-
Journal of the American Board of Family... 2018Studies have shown increased incidence of severe vaginal lacerations (third and fourth degree) in women under the influence of epidural analgesia. This increase has been... (Comparative Study)
Comparative Study
BACKGROUND
Studies have shown increased incidence of severe vaginal lacerations (third and fourth degree) in women under the influence of epidural analgesia. This increase has been attributed to the increased the use of operative vaginal delivery (OVD), with attendant increased risk of laceration. Although mild and moderate vaginal lacerations requiring suturing are clinically significant, their relationship to epidural analgesia has not been extensively studied.
OBJECTIVE
The purpose of this study is to examine relationships between epidural analgesia in laboring women and vaginal lacerations at delivery. Our research addresses the question: "Is epidural analgesia in labor associated with reduced likelihood of vaginal laceration at delivery, compared with delivery without epidural analgesia? In addition, is there a difference in vaginal laceration rates between an urban hospital staffed by obstetricians and a suburban hospital staffed mainly by family physicians?"
STUDY DESIGN
For the purposes of our study we included mild and severe perineal lacerations (first through fourth degree). We included all-term singleton vaginal deliveries at Truman Medical Centers Hospital Hill and Lakewood during 2013. We conducted a retrospective chart review that included 2131 women. We examined the relationship of OVD to epidural and to laceration. Since the 2 hospitals had different characteristics, we also examined the relationship of location of delivery to laceration. We controlled for maternal age, birth weight, location of delivery, OVD, parity, and race. We examined these factors using a logistic regression analysis.
RESULTS
After controlling for all factors mentioned above, epidural was negatively associated with laceration (odd ratio [OR], 0.886; 95% CL, 0.665, 0.991). Other factors negatively associated with laceration included black race, parity, and delivery at Truman Medical Center Lakewood (TMCLW).
CONCLUSIONS
Patients who received epidural analgesia experienced fewer vaginal lacerations. There was no increase in OVD in patients who received epidural analgesia. Patients who delivered at a suburban hospital staffed by family medicine residents experienced fewer lacerations than those delivering at an urban hospital staffed by Obstetrics and Gynecology residents after controlling for race and other factors.
Topics: Analgesia, Epidural; Delivery, Obstetric; Female; Hospitals, Urban; Humans; Lacerations; Logistic Models; Missouri; Pregnancy; Retrospective Studies; Vagina
PubMed: 30201673
DOI: 10.3122/jabfm.2018.05.170400 -
American Family Physician May 2017The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Many aspects of laceration repair have... (Review)
Review
The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Many aspects of laceration repair have not changed over the years, but there is evidence to support some updates to standard management. Studies have been unable to define a "golden period" for which a wound can safely be repaired without increasing risk of infection. Depending on the type of wound, it may be reasonable to close even 18 or more hours after injury. The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves. Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection. Good evidence suggests that local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits. Local anesthetic with epinephrine in a concentration of 1:200,000 is safe for use on the nose and ears. Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas. Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available. Tetanus prophylaxis should be provided if indicated. Timing of suture removal depends on location and is based on expert opinion and experience.
Topics: Antibiotic Prophylaxis; Gloves, Surgical; Humans; Lacerations; Suture Techniques; Tissue Adhesives; Wound Healing; Wound Infection; Wounds and Injuries
PubMed: 28671402
DOI: No ID Found -
Journal of Mother and Child Jun 2023Nowadays, we are witnessing a decrease of vaginal instrumental deliveries and continuous increase of caesarean section rate. However, proper identification of... (Review)
Review
BACKGROUND
Nowadays, we are witnessing a decrease of vaginal instrumental deliveries and continuous increase of caesarean section rate. However, proper identification of possibility of execution, indications for instrumental delivery and their skilful use may improve the broadly understood maternal and neonatal outcomes. The aim of this study is to present prevalence, risk factors, indications and outcomes of forceps deliveries among the patients at Department of Perinatology, Lodz.
MATERIAL AND METHODS
A retrospective study was conducted at the Department of Perinatology, Medical University of Lodz. The study included forceps deliveries carried out between January 2019 and December 2022. Total number of 147 cases were analysed in terms of indications for forceps delivery and maternal and neonatal outcomes such as vaginal - or cervical - laceration, postpartum haemorrhage, perineal tear, newborn injuries, Apgar score, umbilical cord blood gas analysis, NICU admission and cranial ultrasound scans.
RESULTS
The prevalence of forceps delivery was 2.2%. The most common indication for forceps delivery was foetal distress (81.6%). Among mothers, the most frequent complication was vaginal laceration (40.1%). Third-and fourth-degree perineal tears were not noted. Regarding neonatal outcomes, Apgar score ≥ 8 after 1st and 5th minute of life received accordingly 91.2% and 98% of newborns. Only 8.8% experienced severe birth injuries (subperiosteal haematoma, clavicle fracture).
CONCLUSIONS
Although foetal distress is the most common indication for forceps delivery, the vast majority of newborns were born in good condition and did not require admission to NICU. Taking into consideration high efficacy and low risk of neonatal and maternal complications, forceps should remain in modern obstetrics.
