scholarly journals Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Shamir O. Cawich ◽  
Dwayne Wright ◽  
Santosh Kulkarni ◽  
Carol Rattray ◽  
Ian Bambury ◽  
...  
Keyword(s):  
Best Practice ◽  
Cleveland Clinic ◽  
Wound Dehiscence ◽  
Tertiary Referral Hospital ◽  
Fourth Degree ◽  
Incontinence Score ◽  
Institutional Practice ◽  
Perineal Lacerations ◽  
Sphincter Disruption ◽  
Vaginal Deliveries

Background. There is a high incidence of failure after repair of severe perineal lacerations (SPLs). A tertiary referral hospital in the Caribbean introduced guidelines in an attempt to improve outcomes. We performed an audit of SPL repairs at this centre in an attempt to determine the effect on repair failure. Methods. All patients with SPL repairs between November 1, 2007, and December 30, 2012, were identified. The primary aim was to determine the incidence of failed repairs (wound dehiscence, anal sphincter disruption, rectovaginal fistula, and/or faecal incontinence). The Cleveland Clinic Incontinence Score (CCIS) was used to assess continence at discharge and 24 weeks after repair. Data were analyzed with SPSS version 12. Results. There were 8108 vaginal deliveries, 23 third-degree injuries, and 3 fourth-degree injuries. Three patients experienced a repair failure. Notably, 69% of surgeons chose an inappropriate suture for sphincter repair. Conclusions. Experienced operators are performing repairs, but there is a high prevalence of inappropriate suture choice for repairs. A targeted educational campaign may be necessary to remind clinicians of the best practice in repair techniques.

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

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

<strong>Objective</strong>. 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. <strong>Method</strong>. 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. <strong>Results</strong>. 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. <strong>Conclusions</strong>. 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.

scholarly journals Obesity May Be Protective against Severe Perineal Lacerations

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Diana Garretto ◽  
Brian B. Lin ◽  
Helen L. Syn ◽  
Nancy Judge ◽  
Karen Beckerman ◽  
...  
Keyword(s):  
Birth Weight ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Mode Of Delivery ◽  
Multivariate Logistic Regression ◽  
Retrospective Case ◽  
Fourth Degree ◽  
Perineal Lacerations ◽  
Vaginal Deliveries ◽  
Control Study

Objective.To determine if there is an association between BMI and 3rd- or 4th-degree perineal lacerations in normal spontaneous and operative vaginal deliveries.Study Design.We performed a retrospective case control study using a large obstetric quality improvement database over a six-year period. Cases were identified as singleton gestations with third- and fourth-degree lacerations. Controls were obtained randomly from the database of patients without third- or fourth-degree lacerations in a 1 : 1 ratio. Univariate and multivariate logistic regression analyses were performed.Results.Of 32,607 deliveries, 22,011 (67.5%) charts with BMI documented were identified. Third- or fourth-degree lacerations occurred in 2.74% (n=605) of patients. 37% (n=223) were identified in operative vaginal deliveries. In the univariate analysis, obesity, older maternal age, non-Asian race, and birth weight <4000 g were all protective against 3rd- and 4th-degree lacerations. After controlling for age, race, mode of vaginal delivery, and birth weight, obesity remained significant.Conclusion.Being obese may protect against third- and fourth-degree lacerations independent of parity, race, birth weight, and mode of delivery.

scholarly journals Carbapenemase screening in an Irish tertiary referral hospital: Best practice, or can we do better?

2020 ◽  
Vol 2 (4) ◽  
pp. 100100
Author(s):  
S. Fahy ◽  
J.A. O'Connor ◽  
D. O'Brien ◽  
L. Fitzpatrick ◽  
M. O'Connor ◽  
...  
Keyword(s):  
Best Practice ◽  
Referral Hospital ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital

Therapeutic Effect of Changqiang Acupoint Injection on Children with Functional Fecal Incontinence

2021 ◽  
Author(s):  
Changying Yi ◽  
Jie Zhang ◽  
Meili Fan
Keyword(s):  
Treatment Group ◽  
Fecal Incontinence ◽  
Cleveland Clinic ◽  
Control Group ◽  
Incontinence Score ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Stool Incontinence ◽  
Acupoint Injection ◽  
Significant Difference

