: 10.1055/a-0858-0138
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Birth Lacerations in Different Genital Compartments and their Effect on Maternal Subjective Outcome: A Prospective Observational Study

Geburtsverletzungen in verschiedenen genitalen Kompartimenten und deren Effekt auf das subjektive maternale Befinden: eine prospektive Observationsstudie
Nina Kimmich
1   Department of Obstetrics, UniversitätsSpital Zürich, Zürich, Switzerland
,
Vera Grauwiler
1   Department of Obstetrics, UniversitätsSpital Zürich, Zürich, Switzerland
,
Anne Richter
1   Department of Obstetrics, UniversitätsSpital Zürich, Zürich, Switzerland
,
Roland Zimmermann
1   Department of Obstetrics, UniversitätsSpital Zürich, Zürich, Switzerland
,
Martina Kreft
1   Department of Obstetrics, UniversitätsSpital Zürich, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

received 30 October 2018

accepted 06 February 2019

Publication Date:
11 April 2019 (online)

Abstract

Introduction Lacerations are common in vaginal births, but little is known about tears other than perineal tears and their association with maternal impairment. This study aimed to evaluate the frequency and distribution of birth lacerations and their association with maternal discomfort.

Methods From 2/2015 to 12/2016, we conducted a prospective observational study on 140 women with singletons in vertex presentation at term, who gave birth vaginally in our center and were affected by a laceration. The lacerations were assigned objectively and subjectively to eight genital tract compartments. The presence and effect of lacerations on maternal health were assessed by questionnaires for the time before birth (T1), 1–4 days (T2), and 6–8 weeks postpartum (T3).

Results The number of affected compartments was 1.33 objectively and 2.99 at T2 and 1.27 at T3 subjectively. The most affected compartment was the right perineum (73%) followed by the right inner posterior (21%) and the right outer anterior (14%) compartment. Subjective and objective assessment concurred in 83% at T2 and 69% of cases at T3. Overall, impairment of women was low, reversible, and not directly associated with the location of lacerations, although women were psychologically affected.

Conclusion Birth lacerations predominantly appear at the right perineum. Physical impairment from these lacerations is generally low, reversible, and not directly associated with the location of lacerations, although psychological impairment is not negligible.

Zusammenfassung

Einführung Verletzungen bei vaginalen Geburten sind häufig, jedoch ist wenig hinsichtlich anderer Verletzungen als am Damm und deren Assoziation zu maternalen Beschwerden bekannt. Ziel der Studie war die Evaluation der Häufigkeit und Verteilung von Geburtsverletzungen und deren Assoziation zu maternalen Beschwerden.

Methode In einer prospektiven Observationsstudie evaluierten wir von 2/2015–12/2016 140 Frauen mit Einlingsschwangerschaften in Schädellage ab 37+0 SSW, welche in unserer Klinik gebaren und dabei Geburtsverletzungen erlitten. Die Verletzungen wurden objektiv und durch die Patientin selbst acht genitalen Kompartimenten zugeordnet und ihre Assoziation zu maternalen Beschwerden mittels Fragebögen präpartal (T1), 1–4 Tage (T2) sowie 6–8 Wochen postpartal (T3) ermittelt.

Ergebnisse Die Anzahl betroffener Kompartimente war objektiv 1.33 und subjektiv 2.99 an T2 und 1.27 an T3. Das häufigste betroffene war das Perineum rechts (73%), gefolgt vom rechten inneren hinteren (21%) und dem rechten äusseren vorderen Kompartiment (14%). Eine Übereinstimmung zwischen objektiver und subjektiver Zuordnung bestand zu 83% bei T2 und zu 69% bei T3. Insgesamt waren die Beeinträchtigungen gering, reversibel und nicht direkt mit der Lokalisation der Beschwerden assoziiert, jedoch zeigten sich die Frauen psychisch beeinträchtigt.

Schlussfolgerung Geburtsverletzungen treten v. a. im Bereich des Perineums rechts auf. Die physische Beeinträchtigung durch diese Beschwerden ist gering, reversibel und nicht direkt assoziiert zur Lokalisation der Verletzung, jedoch ist eine psychische Beeinträchtigung gegeben.

