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The Australian & New Zealand Journal of... Feb 2021Birth-related third- and fourth-degree perineal trauma is common and associated with short- and long-term complications. (Review)
Review
BACKGROUND
Birth-related third- and fourth-degree perineal trauma is common and associated with short- and long-term complications.
AIM
To conduct a review of clinical audits investigating management of women with perineal trauma.
MATERIALS AND METHODS
We identified all audits undertaken in eight New Zealand public hospitals between 2005 and 2014 that investigated whether women with birth-related third- and fourth-degree perineal trauma were receiving care according to clinical guidelines. We aggregated audit results and calculated the proportion of women receiving the recommended standard of care.
RESULTS
During the review period, 25 audits investigated intra-operative (n = 11), post-operative (n = 14) and outpatient care (n = 18). Baseline audits showed variation in care by site; intra-operative care (range 39-96% for repair conducted under anaesthesia, 60-96% for repair by or under supervision of a senior clinician, and 33-54% for completion of Accident Compensation Corporation forms); post-operative care (range 40-93% for prescribed antibiotics and 33-96% for stool softeners) and outpatient care (45-84% for referral to outpatient clinic and 54-78% for physiotherapy follow-up). Sustained high quality of care and improvements in adherence with recommendations were seen for most of the follow-up audits (eg 90% adherence for prescribed stool softeners over three audits; over 50% increase in prescribed antibiotics over seven years).
CONCLUSIONS
These clinical audits exemplify the need to measure patient care against standards, learn from the findings, implement changes to improve patient experience and reduce life-long sequelae from perineal trauma. This review showed some progress in some care services and highlighted where further changes are needed to close evidence-practice gaps.
Topics: Clinical Audit; Episiotomy; Humans; New Zealand; Parturition; Perineum; Standard of Care
PubMed: 33094500
DOI: 10.1111/ajo.13262 -
Radiographics : a Review Publication of... 2018A wide range of acute conditions can affect the perineum, from self-limited disease to conditions that are potentially life threatening or contribute to substantial... (Review)
Review
A wide range of acute conditions can affect the perineum, from self-limited disease to conditions that are potentially life threatening or contribute to substantial patient morbidity if not promptly diagnosed and appropriately treated. Imaging is essential in the clinical management of perineal disease because it allows accurate anatomic localization of the origin and extent of the disease to be determined. Familiarity with complex perineal anatomy, appropriate use of imaging modalities, and the spectrum of imaging findings seen in acute perineal conditions is crucial for radiologists to make a rapid and accurate diagnosis. Various imaging modalities are available to evaluate acute perineal conditions, each with their own advantages and disadvantages. Computed tomography is used most commonly in the acute care setting because of its widespread availability and rapid image acquisition. Ultrasonography could be used to evaluate superficial and palpable abnormalities and is especially helpful for diagnosis of genital injuries. Magnetic resonance (MR) imaging exhibits superior tissue contrast resolution, provides excellent characterization of conditions, and lacks ionizing radiation. Its role is increasing in the acute care setting; however, MR imaging is not always readily available and is currently reserved for use as a problem-solving technique. Retrograde urethrography is the modality of choice for evaluating traumatic urethral injury. RSNA, 2018.
Topics: Acute Disease; Contrast Media; Diagnosis, Differential; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Perineum; Rectal Diseases
PubMed: 29906202
DOI: 10.1148/rg.2018170151 -
Magnetic Resonance Imaging Clinics of... Aug 2017The female perineum has a complex anatomy and can be involved by a wide range of pathologies. In this article, we specifically focus on the clitoris, labia, and... (Review)
Review
The female perineum has a complex anatomy and can be involved by a wide range of pathologies. In this article, we specifically focus on the clitoris, labia, and introitus. We discuss the normal anatomy of these structures, the MR imaging techniques to optimize their evaluation, and several common and uncommon entities that may affect them, including benign and malignant tumors, as well as infectious and inflammatory, vascular, iatrogenic, and developmental entities.
Topics: Clitoris; Female; Humans; Magnetic Resonance Imaging; Perineum; Vulva
PubMed: 28668154
DOI: 10.1016/j.mric.2017.03.011 -
Cirugia Espanola 2016Perineal injuries are uncommon, but not rare. They may present a wide variety of injury patterns which demand an accurate diagnostic assessment and treatment. Perineal... (Review)
Review
Perineal injuries are uncommon, but not rare. They may present a wide variety of injury patterns which demand an accurate diagnostic assessment and treatment. Perineal injuries may occur as isolated injuries to the soft tissues or may be associated with pelvic organ, abdominal or even lower extremity injury. Hence the importance to know in depth not only the anatomy of the perineum and its organs, but also the implications of the patient's hemodynamic stability on the decision making process when treating these injuries using established trauma guidelines. The purpose of this review is to describe the current epidemiology and clinical presentation of perineal injuries in order to provide specific guidelines for the diagnosis and treatment of both stable and unstable patients.