<B>Objective:</B> Functional fecal incontinence in children (FFIC), also known as functional fecal disorder in children, is a type of childhood diseases characterized by excretory dysfunction. In the study, we observed the clinical effect of Changqiang acupoint injection on functional fecal incontinence in children (FFIC) by randomized controlled clinical trials. <BR><B>Materials and methods:</B> 140 children with functional fecal incontinence who met the screening criteria were respectively assigned into the treatment group (100 cases) and the control group (40 cases) according to the completely randomized controlled design. In the treatment group, Chuankezhi injection was administrated at the Changqiang acupoint once a week for three weeks (one course of treatment). In contrast, the subjects in the control group was instructed to receive sphincter exercise and defecation training, followed by an assessment on the therapeutic efficacy after one course of treatment. <BR><B>Results:</B> The overall response rate of the two groups was 93.00% (93/100) and 57.50% (23/40), respectively, with a statistically significant difference (P<0.01). The treatment group showed a performance superior to the control group based on the Cleveland Clinic Florida Fecal Incontinence Score System (CCF-FI)—dry stool incontinence, liquid incontinence, gas incontinence, lifestyle change, necessity of using pads or antidiarrheals, the ability to delay defecation, and the total score. The inter-group comparison revealed a statistically significant difference (P<0.01). <BR><B>Conclusion:</B>Changqiang acupoint injection has significant curative effect on FFIC as demonstrated by significant relief in the symptoms associated with fecal incontinence, and thus is considered as a useful approach to be widely applied in clinical practice.

scholarly journals Prevalence of Episiotomy and Perineal Lacerations in a University Teaching Hospital, North-Central Nigeria

2018 ◽  
Vol 1 (2) ◽  
pp. 142-147
Author(s):  
S K Hembah-Hilekaan ◽  
A O Ojabo ◽  
O Audu ◽  
P E Onche ◽  
M T Maanongun
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Teaching Hospital ◽  
Maternal Age ◽  
Fetal Weight ◽  
University Teaching ◽  
Warning Sign ◽  
Perineal Laceration ◽  
Perineal Lacerations ◽  
Vaginal Deliveries

Episiotomy is an incision on the introitus and the perineum to increase pelvic outlet to facilitate childbirth and prevent trauma to fetal and maternal tissues. Episiotomy and perineal laceration may predispose the woman to short and long term complications. The objective of this study was to determine the prevalence of episiotomy and perineal lacerations and their associated risks factors at Benue State University Teaching Hospital, Makurdi, Nigeria. Retrospective data of all women who had spontaneous vagina delivery over a 3 year period with perineal laceration/episiotomy were reviewed. Data was obtained from the records and information on the socio-demographic variables, episiotomies, lacerations and the birth weight of infants. The associated risk factors were recorded using Statistical Package for Social Sciences version 22.Of the 636 vaginal deliveries, 85(13.4%) had lacerations with 65(10.2%) first degree, 19(3.0%) second degree and 1(0.2%) major laceration. Episiotomy rate was 132(20.8%). The mean parity and birth weight of infants were 2.62(SD= ± 1.83) and 3.1 kg (SD= ± 0.767) respectively. The highest number of perineal tears 69(10.8%) were in the lower age group (≤ 30 years). A similar observation was noted in respect of episiotomies which rate however decreased with parity. The relationship between maternal age, parity, booking status, fetal weight and the perineal status at delivery was statistically significant (P≤ 0.05). Episiotomy and perineal laceration rates in our institution were low. The major risk factors were low parity, young maternal age and increasing fetal weight at birth and their presence should be an early warning sign. We advise perineal support for all women during delivery.

scholarly journals Third and Fourth Degree Perineal Tear in Four-Year Period at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia

2018 ◽  
Vol 6 (6) ◽  
pp. 1067-1071 ◽  
Author(s):  
Ivka Djaković ◽  
Emina Ejubović ◽  
Ivan Bolanča ◽  
Marina Markuš Sandrić ◽  
Dino Bečić ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Gestational Age ◽  
Obstetric Anal Sphincter Injury ◽  
Large For Gestational Age ◽  
Vacuum Extraction ◽  
Sphincter Injury ◽  
Fourth Degree ◽  
Anal Sphincter Injury ◽  
Perineal Injury ◽  
Vaginal Deliveries

OBJECTIVES: Obstetric anal sphincter injury (OASIS) includes the third and fourth degree of perineal injury. The risk for OASIS is about 1% of all vaginal deliveries. If not recognised and treated properly, obstetric anal sphincter injury can have serious consequences for reproductive age woman.MATERIAL AND METHODS: We have retrospectively gathered and analysed data on obstetric anal sphincter injury in a four-year period at our department. The control group in this study included vaginal deliveries in 2012.RESULTS: We recorded 0.34% third and fourth degree of perineal injury in all vaginal deliveries, and 87.9% of those patients were primiparae. Episiotomy was performed in 57.6% of all women with obstetric anal sphincter injury. In 30.3% of cases, newborns were large for gestational age. Gestational diabetes was found in 9.1% of OASIS cases, occipitoposterior position was found in 9.1% of cases. Induced labour took place in 39.4%, and oxytocin infusion was applied in 60.6% of OASIS cases. Vacuum extraction was performed in 12.1% of deliveries with OASIS. The average BMI in 3a and 3b injuries was 29.9. In 3c degree it was 28.0, and in the fourth degree, it was 32.1. In 27.0% of OASIS cases due to the extent of the injury surgeon engagement was necessary. When compared with vaginal deliveries in 2012 we found a significant increase in OASIS in primiparas, large for gestational age, occipitoposterior position, induced labour, vacuum extraction and hypertension (P < 0.01). There is also increased incidence of OASIS in episiotomy and oxytocin use group (P < 0.05).CONCLUSION: Low incidence of OASIS in our department is a result of active management of delivery, manual perineal protection and timely episiotomy.