Topics: Humans; Infant, Newborn; Pregnancy; Female; Cesarean Section; Fetal Distress; Retrospective Studies; Lacerations; Vacuum Extraction, Obstetrical; Obstetrical Forceps
PubMed: 37920112
DOI: 10.34763/jmotherandchild.20232701.d-23-00057 -
Computational and Mathematical Methods... 2022Finding valuable risk factors for the prognosis of brain contusion and laceration can help patients understand the condition and improve the prognosis. This study is...
OBJECTIVE
Finding valuable risk factors for the prognosis of brain contusion and laceration can help patients understand the condition and improve the prognosis. This study is aimed at analyzing the risk factors of poor prognosis in patients with brain contusion after the operation.
METHODS
A total of 136 patients with cerebral contusion and laceration combined with cerebral hernia treated by neurosurgical craniotomy in our hospital were retrospectively selected and divided into a training set ( = 95) and a test set ( = 41) by the 10-fold crossover method. Logistic regression and back-propagation neural network prediction models were established to predict poor prognosis factors. The receiver operating characteristic curve (ROC) and the calibration curve were used to verify the differentiation and consistency of the prediction model.
RESULTS
Based on logistic regression and back-propagation neural network prediction models, GCS score ≤ 8 on admission, blood loss ≥ 30 ml, mannitol ≥ 2 weeks, anticoagulants before admission, and surgical treatment are the risk factors that affect the poor prognosis of patients with a cerebral contusion after the operation. The area under the ROC was 0.816 (95% 0.705~0.926) and 0.819 (95% 0.708~0.931), respectively.
CONCLUSION
The prediction model based on the risk factors that affect the poor prognosis of patients with brain contusion and laceration has good discrimination and accuracy.
Topics: Brain Contusion; Humans; Lacerations; Machine Learning; Prognosis; ROC Curve; Retrospective Studies
PubMed: 35602351
DOI: 10.1155/2022/4311434 -
MedEdPORTAL : the Journal of Teaching... Feb 2020Declining rates of operative vaginal deliveries and routine episiotomy in obstetric practice, along with rising cesarean section rates, have decreased OB/GYN resident...
INTRODUCTION
Declining rates of operative vaginal deliveries and routine episiotomy in obstetric practice, along with rising cesarean section rates, have decreased OB/GYN resident experience with episiotomy repair and obstetric anal sphincter injuries (OASIS). Simulation models are valuable educational tools in procedural training. Several models have been reported, each with its own limitations and benefits.
METHODS
We developed a 1-hour workshop to teach novice OB/GYN residents perineal laceration repair skills on a modified beef tongue model. The model required 5-10 minutes to assemble following written and video instruction, and learners had 30-50 minutes to practice using learner instructions. Learners were evaluated using a procedure checklist and global objective structured assessment of technical skills. To evaluate the session, we surveyed current faculty and residents, as well as residency graduates.
RESULTS
Between 2008 and 2017, an estimated 82 OB/GYN residents participated in this activity, and 95 participants and facilitators received the survey. Forty-one (59%) respondents agreed that this model was similar to repairing OASIS in clinical practice. Our trainees reported that the optimal time for simulated OASIS repair was the R2 and R3 years; however, 90% of respondents felt residents should be offered this simulation yearly.
DISCUSSION
Based on our survey of trainees, graduates, and faculty, we created a realistic simulated OASIS repair training, despite the limitation that the model lacked a rectum. Learners reported an interest in repeating the simulation frequently during residency to augment their clinical experience and increase perceived competence in third- and fourth-degree laceration repair by their graduation.
Topics: Adult; Animals; Cattle; Clinical Competence; Education, Medical, Graduate; Episiotomy; Female; Humans; Internship and Residency; Lacerations; Obstetrics; Pregnancy; Red Meat; Surveys and Questionnaires
PubMed: 32175472
DOI: 10.15766/mep_2374-8265.10881 -
Circulation. Cardiovascular... Nov 2021Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet...
Balloon-Augmented Leaflet Modification With Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction and Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction: Benchtop Validation and First In-Man Experience.
BACKGROUND
Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay.
METHODS
We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers.
RESULTS
BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days.
CONCLUSIONS
BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy. Graphic Abstract: A graphic abstract is available for this article.
Topics: Animals; Coronary Vessels; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Iatrogenic Disease; Lacerations; Mitral Valve; Pectinidae; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34674556
DOI: 10.1161/CIRCINTERVENTIONS.121.011028 -
Journal of General Internal Medicine Jun 2005
Topics: Emergency Service, Hospital; Humans; Lacerations; Male; Physician-Patient Relations
PubMed: 15987337
DOI: 10.1111/j.1525-1497.2005.01535_1.x -
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 -
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 -
The Western Journal of Emergency... Dec 2015Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and... (Review)
Review
INTRODUCTION
Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge.
DISCUSSION
The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of arterial perfusion. In a well-perfused hand, however, the presence of one intact artery is adequate to sustain viability without long-term functional disability, provided the palmar arch circulation is intact. Early consultation with a hand specialist should be pursued, and follow-up arrangement made for delayed primary repair in cases of complex injury.
CONCLUSION
Management in accordance with well-established clinical principles will maximize treatment efficacy and functional outcome while minimizing the cost of medical care.
Topics: Arteries; Forearm; Forearm Injuries; Humans; Lacerations; Ligation; Tourniquets; Trauma Centers
PubMed: 26759666
DOI: 10.5811/westjem.2015.10.28327