Emergent repair of a fourth‐degree perineal tear – a video vignette

2020 ◽  
Vol 22 (11) ◽  
pp. 1767-1767
Author(s):  
J. M. Ryan ◽  
D. P. Toomey
Keyword(s):  
Perineal Tear ◽  
Fourth Degree ◽  
Video Vignette

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

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.

scholarly journals Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Rodrigo Ayala-Yáñez ◽  
Paulette Bayona-Soriano ◽  
Arturo Hernández-Jimenez ◽  
Alejandra Contreras-Rendón ◽  
Paulina Chabat-Manzanera ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Medical Center ◽  
Prevention Study ◽  
Perineal Tear ◽  
Safe Alternative ◽  
Fourth Degree ◽  
Actual Use ◽  
Life Threatening ◽  
Prophylactic Use ◽  
Threatening Situation

Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country’s high cesarean section incidence.Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p=0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (p=0.016), RR of 3.4 (95% CI: 1.15–10.04).Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications.

scholarly journals Perineal trauma during vaginal birth in Slovenia

2018 ◽  
Vol 52 (3) ◽  
Author(s):  
Petra Petročnik ◽  
Ana Polona Mivšek ◽  
Teja Škodič Zakšek ◽  
Ivan Verdenik ◽  
Anita Jug Došler
Keyword(s):  
Information System ◽  
Health Professionals ◽  
Perineal Trauma ◽  
Descriptive Statistics ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Maternity Hospitals ◽  
Severe Perineal Trauma ◽  
Third Degree Tears

Introduction: The aim of this retrospective study was to examine the rates of perineal tears during childbirth in Slovenian  maternity hospitals in the period from 2013 to 2015.Methods: A causal non-experimental method of quantitative empirical approach was conducted. Data were pooled from the Slovenian National Perinatal Information System and analysed for the period of 2013 to 2015. Data analysis was performed with the use of frequency distribution of attributive variables and the basic descriptive statistics of numerical variables.Results: The incidence of perineal trauma during childbirth in all the 14 maternity hospitals varies from the "perineum without injury" to the "fourth degree perineal tear". Overall, 26.1 % of women sustained a first degree perineal tear, whereas 4.8 % of women had a second degree perineal tear. Severe perineal trauma included 0.8 % of third degree tears and 0.1 % of fourth degree tears.Discussion and conclusion: Perineal trauma varies between Slovenian maternity hospitals. Women who have sustained tears that cut into their bowels may face serious health problems and should be given relevant advice regarding the state of their pelvic floor after childbirth. It is of great importance to appropriately recognise the severity of the perineal trauma. Moreover, health professionals should be familiar with the perineal trauma classification and the factors that may cause the perineum to tear during childbirth.

Antibiotic prophylaxis for fourth-degree perineal tear during vaginal birth

2005 ◽  
Author(s):  
Pranom Buppasiri ◽  
Pisake Lumbiganon ◽  
Jadsada Thinkhamrop ◽  
Bandit Thinkhamrop
Keyword(s):  
Antibiotic Prophylaxis ◽  
Vaginal Birth ◽  
Perineal Tear ◽  
Fourth Degree

Restricted Use of Episiotomy

2017 ◽  
Vol 9 (3) ◽  
pp. 260-262
Author(s):  
Anju Sharma ◽  
Nupur Hooja ◽  
Brijesh Dadhich ◽  
Sapna Aseri ◽  
Avantika Sharma ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Judgment ◽  
Maternal Morbidity ◽  
Scientific Evidence ◽  
Perineal Pain ◽  
Satisfaction Level ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Vaginal Deliveries ◽  
Restricted Use

ABSTRACT Aim There is extensive disagreement about the necessity and benefits of routine episiotomy for all. The American Congress of Obstetricians and Gynecologists Committee on Practice Bulletins, 2006 based on good scientific evidence recommends restricted use of episiotomy to be preferred, yet its restricted use is not being practiced. Keeping these in mind, the study was done with the aim to assess the effects of restrictive use of episiotomy during vaginal birth. Materials and methods This was a prospective study. Singleton primigravida term vaginal deliveries over 3 months were included. Under the policy of restricted use of episiotomy, great restraint was observed in giving an episiotomy. Mediolateral episiotomy was given in women where expected baby weight >3 kg or perineal tear was anticipated, and in cases of instrumental deliveries. Perineal tears, postpartum status, and satisfaction level of women were compared between patients with or without episiotomy. Data so obtained were analyzed. Results About 29.8% women delivered with episiotomy, 65.5% had intact perineum; 5.67% women had first-degree perineal tear and only 1.42% women had second-degree perineal tear using a policy of restricted use of episiotomy. None of the women had third- and fourth-degree perineal tear. Patients delivered without episiotomy were more comfortable in terms of less perineal pain, early evacuation of bladder, and ambulation. Conclusion With the restricted use of episiotomy using precise clinical judgment, the unnecessary episiotomies could be avoided, giving better care and patient satisfaction with minimum maternal morbidity. Clinical significance The policy of restricted use of episiotomy would result in considerable reduction in maternal morbidity, decreased hospital stay and overall cost, and good patient satisfaction level. How to cite this article Dadhich B, Hooja N, Sharma A, Aseri S, Sharma A, Kumawat B. Restricted Use of Episiotomy. J South Asian Feder Obst Gynae 2017;9(3):260-262.

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