Transcutaneous tibial nerve stimulation for the treatment of faecal incontinence: results of a prospective study

2014 ◽  
Vol 21 (2) ◽  
pp. 91-98 ◽  
Author(s):  
Ieva Stundienė ◽  
Paulius Žeromskas ◽  
Jonas Valantinas
Keyword(s):  
Quality Of Life ◽  
Prospective Study ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Cleveland Clinic ◽  
Life Questionnaire ◽  
Incontinence Score ◽  
Tibial Nerve Stimulation

Background. Transcutaneous tibial nerve stimulation is a simple, non-invasive treatment, which can be used to treat faecal incontinence. Optimal treatment regimen is not known and various stimulation regimens are used in different centers. The aim of this prospective study was to evaluate the efficacy of twice weekly transcutaneous tibial nerve stimulation for faecal incontinence patients, who have failed to respond to maximal conservative treatment. Material and methods. Twenty patients with faecal incontinence resistant to maximal conservative therapy were treated with transcutaneous posterior tibial nerve stimulation twice a week for six weeks. The number of the bowel movements per two weeks and the Cleveland Clinic Florida Feacal Incontinence Score were assessed before and after the treatment. The quality of life was estimated using the Faecal Incontinence Quality of Life questionnaire and the Gastrointestinal Quality of Life Index. Results. Effect was seen in 55% of patients. Two-week faecal incontinence episodes decreased from median 4  (2–84) to 2  (0–56) (p = 0.002). The mean Cleveland Clinic Florida Faecal Incontinence score improved from 10.9 ± 4.34 to 7.8 ± 3.96 (p = 0.002). The quality of life improved significantly after the treatment. The therapy was well tolerated and no participant experienced any adverse event. Conclusions. Transcutaneous tibial nerve stimulation twice a week for 6 weeks may be efficacious in patients with faecal incontinence, who have failed to respond to maximal conservative treatments.

scholarly journals 1057 Outcome Reporting Following Rectopexy Requires Standardisation for Reproducibility and Transparent Outcome Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Wa Katolo ◽  
C Fleming ◽  
G Wilkinson ◽  
A Brannigan
Keyword(s):  
Quality Of Life ◽  
Rectal Prolapse ◽  
English Language ◽  
Cleveland Clinic ◽  
Outcome Analysis ◽  
Incontinence Score ◽  
Outcome Reporting ◽  
Randomised Controlled ◽  
The Impact

Abstract Aim Rectopexy is a surgical procedure commonly used to correct rectal prolapse. Several studies have investigated different approaches (abdominal, perineal) and techniques (open, laparoscopic, robotic) in this field however reporting outcomes vary significantly among studies impeding comparison of techniques. We aimed to comprehensively analyse primary outcome reporting methods following rectopexy in published literature. Method A systematic search was performed in keeping with PRISMA guidelines and search protocol registered with PROSPERO. Published databases were searched using the following terms: “rectopexy”, “abdominal rectopexy” and “rectopexy outcomes”. Randomised controlled trials, comparative and non-comparative prospective and retrospective studies published between 1992 and 2019 were included for analysis. Review articles, letters, editorials, abstracts, and non-English language studies were excluded. A narrative description of outcomes was reported. Results A total of 1089 articles were screened, and 32 articles were identified as suitable for inclusion, reporting on 1780 patients who underwent rectopexy surgery. Over 30 unique methods of reporting outcomes were recorded, with the most common being the rate of recurrence (n = 15), Cleveland Clinic Faecal Incontinence score (CCIS) (n = 11), and customised symptom questionnaires (n = 10). Many studies recognised the impact of symptoms of rectal prolapse on patients’ quality of life (QoL) however, few utilised standardised quality of life scores to evaluate the outcome of the procedures. Conclusions As surgical technique evolves in rectopexy, incorporating minimally invasive surgery and robotic surgery, it is important that outcome reporting is standardised to facilitate transparent comparison. Improving patient QoL is the mainstay of surgical intervention and it is important that QoL outcome measures are incorporated.

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