-
Gynecologie, Obstetrique, Fertilite &... Oct 2022To analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of...
OBJECTIVE
To analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of perineal injuries between 2017, when the manoeuvre was not performed at all, and 2020.
MATERIALS AND METHOD
A single-centre retrospective study of patients who delivered a singleton eutociously at term from 1 January to 31 December 2017 and 2020.
RESULTS
In total, 2930 records were analysed. The Couder manoeuvre rate was 32.12% in 2020. A change in the distribution of perineal lesions was observed: the rate of intact perineum increased (P<0.001), while 2nd degree lesions decreased between 2017 and 2020 (P<0.05). The 1st degree perineum and obstetric anal sphincter injuries remained stable. The rate of episiotomy decreased significantly by almost a factor of 7.
CONCLUSION
The practice of the Couder manoeuvre can be implemented fairly quickly after training of the actors with nearly a third of normal deliveries at term concerned one year after its introduction. This manoeuvre seems, in our practice, to have contributed to the reduction, as previously reported, of the rate of second degree perineal injuries.
Topics: Delivery, Obstetric; Female; Humans; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 34896636
DOI: 10.1016/j.gofs.2021.12.001 -
Journal of Biomechanics Jun 2024The perineum is a layered soft tissue structure with mechanical properties that maintain the integrity of the pelvic floor. During childbirth, the perineum undergoes...
The perineum is a layered soft tissue structure with mechanical properties that maintain the integrity of the pelvic floor. During childbirth, the perineum undergoes significant deformation that often results in tears of various degrees of severity. To better understand the mechanisms underlying perineal tears, it is crucial to consider the mechanical properties of the different tissues that make up the perineum. Unfortunately, there is a lack of data on the mechanical properties of the perineum in the literature. The objective of this study is to partly fill these gaps. Hence sow perineums were dissected and the five perineal tissues involved in tears were characterized by uniaxial tension tests: Skin, Vagina, External Anal Sphincter, Internal Anal Sphincter and Anal Mucosa. From our knowledge, this study is the first to investigate all these tissues and to design a testing protocol to characterize their material properties. Six material models were used to fit the experimental data and the correlation between experimental and predicted data was evaluated for comparison. As a result, even if the tissues are of different nature, the best correlation was obtained with the Yeoh and Martins material models for all tissues. Moreover, these preliminary results show the difference in stiffness between the tissues which indicates that they might have different roles in the structure. These obtained results will serve as a basis to design an improved experimental protocol for a more robust structural model of the porcine perineum that can be used for the human perineum to predict perineal tears.
Topics: Animals; Perineum; Swine; Female; Biomechanical Phenomena; Models, Biological; Anal Canal; Vagina; Stress, Mechanical
PubMed: 38908107
DOI: 10.1016/j.jbiomech.2024.112175 -
Clinical Anatomy (New York, N.Y.) Apr 2017Childbirth can be a traumatic experience on the female body. Some techniques may be implemented to make the process smoother and decrease the potential lacerations that... (Review)
Review
Childbirth can be a traumatic experience on the female body. Some techniques may be implemented to make the process smoother and decrease the potential lacerations that can occur. Episiotomies have been used by obstetricians and midwives to help make the fetal decent down the vaginal canal less turbulent. A physician must use his best judgment on when it is necessary to make this incision and what form of incision to make. Before making an incision one must understand the female external and internal anatomy and thoroughly comprehend the stages of birth to understand how and what complications can occur. Even though an episiotomy is a minor incision, it is still a surgical incision nonetheless and as with any form of surgery there are both risks and benefits that are to be considered. Nevertheless, episiotomies have proven to help ease births that are complicated by shoulder dystocia, prevent severe lacerations, and decrease the second stage of labor. The following comprehensive review provides a description of the female anatomy, as well as an extensive description of why, when, and how an episiotomy is done. Clin. Anat. 30:362-372, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Delivery, Obstetric; Episiotomy; Female; Genitalia, Female; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Labor Stage, Second; Lacerations; Perineum; Pregnancy; Risk Factors
PubMed: 28195378
DOI: 10.1002/ca.22836 -
Journal of Clinical Nursing May 2023To investigate the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth. (Meta-Analysis)
Meta-Analysis Review
AIMS AND OBJECTIVES
To investigate the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth.
BACKGROUND
Due to the high incidence and severe consequences of perineal trauma during childbirth, tissue adhesives are recommended as an alternative to conventional sutures to repair perineal trauma. Although many original studies have explored the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth, these studies have differed in participants, interventions and outcomes. Therefore, the effect of tissue adhesives on wound healing and pain relief in perineal trauma during childbirth is inconclusive.