Topics: Algorithms; Humans; Perineum; Surgical Procedures, Operative
PubMed: 26895924
DOI: 10.1016/j.ciresp.2015.11.010 -
Abdominal Imaging Oct 2015The female perineum, which is divided into the anterior urogenital triangle and the posterior anal triangle, is a surface structure often overlooked. Female perineal... (Review)
Review
The female perineum, which is divided into the anterior urogenital triangle and the posterior anal triangle, is a surface structure often overlooked. Female perineal diseases may present with nonspecific clinical signs due to its close anatomical relationship between the different compartments. Diagnosis of the origin of a perineal disorder may also be a difficult problem encountered in pelvi-perineal imaging. Therefore, a precise knowledge of the female perineal anatomy and the associated disease processes is essential to radiologists, pathologists, and surgeons alike who are involved in the evaluation of the patient who presents with a perineal mass. Cross-sectional imaging plays a crucial role for proper management. Due to the robust contrast resolution of MR, MR imaging is the modality of choice for evaluation of the extent of a complex perineal lesion, its relationship to the adjacent structures. It has a greater sensitivity and specificity for the diagnosis than the other non-invasive imaging techniques and is helpful in guidance for surgical planning. The purpose of this article is to highlight the spectrum of imaging findings of female perineal diseases.
Topics: Adult; Aged; Female; Female Urogenital Diseases; Humans; Magnetic Resonance Imaging; Middle Aged; Perineum; Rectal Diseases; Young Adult
PubMed: 25896612
DOI: 10.1007/s00261-015-0427-7 -
Annali Italiani Di Chirurgia 2022Aggressive angiomyxoma is a type of mesenchymal tumor occurring predominantly in the pelvic and perineal region. The aim of our study was to reveal our experience with... (Review)
Review
BACKGROUND
Aggressive angiomyxoma is a type of mesenchymal tumor occurring predominantly in the pelvic and perineal region. The aim of our study was to reveal our experience with gonadotropin-releasing hormone (GnRH) treatment in patients with angiomyxoma and provide a comprehensive review of management.
PATIENTS AND METHODS
This study is a case-series including seven female patients diagnosed with aggressive angiomyxoma from a single institution, between 2012 and 2020. Follow-up after surgery was ranged between 2-45 months with an average of 17.6 months. Resection was performed in all patients without any complications, and five had received GnRH analogue (Goserelin acetate) therapy after surgery. Immunohistochemistry analyses showed positivity for smooth muscle actin and desmin in all cases, while both estrogen receptor (ER) and progesterone receptor (PR) positivity were identified in 6 patients. None of the seven patients had recurrence during follow up period.
CONCLUSION
The mean treatment of aggressive angiomyxoma is surgery, and the use of GnHR analogues in cases with positive ER and PR may be effective in preventing recurrence.
KEY WORDS
Aggressive Angiomyxoma, Gonadotropin-Releasing Hormone, Soft Tissue Neoplasm.
Topics: Humans; Female; Myxoma; Receptors, Estrogen; Immunohistochemistry; Perineum; Gonadotropin-Releasing Hormone
PubMed: 36353852
DOI: No ID Found -
Diseases of the Colon and Rectum Feb 2015
Topics: Humans; Perineum; Rectal Neoplasms; Wound Healing
PubMed: 25585093
DOI: 10.1097/DCR.0000000000000302 -
Obstetrical & Gynecological Survey Jan 2018Obstetric anal sphincter injuries (OASISs) complicate up to 11% of vaginal deliveries; obstetricians must be able to recognize and manage these technically challenging... (Review)
Review
IMPORTANCE
Obstetric anal sphincter injuries (OASISs) complicate up to 11% of vaginal deliveries; obstetricians must be able to recognize and manage these technically challenging injuries.
OBJECTIVE
The aim of this study was to share our approach for management of these challenging complications of childbirth based on a multidisciplinary collaboration between general obstetrician-gynecologists, maternal fetal medicine specialists, and female pelvic medicine and reconstructive surgeons established at our institution.
