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Iranian Journal of Nursing and... 2021After childbirth, sexual dysfunction refers to a chain of psychiatric, physiological, social changes and a couple's experiences. The purpose of our Systematic Review... (Review)
Review
BACKGROUND
After childbirth, sexual dysfunction refers to a chain of psychiatric, physiological, social changes and a couple's experiences. The purpose of our Systematic Review (Syst.Rev.) is to evaluate available high-quality evidence and construct a Bio Psycho Social (BPS) model of couple's sexual function after childbirth.
MATERIALS AND METHODS
A systematic search was done with MeSH terms in databases, including PubMed, Web of Science, Scopus, and Science direct. A total number of 9 Syst.Rev. were evaluated from 2009 to 2019 years. The quality of extracted articles was evaluated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of contents using two qualified reviewers. Data synthesis was performed using the thematic analysis.
RESULTS
Biopsychosocial Model of Postpartum Couple's Sexual Function (BMPCSF) is proposed as a developmental process similar to Bronfenbrenner's Bioecological Systems Model. Studies showed a significant relationship among the type of childbirth, trauma of perineum, breastfeeding, mood swings, fears, changes in the self-body image, spousal support, and Postpartum Sexual Dysfunction (PSD). Hence, the evidence about male sexuality in the postpartum period doesn't seem sufficient.
CONCLUSIONS
The information from this study will help health policymakers develop the appropriate guidelines to inform couples and healthcare professionals about the BPS changes after childbirth and PSD. Besides, BMPCSF can be used in postpartum sexual counseling to improve sexual health and marital relationships. We propose comprehensive original study on couples' postpartum sexuality, especially men's conduct, emphasizing socio-cultural factors.
PubMed: 34900644
DOI: 10.4103/ijnmr.IJNMR_426_20 -
International Urogynecology Journal Oct 2016There is conflicting evidence on whether mediolateral episiotomy (MLE) reduces the risk of obstetric anal sphincter injuries (OASI) in spontaneous vaginal deliveries... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
There is conflicting evidence on whether mediolateral episiotomy (MLE) reduces the risk of obstetric anal sphincter injuries (OASI) in spontaneous vaginal deliveries (SVD).
OBJECTIVES
A systematic review was undertaken to compare rates of OASI amongst women who had undergone mediolateral episiotomy versus those who did not.
SEARCH STRATEGY
Electronic searches were performed in literature databases: CINAHL, Cochrane, EMBASE, Medline and MIDIRS from database inception to July 2015. Studies were eligible if MLE was compared to spontaneous tears and if OASI was the outcome of interest. Two reviewers independently selected and extracted data on study characteristics, quality and results. We computed events of OASI in those who did and did not have an episiotomy from individual studies and pooled these results in a meta-analysis where possible.
MAIN RESULTS
Of the 2090 citations, 16 were included in the review. All were non-randomised, population based or retrospective cohort studies. There was great variation in quality amongst these studies. Data from 7 studies was used for meta-analysis. On collating data from these studies where the majority of women (636755/651114) were nulliparous, MLE reduced the risk of OASI (RR 0.67 95 % CI 0.49-0.92) in vaginal delivery.
CONCLUSION
The pooled analysis of a large number of women undergoing vaginal birth, most of who were nulliparous, indicates that MLE has a beneficial effect in prevention of OASI. An accurately given MLE might have a role in reducing OASI and should not be withheld, especially in nulliparous women. Caution is advised as the data is from non-randomised studies.
Topics: Anal Canal; Case-Control Studies; Delivery, Obstetric; Episiotomy; Female; Humans; Perineum; Pregnancy; Retrospective Studies; Risk; Vagina
PubMed: 26894605
DOI: 10.1007/s00192-016-2956-1 -
Colorectal Disease : the Official... Jul 2016The introduction of anti-tumour necrosis factor (anti-TNF; infliximab and adalimumab) has changed the management of Crohn's perianal fistula from almost exclusively... (Comparative Study)
Comparative Study Meta-Analysis Review
AIM
The introduction of anti-tumour necrosis factor (anti-TNF; infliximab and adalimumab) has changed the management of Crohn's perianal fistula from almost exclusively surgical treatment to one with a much larger emphasis on medical therapy. The aim of this systematic review was to provide an overview of the success rates of setons and anti-TNF for Crohn's perianal fistula.
METHOD
Studies evaluating the effect of setons and anti-TNF on Crohn's perianal fistula were included. Studies assessing perianal fistula in children, rectovaginal and rectourinary fistulae were excluded. The primary end-point was the fistula closure rate. Partial closure and recurrence rates were secondary end-points.
