Lawrence Leeman1, Rebecca Rogers2, Noelle Borders3, Dusty Teaf4, Clifford Qualls5. 1. Departments of Family and Community Medicine, and Obstetrics and Gynecology at the University of New Mexico School of Medicine, Albuquerque, NM, USA. 2. Department of Obstetrics and Gynecology at the University of New Mexico School of Medicine, Albuquerque, NM, USA. 3. University of New Mexico, Albuquerque, NM, USA. 4. University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 5. Clinical and Translational Research Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Abstract
OBJECTIVE: To determine the effect of perineal lacerations on pelvic floor outcomes, including urinary and anal incontinence, sexual function, and perineal pain in a nulliparous cohort with low incidence of episiotomy. METHODS: Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination, and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with second-, third-, or fourth-degree lacerations. RESULTS: Four hundred and forty-eight women had vaginal deliveries. One hundred and fifty-one sustained second-degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. Three hundred and thirty-six (74.8%) presented for 6-month follow-up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity; however, they had slightly lower sexual function scores (27.3 vs 29.1). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2 centimeter) perineal trauma demonstrated increased likelihood of perineal pain (15.5% vs 6.2%) and weaker pelvic floor muscle strength (61.0% vs 44.3%) compared with women with more superficial trauma. CONCLUSION: Women having second-degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.
OBJECTIVE: To determine the effect of perineal lacerations on pelvic floor outcomes, including urinary and anal incontinence, sexual function, and perineal pain in a nulliparous cohort with low incidence of episiotomy. METHODS: Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination, and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with second-, third-, or fourth-degree lacerations. RESULTS: Four hundred and forty-eight women had vaginal deliveries. One hundred and fifty-one sustained second-degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. Three hundred and thirty-six (74.8%) presented for 6-month follow-up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity; however, they had slightly lower sexual function scores (27.3 vs 29.1). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2 centimeter) perineal trauma demonstrated increased likelihood of perineal pain (15.5% vs 6.2%) and weaker pelvic floor muscle strength (61.0% vs 44.3%) compared with women with more superficial trauma. CONCLUSION:Women having second-degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.
Authors: R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith Journal: Am J Obstet Gynecol Date: 1996-07 Impact factor: 8.661
Authors: Victoria Garcia; Rebecca G Rogers; Suzy S Kim; Rebecca J Hall; Dorothy N Kammerer-Doak Journal: Am J Obstet Gynecol Date: 2005-05 Impact factor: 8.661
Authors: Catherine S Bradley; Eric S Rovner; Mark A Morgan; Michelle Berlin; Joseph M Novi; Judy A Shea; Lily A Arya Journal: Am J Obstet Gynecol Date: 2005-01 Impact factor: 8.661
Authors: R G Rogers; L M Leeman; N Borders; C Qualls; A M Fullilove; D Teaf; R J Hall; E Bedrick; L L Albers Journal: BJOG Date: 2014-02-19 Impact factor: 6.531
Authors: Kate V Meriwether; Rebecca J Hall; Lawrence M Leeman; Laura Migliaccio; Clifford Qualls; Rebecca G Rogers Journal: Int Urogynecol J Date: 2013-10-09 Impact factor: 2.894
Authors: Margarita Manresa; Ana Pereda; Eduardo Bataller; Carmen Terre-Rull; Khaled M Ismail; Sara S Webb Journal: Int Urogynecol J Date: 2019-02-15 Impact factor: 2.894
Authors: Thomas G Gray; Holly Vickers; Swati Jha; Georgina L Jones; Steven R Brown; Stephen C Radley Journal: Int Urogynecol J Date: 2018-11-23 Impact factor: 2.894
Authors: Rebecca G Rogers; Cara Ninivaggio; Kelly Gallagher; A Noelle Borders; Clifford Qualls; Lawrence M Leeman Journal: Int Urogynecol J Date: 2017-04-17 Impact factor: 2.894