EVIDENCE ACQUISITION
A systematic literature search was performed in 3 search engines: PubMed 1946-, EMBASE 1947-, and the Cochrane Database of Systematic Reviews using keywords and
RESULTS
Identification should begin with an assessment of risk factors, notably nulliparity and operative vaginal delivery, consistently associated with the highest risk of OASISs, and proceed with a thorough examination to grade the degree of laceration. Repair should be performed or supervised by an experienced clinician in an operating room with either regional or general anesthesia. The external anal sphincter may be repaired using either an overlapping or end-to-end anastomosis. Providers should be comfortable with both approaches as the degree of laceration may necessitate one approach over the other. We advocate for use of monofilament suture on all layers to decrease risk of bacterial seeding, as well as preoperative antibiotics and postoperative bowel regimen, which are associated with improved outcomes.
CONCLUSIONS AND RELEVANCE
Long-term sequelae, including pain, dyspareunia, and fecal incontinence, significantly impact quality of life for many patients who suffer OASISs and may be avoided if evidence-based guidelines for recognition and repair are utilized.
Topics: Anal Canal; Anti-Bacterial Agents; Delivery, Obstetric; Episiotomy; Female; Humans; Lacerations; Obstetric Labor Complications; Perineum; Practice Guidelines as Topic; Pregnancy; Risk Factors; Suture Techniques; Vagina
PubMed: 29368789
DOI: 10.1097/OGX.0000000000000521 -
Nursing Standard (Royal College of... Feb 2016Rationale and key points Skilful repair of an episiotomy is an important aspect of maternal health care. It is essential that midwives and doctors have the knowledge and...
Rationale and key points Skilful repair of an episiotomy is an important aspect of maternal health care. It is essential that midwives and doctors have the knowledge and skills to undertake this procedure in a safe and effective manner. ▶ An episiotomy should be repaired promptly to reduce blood loss and prevent infection. ▶ Repair of an episiotomy is undertaken in three stages: repair of the vaginal mucosa, repair of the muscle layer and repair of the skin layer. ▶ Adequate pain relief should be provided before suturing. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Why a rectal examination is recommended before and following repair of an episiotomy. 2. What you would do to improve your suturing skills. 3. The factors that may prevent or delay an episiotomy from healing. Subscribers can upload their reflective accounts at rcni.com/portfolio .
Topics: Delivery, Obstetric; Episiotomy; Female; Humans; Pain Management; Perineum; Pregnancy; Sutures
PubMed: 26884039
DOI: 10.7748/ns.30.25.36.s46 -
Midwifery Dec 2020Perineal injury during childbirth is a very common event which affect women during childbirth. Significant morbidities are associated with third-and-fourth degree... (Review)
Review
BACKGROUND
Perineal injury during childbirth is a very common event which affect women during childbirth. Significant morbidities are associated with third-and-fourth degree perineal tears in particular, also referred to as obstetric anal sphincter injuries (OASIS). With an increasing global birth rate and rising interventions in birth, the incidence of perineal trauma following vaginal birth is increasing on an international scale, impacted also by more accurate classification and definitions of OASIS and increased pre-existing co morbidities amongst affected women. The consequences of OASIS can be physically and psychologically distressing for affected women and have significant impact on quality of life.
METHODOLOGY
The aim of this integrative review was to examine women's experience of OASIS following childbirth using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A number of academic electronic databases were systematically searched and results are presented and analysed. Results of the complete search are presented in PRISMA format. Eight papers, which were assessed for quality using an appropriate appraisal tool, are included in the review and thematic analysis used to identify themes.
FINDINGS
The themes identified were; psychological consequences, the role of the health care professionals and implications for future pregnancies. Psychological consequences included anxiety, loneliness, isolation, shame, fear, many of which were associated with physical ramifications of OASIS and how these feelings affect activities of daily living. The importance of access to and support from health care professionals was highlighted. The impact the experience of OASIS had on women's decisions about future pregnancies was also evident.
CONCLUSION
The association between OASIS and maternal quality of life following childbirth can be substantial as evidenced by this literature review. The review identifies the need for improvement in the care and management of these women to alleviate the physical and psychological consequences of OASIS, including decisions in relation to future pregnancies and childbirth. Health care professionals caring for women in pregnancy and childbirth need to be educated and informed on the sequelae of OASIS, to ensure appropriate information and support is provided to these women and their families. Such knowledge may enable health care professionals to alleviate symptoms associated with OASIS and help women make sense and cope with their experiences.
Topics: Adult; Female; Humans; Lacerations; Mothers; Obstetric Labor Complications; Parturition; Perineum; Pregnancy
PubMed: 32861872
DOI: 10.1016/j.midw.2020.102820