RESULTS
Ten studies on seton drainage were included (n = 305). Complete closure varied from 13.6% to 100% and recurrence from 0% to 83.3%. In 34 anti-TNF studies (n = 1449), complete closure varied from 16.7% and 93% (partial closure 8.0-91.2%) and recurrence from 8.0% to 40.9%. Four randomized controlled trials (n = 1028) comparing anti-TNF with placebo showed no significant difference in complete or partial closure in meta-analysis (risk difference 0.12, 95% CI -0.06 to 0.30 and 0.09, 95% CI -0.23 to 0.41, respectively). Subgroup analysis (n = 241) showed a significant advantage for complete fistula closure with anti-TNF in two trials with follow-up > 4 weeks (46% vs 13%, P = 0.003 and 30% vs 13%, P = 0.03). Of four included cohort studies, two revealed a significant difference in response in favour of combined treatment (P = 0.001 and P = 0.014).
CONCLUSION
Closure and recurrence rates after seton drainage as well as anti-TNF vary widely. Despite a large number of studies, no conclusions can be drawn regarding the preferred strategy. However, combination therapy with (temporary) seton drainage, immunomodulators and anti-TNF may be beneficial in achieving perianal fistula closure.
Topics: Adalimumab; Adult; Cohort Studies; Crohn Disease; Drainage; Female; Gastrointestinal Agents; Humans; Infliximab; Male; Perineum; Randomized Controlled Trials as Topic; Rectal Fistula; Recurrence; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 26921847
DOI: 10.1111/codi.13311 -
American Journal of Obstetrics &... Dec 2023There are over 145 million births worldwide, with over 30 million cesarean deliveries yearly. There are limited data comparing the perinatal and maternal outcomes... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
There are over 145 million births worldwide, with over 30 million cesarean deliveries yearly. There are limited data comparing the perinatal and maternal outcomes between planned cesarean delivery and planned vaginal delivery. This study aimed to evaluate perinatal and maternal morbidity and mortality by meta-analysis of randomized controlled trials that randomly assigned patients to either planned cesarean delivery or planned vaginal delivery.
DATA SOURCES
Scopus, PubMed, CINAHL, Cochrane Library, and the World Health Organization clinical trial databases were searched from inception through August 2022.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials that compared planned cesarean delivery with planned vaginal delivery at any gestational age and for any delivery indication were included.
METHODS
Two authors independently extracted data. PRISMA guidelines were used for data extraction and quality assessment. The primary outcome was perinatal mortality. The summary measures were reported as relative risks or as mean differences with 95% confidence intervals. Pooled odds ratios and 95% confidence intervals were calculated using Mantel-Haenszel random-effects models for outcomes.
RESULTS
In 15 primary randomized controlled trials, 3265 patients were randomized to planned cesarean delivery and 3353 to planned vaginal delivery. The incidence of perinatal deaths was not different (1.3% vs 1.3%; relative risk, 0.71; 95% confidence interval, 0.33-1.52). Planned cesarean delivery was associated with lower neonatal incidences of low umbilical artery pH (0.3% vs 2.4%; relative risk, 0.18; 95% confidence interval, 0.05-0.67), birth trauma (0.3% vs 0.7%; relative risk, 0.46; 95% confidence interval, 0.22-0.96), tube feeding requirement (2.5% vs 7.1%; relative risk, 0.36; 95% confidence interval, 0.19-0.66), and hypotonia (0.4% vs 3.5%; relative risk, 0.11; 95% confidence interval, 0.03-0.47), compared to planned vaginal delivery. Chorioamnionitis was less frequent in the planned cesarean delivery group (0.3% vs 1.0%; relative risk, 0.27; 95% confidence interval, 0.08-0.98). Wound infection was more common in the planned cesarean delivery group (1.9% vs 1.1%; relative risk, 1.61; 95% confidence interval, 1.04-2.52). Lower rates were observed in the planned cesarean delivery group for urinary incontinence at both ≤3 months (8.7% vs 12.2%; relative risk, 0.71; 95% confidence interval, 0.59-0.85) and 1 to 2 years (16.9% vs 22%; relative risk, 0.77; 95% confidence interval, 0.67-0.88) and for a painful perineum at 2 years (4% vs 6.2%; relative risk, 0.64; 95% confidence interval, 0.47-0.87) compared to planned vaginal delivery. Among singleton pregnancies, planned cesarean delivery was associated with a lower rate of perinatal death (0.69% vs 1.81%; relative risk, 0.45; 95% confident interval, 0.21-0.93).