DESIGN
A systematic review and meta-analysis based on PRISMA 2020.
METHODS
A systematic and comprehensive literature search was conducted. Eight electronic databases, three clinical trial registers, and grey literature were searched from inception to 28th April 2021 and reference lists were also retrieved. Randomised controlled trials (RCTs) involving women with first- or second-degree perineal lacerations or women who underwent episiotomy were included. The intervention was the use of tissue adhesives alone or in combination with sutures. For the outcome indicators of perineal wound healing and pain relief, subgroup analyses based on the extent of perineal trauma and measurement time points were conducted, respectively.
RESULTS
A total of 14 RCTs involving 2264 participants were included in this research. The results indicated that for first-degree lacerations, the incidence of wound complications was significantly higher in the tissue adhesives group. In contrast, for episiotomy, the effect of the combination of tissue adhesives and sutures was comparable to that of sutures exclusively. The pooled results revealed that tissue adhesives exerted a positive effect on relieving immediate and short-term perineal pain, but no significant difference was found in the effect of long-term pain relief. Moreover, this review also supported the effect of tissue adhesives in shortening intraoperative repair time and improving clinician-maternal satisfaction.
CONCLUSIONS
The existing evidence illustrates that tissue adhesives effectively promote perineal wound healing and relieve immediate and short-term pain. However, for first-degree lacerations, the increased occurrence of wound complications must be prudently considered when applying tissue adhesives alone, whereas, for episiotomy, the combination of tissue adhesives and sutures may be a promising repair alternative. Future studies are encouraged to adopt long-term effect, adverse effect, and cost-effect analysis as important outcome indicators to comprehensively validate the applicability and generalisability of tissue adhesives.
RELEVANCE TO CLINICAL PRACTICE
For first-degree perineal lacerations, we do not recommend using tissue adhesives alone to repair the wound, given the increased wound complications. While for episiotomy, the combination of tissue adhesives and sutures may be a promising alternative to the use of sutures exclusively. Additionally, the adverse effect and long-term effect of using tissue adhesives alone to repair perineal trauma should be further clarified.
Topics: Pregnancy; Female; Humans; Tissue Adhesives; Lacerations; Perineum; Parturition; Delivery, Obstetric; Episiotomy; Pain; Obstetric Labor Complications
PubMed: 34672033
DOI: 10.1111/jocn.16086 -
Veterinary Medicine and Science Feb 2019Understanding the homologies between male and female perineal structure helps both evolutionary biologists and clinicians better understand the evolution and anatomy of...
Understanding the homologies between male and female perineal structure helps both evolutionary biologists and clinicians better understand the evolution and anatomy of canines. Domestic dogs (Canis familiaris) play an important role in human society, and canine perineal anatomy is important for maintaining dogs' reproductive health for successful breeding and a wide variety of pathologies. Here, we investigate homologies between male and female perineal structure, identifying structures based on common function, anatomical relationships and attachments. In this investigation we dissected 21 male and female large-breed dogs. We find broad structural homologies between male and female dogs related to erection, micturition and defecation, including muscles, fasciae and erectile tissue. Using these homologies will help anatomists and clinicians interpret the anatomical organization of the perineum, a notoriously difficult area of anatomy.
Topics: Animals; Dogs; Female; Genitalia, Female; Genitalia, Male; Male; Perineum
PubMed: 30663868
DOI: 10.1002/vms3.128 -
Journal of Pediatric Surgery Aug 2020Perineal groove is a rare congenital anomaly of the perineum, and only a few papers describing a small number of cases have been reported in the medical literature. This...
PURPOSE
Perineal groove is a rare congenital anomaly of the perineum, and only a few papers describing a small number of cases have been reported in the medical literature. This study aimed to evaluate the clinical characteristics and proper management of perineal groove.
METHODS
We performed a retrospective review of 26 pediatric patients who were diagnosed with perineal groove between January 2012 and October 2018 at our institution.
RESULTS
Perineal groove was extremely prevalent among the females: 25 of the 26 patients were girls, and only one patient was a boy. All the patients presented with an unusual lesion at the anus or perineum, but no symptoms related to this anomaly. The median age at the first visit to our clinic was 1.5 month (range, 0.3-11.4 month). Two types, complete and partial, were used to categorize the appearance of perineal groove. In a sample group, 55% (12/22) of the patients had complete perineal groove while 45% (10/22) had partial perineal groove. One patient underwent an anoplasty at another hospital following the diagnosis of an imperforate anus. One male and 13 female patients were followed beyond the age of two, and 10 patients (71%) showed a natural healing process.
