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Revista Da Escola de Enfermagem Da U S P 2020To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position.
METHOD
A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles.
RESULTS
There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations.
CONCLUSION
Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.
Topics: Delivery, Obstetric; Female; Humans; Lacerations; Parturition; Patient Positioning; Perineum; Pregnancy
PubMed: 32935765
DOI: 10.1590/S1980-220X2018027503610 -
BMJ Clinical Evidence Mar 2015More than 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least one third of women in... (Review)
Review
INTRODUCTION
More than 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least one third of women in the UK and US. Perineal trauma can lead to long-term physical and psychological problems.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of different methods and materials for primary repair of first- and second-degree tears and episiotomies? What are the effects of different methods and materials for primary repair of obstetric anal sphincter injuries (third- and fourth-degree tears)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: conventional suturing; different methods and materials for primary repair of obstetric anal sphincter injuries; non-suturing of muscle and skin (or perineal skin alone); and sutures (absorbable synthetic sutures, catgut sutures, continuous sutures, interrupted sutures).
Topics: Anal Canal; Episiotomy; Female; Humans; Perineum; Pregnancy; Sutures; Treatment Outcome
PubMed: 25752310
DOI: No ID Found -
Nature Reviews. Urology Apr 2017Despite advances in the evaluation, treatment, and pathophysiological understanding of necrotizing soft-tissue infections, Fournier's gangrene remains a life-threatening... (Review)
Review
Despite advances in the evaluation, treatment, and pathophysiological understanding of necrotizing soft-tissue infections, Fournier's gangrene remains a life-threatening urological emergency. Although the condition can affect patients of any age and gender, it might be more prevalent in some high-risk groups with certain comorbidities. Several prognostic and diagnostic tools have been developed to assist with clinical decision-making once the diagnosis is made - primarily based on the physician's physical exam and potentially supported by laboratory and imaging findings. Expedited treatment with resuscitation, antibiotic administration, and rapid, wide surgical debridement are key elements of the initial management. These procedures must be followed by meticulous wound care and liberal use of planned subsequent surgical debridements. Once the patient has overcome the associated systemic illness, several reconstructive options for the genitalia and perineum can be considered to improve functionality and cosmesis.
Topics: Anti-Bacterial Agents; Debridement; Female; Fournier Gangrene; Humans; Male; Perineum; Prognosis; Risk Factors; Scrotum
PubMed: 27958393
DOI: 10.1038/nrurol.2016.243 -
Cleveland Clinic Journal of Medicine Sep 2018
Topics: Aged, 80 and over; Fatal Outcome; Fournier Gangrene; Humans; Male; Perineum
PubMed: 30192736
DOI: 10.3949/ccjm.85a.18036 -
Obstetrics and Gynecology Jul 2015
Topics: Anal Canal; Female; Hospitals; Humans; Lacerations; Perineum; Pregnancy
PubMed: 26241283
DOI: 10.1097/AOG.0000000000000943 -
Surgical Oncology Clinics of North... Apr 2022This article reviews the oncological principles of rectal cancer surgery, beginning with an overview of the pertinent rectal and pelvic anatomy, followed by a discussion... (Review)
Review
This article reviews the oncological principles of rectal cancer surgery, beginning with an overview of the pertinent rectal and pelvic anatomy, followed by a discussion of the historical evolution in surgical management. Evidence supporting current practices with respect to proximal, distal, and circumferential margins are reviewed. Finally, operative approaches to restorative proctectomies and abdominoperineal resections are highlighted.
Topics: Humans; Margins of Excision; Perineum; Rectal Neoplasms; Rectum; Treatment Outcome
PubMed: 35351275
DOI: 10.1016/j.soc.2021.11.005 -
Annals of Plastic Surgery Sep 2014The pelvic and perineal regions are affected by a heterogeneous spectrum of pathologies, many with a tendency to recur. Extensive mutilation carries physical, sexual,... (Review)
Review
The pelvic and perineal regions are affected by a heterogeneous spectrum of pathologies, many with a tendency to recur. Extensive mutilation carries physical, sexual, and psychological sequelae. Primary reconstruction reduces morbidity and shortens recovery. Modern management calls for a multidisciplinary approach. Not uncommonly, patients come with previous surgery and/or chemoirradiation. They may also be elderly and debilitated. The literature on reconstruction of the perineum can be confusing because knowledge has evolved by an accumulation of isolated short reports of individual methods. This led to the lack of a unifying basis for nomenclature and a failure to relate specific techniques to their roles in repairing particular types of defects. This article gives an overall summary of the approaches in a structured and rational manner. Defects of the external pelvis and perineal lining are usually amenable to coverage with local or regional fasciocutaneous flaps, if primary closure or skin graft is not appropriate. These flaps depend on the integrity of the vascular territories of the internal pudendal, the upper medial thigh plexus, or the descending branches of the inferior gluteal. The location and extent of the resection usually determine the requirements of the reconstruction and may dictate the choice of options. When defects are pelviperineal, particularly when the vagina needs to be reconstructed, myocutaneous flaps are of proven advantage in dealing with both the resurfacing as well as providing the bulk needed to fill the pelvic cavity after extensive resections. The rectus, gluteus, and gracilis are the best known options. Owing to the intrinsic limitations with the gracilis flap, the rectus and gluteus flaps have largely superseded its role in most situations. The rectus flap, in particular, provides good bulk as well as reliable skin. The use of muscle sparing flaps based on the perforator principle in suitable instances has increasingly been reported. The role of free tissue transfer, however, remains limited to isolated situations not amenable to current standard techniques. New and innovative reconstructive modifications keep appearing and larger scale series are needed for more evidence-based information on the outcomes achieved.
Topics: Female; Humans; Male; Perineum; Plastic Surgery Procedures; Surgical Flaps
PubMed: 25003458
DOI: 10.1097/SAP.0000000000000237 -
Cancer Treatment and Research... 2022
Review
Topics: Abdomen; Humans; Perineum; Proctectomy; Rectal Neoplasms; Rectum
PubMed: 35668011
DOI: 10.1016/j.ctarc.2022.100580 -
La Revue Du Praticien Apr 2019Pelvic organ prolapse is a hernia of the vaginal wall. Elements of vaginal hanging and perineum support undergo mechanical strains that lead to this pelvic floor... (Review)
Review
Pelvic organ prolapse is a hernia of the vaginal wall. Elements of vaginal hanging and perineum support undergo mechanical strains that lead to this pelvic floor disorder. The utero-sacral ligaments and the arcus tendineus of the pelvic fascia lose their elasticity. Atrophic levator anii muscles do not play their trempoline, active support anymore. That is related to the aging of these structures but also to excessive mechanical strains -pregnancy, delivery, dyschesia, physical practices-. Moreover, postural disorders lead to a direct orientation of these strains on the genital slit.
Topics: Female; Humans; Pelvic Floor; Pelvic Organ Prolapse; Perineum; Physical Examination; Pregnancy; Uterus
PubMed: 31626487
DOI: No ID Found -
Current Problems in Surgery Sep 2021
Review
Topics: Digestive System Surgical Procedures; Humans; Pelvic Floor; Perineum; Rectal Prolapse; Rectum; Surgical Mesh
PubMed: 34489052
DOI: 10.1016/j.cpsurg.2020.100952