CONCLUSION
Planned cesarean delivery and planned vaginal delivery were associated with similar rates of perinatal and maternal mortality in this meta-analysis of randomized controlled trials. Planned cesarean delivery was associated with significant decreases in adverse neonatal outcomes such as low umbilical artery pH, birth trauma, tube feeding requirement, and hypotonia, and significant decreases in chorioamnionitis, urinary incontinence, and painful perineum. Planned vaginal delivery was associated with significant decreases in need for general anesthesia and wound infection. Further randomized trials are needed to assess the risks and benefits of planned cesarean delivery vs planned vaginal delivery in lower-risk patients and in the general population.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Chorioamnionitis; Muscle Hypotonia; Randomized Controlled Trials as Topic; Delivery, Obstetric; Wound Infection; Urinary Incontinence
PubMed: 37838013
DOI: 10.1016/j.ajogmf.2023.101186 -
Journal of Midwifery & Women's Health 2015The aim of this study was to systematically review current evidence for the relationship between obstetric anal sphincter injury (ie, episiotomy and third- or... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of this study was to systematically review current evidence for the relationship between obstetric anal sphincter injury (ie, episiotomy and third- or fourth-degree perineal lacerations) and anal incontinence in parous women.
METHODS
PubMed, Ovid (MEDLINE), Cochrane Trials, and Cumulative Index to Nursing and Allied Health Literature were searched. Studies eligible for review assessed the relationship between episiotomy and/or third- or fourth-degree perineal laceration and anal incontinence. Two reviewers independently searched for studies for review and used the Meta-Analysis of Observational Studies in Epidemiology guidelines. Quality of individual studies was appraised using the Downs and Black criteria. Pooled effect sizes were estimated for the relationships between episiotomy and third- or fourth-degree perineal laceration with anal incontinence using random effects meta-analysis models. Heterogeneity of each model was assessed using Cochran Q and I(2) statistics.
RESULTS
Of 578 articles, 19 studies (7 prospective cohort studies, 6 retrospective studies, one case-control study, and 5 population-based cross-sectional studies) met inclusion/exclusion criteria for the systematic review. Of the 19 studies, 3 examined episiotomy, 7 examined third- or fourth-degree perineal laceration, and 9 studies examined both risk factors for anal incontinence. Eight studies (N = 2929 women) examining the relationship between episiotomy and anal incontinence and 12 studies (N = 2288 women) examining the relationship between third- or fourth-degree perineal laceration and anal incontinence met criteria for inclusion in the meta-analyses. Pooled odds ratios (ORs) demonstrated a significant association between perineal trauma (episiotomy [OR, 1.74; 95% confidence interval [CI], 1.28-2.38; Q = 8.9; P < .26; I(2) = 21.4] and third- or fourth-degree perineal laceration (OR, 2.66; 95% CI, 1.77-3.98; Q = 27.9; P = .002; I2 = 64.1) and anal incontinence.
DISCUSSION
Both episiotomy and third- or fourth-degree perineal laceration are significantly associated with anal incontinence after vaginal birth. The evidence provided in this systematic review and meta-analysis highlights the importance of reducing perineal trauma during vaginal births in order to ameliorate anal incontinence in parous women.
Topics: Anal Canal; Episiotomy; Fecal Incontinence; Female; Humans; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy
PubMed: 25712278
DOI: 10.1111/jmwh.12283 -
Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis.International Journal of Gynaecology... May 2022Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear.
OBJECTIVE
To investigate the effectiveness of PFMT in the prevention of perineal laceration.
SEARCH STRATEGY
Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery.
SELECTION CRITERIA
We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations.
DATA COLLECTION AND ANALYSIS
We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R.
MAIN RESULTS
Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration.
CONCLUSION
Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.
Topics: Delivery, Obstetric; Exercise Therapy; Female; Humans; Lacerations; Pelvic Floor; Perineum; Pregnancy
PubMed: 34270799
DOI: 10.1002/ijgo.13826 -
Colorectal Disease : the Official... Aug 2015There are no available guidelines to support surgical decision-making in recurrent rectal prolapse. This systematic review evaluated the results of abdominal or perineal... (Review)
Review
AIM
There are no available guidelines to support surgical decision-making in recurrent rectal prolapse. This systematic review evaluated the results of abdominal or perineal surgery for recurrent rectal prolapse, with the aim of developing an evidence-based treatment algorithm.
METHOD
PubMed and MEDLINE databases were searched for all clinical studies involving patients who underwent surgery for recurrent rectal prolapse between 1950 and 2014. The primary outcome measure was the recurrence rate after abdominal or perineal surgery for recurrent rectal prolapse. Secondary outcomes included morbidity, mortality and quality of life data where available.