Condensed Content

 
  • References

  • 1 Albers L, Garcia J, Renfrew M. et al. Distribution of genital tract trauma in childbirth and related postnatal pain. Birth 1999; 26: 11-17
  • 2 Practice Bulletin No. 165: . Prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 2016; 128: e1-e15
  • 3 de Souza Caroci da Costa A, Gonzalez Riesco ML. A comparison of “hands off” versus “hands on” techniques for decreasing perineal lacerations during birth. J Midwifery Womens Health 2006; 51: 106-111
  • 4 Wang H, Jayasekara R, Warland J. The effect of “hands on” techniques on obstetric perineal laceration: A structured review of the literature. Women Birth 2015; 28: 194-198
  • 5 Smith LA, Price N, Simonite V. et al. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth 2013; 13: 59
  • 6 Rogers RG, Leeman LM, Borders N. et al. Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. BJOG 2014; 121: 1145-1153 discussion 1154
  • 7 Ventolini G, Yaklic JL, Galloway ML. et al. Obstetric vulvar lacerations and postpartum dyspareunia. J Reprod Med 2014; 59: 560-565
  • 8 Vale de Castro Monteiro M, Pereira GM, Aguiar RA. et al. Risk factors for severe obstetric perineal lacerations. Int Urogynecol J 2016; 27: 61-67
  • 9 Aabakke AJ, Willer H, Krebs L. The effect of maneuvers for shoulder delivery on perineal trauma: a randomized controlled trial. Acta Obstet Gynecol Scand 2016; 95: 1070-1077
  • 10 Aasheim V, Nilsen ABV, Reinar LM. et al. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2017; 6: CD006672
  • 11 Radestad I, Olsson A, Nissen E. et al. Tears in the vagina, perineum, sphincter ani, and rectum and first sexual intercourse after childbirth: a nationwide follow-up. Birth 2008; 35: 98-106
  • 12 Handa VL, Zyczynski HM, Burgio KL. et al. The impact of fecal and urinary incontinence on quality of life 6 months after childbirth. Am J Obstet Gynecol 2007; 197: 636 e631-636 e636
  • 13 Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J 2013; 24: 901-912
  • 14 Leeman LM, Rogers RG. Sex after childbirth: postpartum sexual function. Obstet Gynecol 2012; 119: 647-655
  • 15 Yang X, Zhang HX, Yu HY. et al. The prevalence of fecal incontinence and urinary incontinence in primiparous postpartum Chinese women. Eur J Obstet Gynecol Reprod Biol 2010; 152: 214-217
  • 16 Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand 2010; 89: 1511-1522
  • 17 Williams A, Herron-Marx S, Carolyn H. The prevalence of enduring postnatal perineal morbidity and its relationship to perineal trauma. Midwifery 2007; 23: 392-403
  • 18 Bols EM, Hendriks EJ, Berghmans BC. et al. A systematic review of etiological factors for postpartum fecal incontinence. Acta Obstet Gynecol Scand 2010; 89: 302-314
  • 19 Hall W, McCracken K, Osterweil P. et al. Frequency and predictors for postpartum fecal incontinence. Am J Obstet Gynecol 2003; 188: 1205-1207
  • 20 Kimmich N, Zimmermann R, Kreft M. Video analysis for the evaluation of vaginal births: a prospective observational study. Swiss Med Wkly 2018; 148: w14634
  • 21 Rockner G, Wahlberg V, Olund A. Episiotomy and perineal trauma during childbirth. J Adv Nurs 1989; 14: 264-268
  • 22 Rogers RG, Leeman LM, Kleyboecker S. et al. Is anterior genital tract trauma associated with complaints of postpartum urinary incontinence?. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 1417-1422
  • 23 Leeman LM, Rogers RG, Greulich B. et al. Do unsutured second-degree perineal lacerations affect postpartum functional outcomes?. J Am Board Fam Med 2007; 20: 451-457
  • 24 Leeman L, Rogers R, Borders N. et al. The effect of perineal lacerations on pelvic floor function and anatomy at 6 Months postpartum in a prospective cohort of nulliparous women. Birth 2016; 43: 293-302
  • 25 De Souza A, Dwyer PL, Charity M. et al. The effects of mode delivery on postpartum sexual function: a prospective study. BJOG 2015; 122: 1410-1418
  • 26 Stedenfeldt M, Pirhonen J, Blix E. et al. Anal incontinence, urinary incontinence and sexual problems in primiparous women – a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury. BMC Womens Health 2014; 14: 157
  • 27 Andreucci CB, Bussadori JC, Pacagnella RC. et al. Sexual life and dysfunction after maternal morbidity: a systematic review. BMC Pregnancy Childbirth 2015; 15: 307
  • 28 Yohay D, Weintraub AY, Mauer-Perry N. et al. Prevalence and trends of pelvic floor disorders in late pregnancy and after delivery in a cohort of Israeli women using the PFDI-20. Eur J Obstet Gynecol Reprod Biol 2016; 200: 35-39
  • 29 Tahtinen RM, Cartwright R, Tsui JF. et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol 2016; 70: 148-158
  • 30 Wesnes SL, Hannestad Y, Rortveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand 2017
  • 31 Morkved S, Bo K. Prevalence of urinary incontinence during pregnancy and postpartum. Int Urogynecol J Pelvic Floor Dysfunct 1999; 10: 394-398
  • 32 Solans-Domenech M, Sanchez E, Espuna-Pons M. et al. Pelvic Floor Research Group. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol 2010; 115: 618-628
  • 33 Meyer S, Hohlfeld P, Achtari C. et al. Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters. BJOG 2000; 107: 1360-1365
  • 34 Glazener CM, Herbison GP, MacArthur C. et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 2006; 113: 208-217
  • 35 Burgio KL, Borello-France D, Richter HE. et al. Risk factors for fecal and urinary incontinence after childbirth: the childbirth and pelvic symptoms study. Am J Gastroenterol 2007; 102: 1998-2004
  • 36 Farrell SA, Allen VM, Baskett TF. Parturition and urinary incontinence in primiparas. Obstet Gynecol 2001; 97: 350-356
  • 37 Handa VL, Harris TA, Ostergard DR. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol 1996; 88: 470-478
  • 38 Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med 2008; 358: 1029-1036
  • 39 Birri J, Kreft M, Zimmermann R et al. Association of birth trauma with the implementation of obstetrical monitoring tools: a retrospective cohort study. Z Geburtshilfe Neonatol 2018