CONCLUSION
Perineal groove manifested as two types of appearance and showed excellent results with conservative treatment in our study. A natural healing process can be expected in the long-term follow-up. Perineal groove must be differentiated from other defects to avoid unnecessary surgical treatment.
LEVELS OF EVIDENCE
Therapeutic Study, Level IV.
Topics: Child, Preschool; Congenital Abnormalities; Conservative Treatment; Female; Humans; Infant; Infant, Newborn; Male; Perineum; Retrospective Studies
PubMed: 31443920
DOI: 10.1016/j.jpedsurg.2019.07.017 -
Journal of Plastic, Reconstructive &... Sep 2022Vulvovaginal reconstruction is challenging. In this study, we evaluated the outcomes of vulvovaginal reconstruction with "perineal perforator switch flap" (PPSF) and...
BACKGROUND
Vulvovaginal reconstruction is challenging. In this study, we evaluated the outcomes of vulvovaginal reconstruction with "perineal perforator switch flap" (PPSF) and compared it with other conventional flaps. In addition, the long-term esthetic results were compared with the perineal perforator propeller flap (PPPF), which we previously used.
METHODS
We retrospectively reviewed the clinical data of 16 patients (27 flaps) who underwent vulvovaginal reconstruction with PPSF. After tumor resection, perineal perforators close to the genitofemoral sulcus were identified. The flap was designed as an island with the perforator at the center. The flap was elevated while preserving the soft tissue surrounding the pedicle, and transferred to the defect via the subcutaneous tunnel without pedicle skeletonization.
RESULTS
All flaps survived and no major surgical complications were observed. The total follow-up period was 16.13±3.38 months. The mean operation time was 79.38±19.65 min, and the initiation of walking and the length of hospitalization were 1.69 ± 0.79 and 5.69 ± 0.79 days, respectively. Perineal function was well preserved. Comparison of esthetic results with PPPF showed that PPSF showed better results in symmetrical and labial shape (2.29 ± 0.73 vs. 3.13 ± 0.81; p=0.015, 2.43 ± 1.02 vs. 3.25 ± 0.68; p=0.031, respectively), and in total score. (10.29 ± 2.16 vs. 12.31 ± 1.82; p=0.017).
CONCLUSION
PPSF was technically simple and significantly reduced the duration of operation and the overall recovery time. PPSF also prevented delay in radiation. Therefore, PPSF is a promising method for vulvovaginal reconstruction.
Topics: Esthetics; Humans; Perforator Flap; Perineum; Plastic Surgery Procedures; Retrospective Studies
PubMed: 35717498
DOI: 10.1016/j.bjps.2022.04.052 -
Anales de Pediatria Jun 2024
Topics: Humans; Perineum
PubMed: 38431449
DOI: 10.1016/j.anpede.2024.02.008 -
Journal of the American College of... Jun 2024
Topics: Humans; Perineum
PubMed: 38451835
DOI: 10.1097/XCS.0000000000001065 -
Progres En Urologie : Journal de... Mar 2015The main objective of that review was to evaluate the pelvi-perineal consequences of the different methods of pushing at vaginal delivery. (Review)
Review
INTRODUCTION
The main objective of that review was to evaluate the pelvi-perineal consequences of the different methods of pushing at vaginal delivery.
METHODS
A review on PubMed, the Cochrane Library and EM-Premium was performed from 1984 to 2014. Among 29 manuscripts analysed, only nine randomised controlled trials (including one meta-analysis of three trials) comparing Valsalva and spontaneous pushing were selected. A 10 th study, secondary analysis of a randomized controlled trial comparing different methods of perineal protection (warm compresses, massage and manual protection), was also selected.
RESULTS
Two trials have shown that spontaneous pushing reduces the risk of perineal tears, but studies were heterogeneous and discordant results do not allowed definitive conclusions. Results on the duration of the second stage of labour are conflicting. The method of pushing does not seem to affect the rate of episiotomy, instrumental delivery and cesarean section. Maternal satisfaction seems to be better after spontaneous pushing. It seems that there is no negative effect of spontaneous pushing on neonate well-being, and one study has shown a significant improvement of prenatal fetal parameters during the expulsive phase.
CONCLUSION
According to current knowledge, both techniques of pushing during the expulsive phase at delivery seem comparable in terms of duration, risk of perineal tears and neonatal outcome.
Topics: Delivery, Obstetric; Female; Humans; Lacerations; Perineum; Pregnancy
PubMed: 25649356
DOI: 10.1016/j.purol.2015.01.003