RESULTS
There were no randomized controlled studies comparing the success rates of abdominal or perineal surgery for recurrent rectal prolapse. Most studies were heterogeneous, of low quality (level IV) and involved small numbers of patients. The follow-up of 144 patients included in the studies undergoing perineal surgery ranged from 8.8 to 81 months, with recurrence rates varying from 0% to 50%. Morbidity ranged from 0% to 17% with no mortality reported. Limited data on quality of life following the Altemeier procedure were available. The follow-up for 158 patients included in the studies who underwent abdominal surgery ranged from 0 to 23 years, during which recurrence rates varied from 0% to 15%. Morbidity rates ranged from 0% to 32% with 4% mortality. No quality of life data were available for patients undergoing abdominal surgery.
CONCLUSION
This systematic review was unable to develop a treatment algorithm for recurrent rectal prolapse due to the variety of surgical techniques described and the low level of evidence within heterogeneous studies. Larger high-quality studies are necessary to guide practice in this difficult area.
Topics: Abdomen; Digestive System Surgical Procedures; Humans; Perineum; Quality of Life; Rectal Prolapse; Recurrence
PubMed: 25772797
DOI: 10.1111/codi.12946 -
Advances in Skin & Wound Care Sep 2023To review the literature about combined urologic and reconstructive management of pressure injuries (PIs) with urethral fistulas.
OBJECTIVE
To review the literature about combined urologic and reconstructive management of pressure injuries (PIs) with urethral fistulas.
DATA SOURCES
Authors searched the PubMed, MEDLINE, EMBASE, and Cochrane databases using the following keywords: "Perineum" or "Perineal" and "Pressure Ulcers" or '' Pressure Injury'' and "Urethral Fistula."
STUDY SELECTION
The search yielded a total of 95 articles. Study selection followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, and the study was designed according to the PICOS (Population, Intervention, Comparison, Outcomes, Study) guidelines. Congress abstracts, letters to the editor, and editorial comments were excluded. After screening, a total of 9 studies (30 patients) were included in the review.
DATA EXTRACTION
Included patients received treatment for a perineal or ischial PI associated with a urinary fistula. The outcomes were recovery, complications, treatment failure, recurrence, and illness-related death.
DATA SYNTHESIS
Pressure injuries were mainly ischiatic (50%) and perineal (43%). Forty-six percent of patients had spinal cord injuries, and at least 40% reported voiding dysfunction. Sixteen percent had previous ischiectomy. Flaps such as posterior thigh flap, biceps femoris flap, and inferiorly based transverse rectus abdominal muscle flap had 88% to 100% success rates when used with urinary diversion techniques. Suprapubic cystostomy, the simplest method of urinary diversion, was successful in 47% of cases when performed alone and in 100% when combined with a pedicled omental flap or a transverse rectus abdominal muscle flap.
CONCLUSIONS
Prevention and wound care are essential for PI management, but when combined with a urinary fistula, surgical management is unavoidable. Urinary diversion is essential before undergoing any type of ulcer reconstruction. Urethral reconstruction showed favorable results, further strengthened when combined with a musculocutaneous flap.
Topics: Humans; Pressure Ulcer; Urinary Fistula; Crush Injuries; Plastic Surgery Procedures; Surgical Flaps
PubMed: 37603321
DOI: 10.1097/ASW.0000000000000023 -
The Cochrane Database of Systematic... Jan 2021Perineal pain is a common but poorly studied adverse outcome following childbirth. Pain may result from perineal trauma due to bruising, spontaneous tears, surgical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Perineal pain is a common but poorly studied adverse outcome following childbirth. Pain may result from perineal trauma due to bruising, spontaneous tears, surgical incisions (episiotomies), or in association with operative vaginal births (ventouse or forceps-assisted births). This is an update of a review last published in 2013.
OBJECTIVES
To determine the efficacy of a single administration of paracetamol (acetaminophen) used in the relief of acute postpartum perineal pain.
SEARCH METHODS
For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (9 December 2019), and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs), including cluster-RCTs, comparing paracetamol to placebo. We excluded quasi-RCTs and cross-over trials. Data from abstracts would be included only if authors had confirmed in writing that the data to be included in the review had come from the final analysis and would not change.
DATA COLLECTION AND ANALYSIS
Two review authors assessed each study for inclusion and extracted data. One review author reviewed the decisions and confirmed calculations for pain relief scores. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
This update identified no new trials so the results remain unchanged. However, by applying the GRADE assessment of the evidence, the interpretation of main results differed from previous version of this review. We identified 10 studies involving 2044 women, but all these studies involved either three or four groups, looking at differing drugs or doses. We have only included the 1301 women who were in the paracetamol versus placebo arms of the studies. Of these, five studies (482 women) assessed 500 mg to 650 mg and six studies (797 women) assessed 1000 mg of paracetamol. One study assessed 650 mg and 1000 mg compared with placebo and contributed to both comparisons. We used a random-effects meta-analysis because of the clinical variability among studies. Studies were from the 1970s to the early 1990s, and there was insufficient information to assess the risk of bias adequately, hence the findings need to be interpreted within this context. The certainty of the evidence for the two primary outcomes on which data were available was assessed as low, downgraded for overall unclear risk of bias and for heterogeneity (I² statistic 60% or greater). More women may experience pain relief with paracetamol compared with placebo (average risk ratio (RR) 2.14, 95% confidence interval (CI) 1.59 to 2.89; 10 trials, 1279 women), and fewer women may need additional pain relief with paracetamol compared with placebo (average RR 0.34, 95% CI 0.21 to 0.55; 8 trials, 1132 women). However, the certainty of the evidence was low, downgraded for unclear overall risk of bias and substantial heterogeneity. One study used the higher dose of paracetamol (1000 mg) and reported maternal drug adverse effects. There may be little or no difference in the incidence of nausea (average RR 0.18, 95% CI 0.01 to 3.66; 1 trial, 232 women; low-certainty evidence), or sleepiness (average RR 0.89, 95% CI 0.18 to 4.30; 1 trial, 232 women; low-certainty evidence). No other maternal adverse events were reported. None of the studies assessed neonatal drug adverse effects.
AUTHORS' CONCLUSIONS
A single dose of paracetamol may improve perineal pain relief following vaginal birth, and may reduce the need for additional pain relief. Potential adverse effects for both women and neonates were not appropriately assessed. Any further trials should also address the gaps in evidence concerning maternal outcomes such as satisfaction with postnatal care, maternal functioning/well-being (emotional attachment, self-efficacy, competence, autonomy, confidence, self-care, coping skills) and neonatal drug adverse effects.
Topics: Acetaminophen; Acute Pain; Episiotomy; Female; Humans; Infant, Newborn; Perineum; Postpartum Period; Pregnancy
PubMed: 34559424
DOI: 10.1002/14651858.CD008407.pub3 -
Techniques in Coloproctology May 2017The incidence of perineal hernia after abdominoperineal excision and extralevator abdominoperineal excision ranges from 1 to 26%. In this systematic review, we compared... (Review)
Review
BACKGROUND
The incidence of perineal hernia after abdominoperineal excision and extralevator abdominoperineal excision ranges from 1 to 26%. In this systematic review, we compared surgical options and postoperative outcomes of perineal hernia repair in this setting from 2012 to 2016 with findings in a review of publications 1944-2011.
METHODS
We searched the PubMed database using the keywords "hernia" AND "perineum" identified 392 papers published from 1946 to 2016. Two hundred and ninety-six papers published before 2012 were excluded and 96 were found to be potentially relevant.
RESULTS
Twenty-one studies with a total of 108 patients were included in the final analysis. Perineal hernia repair was performed using the perineal approach in 75 patients (69.44%), the laparoscopic approach in 25 patients (23.14%), the open abdominal approach in three patients (2.77%) and the laparoscopic perineal approach in three patients (2.77%) and the open abdominoperineal approach in two patients (1.8%). Non-absorbable mesh was used in 41 (37.96%) of cases, composite mesh in 20 (18.51%) and biological mesh in 19 (17.59%). Flap reconstruction was used in 25 patients (23.14%). First and second recurrences were observed in 26 (24.07%) and 7 (26.92%) cases, respectively.
CONCLUSIONS
Comparison of perineal hernia repair from 1944 to 2011 and from 2012 to 2016 showed that perineal and laparoscopic approaches are currently the most commonly used techniques. Primary defect closure was abandoned in favor of synthetic or composite mesh placement. Use of flap reconstruction spread rapidly and the recurrence rate was low. Randomized control trials and a larger sample size are needed to confirm these data and to develop a gold standard treatment for secondary hernia repair after abdominoperineal excision or extralevator abdominoperineal excision.
Topics: Abdomen; Digestive System Surgical Procedures; Hernia, Abdominal; Herniorrhaphy; Humans; Peritoneum; Postoperative Complications; Surgical Flaps; Surgical Mesh; Treatment Outcome
PubMed: 28508281
DOI: 10.1007/s10151-017-1634-8