Search results for: episiotomy

Authors: Clesse C., Lighezzolo-Alnot J., De Lavergne S.

Abstract:

Considered as the most common surgical procedure worldwide, episiotomy can be defined as an incision around the vulva performed to enlarge it, in the aim of preventing the traumatic rupture of the perineum during childbirth. Rather mediatized, this practice raises many questions in the field of mental health, relayed by different users and health professionals. Today, is topicality is moderately hectic since many queries about the prophylactic exercise of episiotomy are subject to a relative consensus, particularly since WHO advocated in 1996 that only 10% of childbirths should involve an episiotomy. This indicator appeared after the publication of numerous results from randomized clinical trials. Unfortunately, these papers seem mostly centered about somatic impacts of episiotomy. From the side of psychological studies, they mostly integrate a major clinical methodological bias, especially considering that every primiparous woman is identical to the others face to the experience of parturition. In the aim to fill this lack of knowledge, we developed a longitudinal research starting in the 7th month of pregnancy and ending one year after delivery. We are studying in a comparative way different possible psychological consequences inherent to the use of episiotomy. To do this, we use a standardized methodology which combines semi-structured clinical interviews (IRMAG, IRMAN ...), free clinical interviews, a projective test (Rorschach) and five questionnaires (QIC, EPDS, CPQ WOMBLSQ4, SF36). Therefore, we can comprehend with shrewdness the question of psychic impacts of episiotomy in a qualitative and quantitative way by comparing it to other obstetric interventions. In this paper, we will present the first results obtained about a population of twenty-two primiparous women by focusing on body image, sexuality, quality of life, depressive affects, post-traumatic stress disorder and investment of the maternal role. Finally, we will consider the different implications and perspectives of this research which could improve the public health policies in the field of perinatal care.

Keywords: assessment, episiotomy, mental health, psychical impacts

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Authors: Azizah Nurdin, Trika Irianta, Mardiah Tahir, Maisuri T. Chalid

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Background: Studies of anal incontinence in the general population are rare however its financial healthcare cost is significant. Women attended Hasanuddin University Teaching Hospital and its networking in Makassar, Indonesia was surveyed between February to April 2015 about their obstetrical and gynecological history. Aims: To establish obstetrical risk factor of anal incontinence among women in Makassar. Methods: In a cross sectional face to face interview study, 135 women aged 30 years or more were selected randomly. Participants were asked to complete an anal incontinence questionnaire. Results: From a total sample of 135 respondents, 42,2 % reported has flatulence incontinence. Parity, history of anal sphincter laceration, history of having large baby, history of assisted vaginal delivery were shown have no significant association with anal incontinence, while history of episiotomy was shown have a significant association with anal incontinence (p value < 0.05). The risk of flatulence incontinence was higher among women with history of episiotomy (OR : 2,85, 95 % CI = 1,58- 5,13) Conclusions: This study has confirmed that fecal incontinence is a fairly common symptom. Flatulence incontinence is the most frequent even. An obstetrical factor like episiotomy is one of risk factor that could be avoided in order to prevent anal incontinence.

Keywords: anal incontinence, flatulence incontinence, obstetrical risk factor, women

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Authors: A. Wahid Uddin

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Obstetric anal sphincter injury carries significant morbidity for a woman and affects the quality of life to the extent of permanent damage to anal sphincter musculature. The study was undertaken in a district general hospital by retrospectively reviewing random 63 case notes of patients diagnosed with a significant third or fourth-degree perineal tear admitted between the year of 2015 to 2018. The observations were collected by a pre-designed questionnaire. All variables were expressed as percentages. The major risk factors noted were nulliparity (37%), instrumental delivery (25%), and birth weight of more than 4 kg (14%). Forceps delivery with or without episiotomy was the major contributing factor (75%). In the majority of the cases (71%), no record of any perineal protection measures undertaken. The study concluded that recommended perineal protection measures should be adopted as a routine practise.

Keywords: forceps, obstetrics, perineal, sphincter

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Authors: Umran Erciyes, Filiz Okumus

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The purpose of this study was the determination of factors which impact the pregnancy, birth experience and the opinions regarding the delivery type of the puerperants, after vaginal birth. This descriptive study includes 349 patients who gave births with normal birth in one of the hospital in İstanbul in May- November 2014. After birth, we interview with these women face to face. The descriptive information form and Perception of Birth Scale were used as data collection tool. SPSS (Statistical Package for the Social Sciences) was used for statistical analysis. The average age of patients was 27.13, and the average score was 76.93±20.22. The patients are primary school graduate, and they do not have a job. They expressed an income outcome equality. More than half of women did not get educated before birth. Among educated patients, few women got educated overcoming the pain during labor process. As the time spent in the hospital for the birth increases, the birth perception of mothers is affected negatively. %86.8 of participants gave assisted delivery. Spontaneous vaginal birth has positive effects on birth perception. Establishing a vascular access, induction of labor performing enema, restriction of orally intake and movement, fundal pressure, episiotomy, nor to perform skin to skin contact with the baby after birth has adverse effects on the birth perceptions.

Keywords: antenatal care, birth experience, perception of birth, vaginal birth

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Authors: Amr Hamdy

Abstract:

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Many methods have been developed to decrease its rate. The aim of this study was to evaluate the applicability of a new non-pharmacologic maneuver in decreasing its rate. Methods: This case series study was conducted in one centre in Cairo, Egypt, from January-2010 to June-2013. 400 pregnant–women aged 18 years or more and candidate for normal labour; were enrolled to this study. High-risk subjects for PPH were excluded. After placental delivery, the new maneuver was done by sustained traction of the anterior and posterior lips of the cervix by two ovum forceps for duration of 90 seconds. The amount of blood loss was estimated by standardized visual estimation after removal of the forceps. All subjects were followed up for 6 hours. Results: The rate of PPH, defined as more than 500 ml, was 8 cases (2%) with 95% CI (0.63-3.37%). The rate of PPH was not affected by parity, gestational age, episiotomy or the presence of tears. PPH is more in cases with anemia (p 0.032). It occurred in all cases with uterine atony (p <0.001). The range of estimated blood loss was 550-600ml in cases with PPH and 150-450ml in cases without PPH. Severe PPH more than 1000 ml, did not occur. Conclusion: This pilot study introduced a novel maneuver that can be helpful in decreasing the rate of PPH and reducing the amount of post partum blood loss.Despite the low rate of PPH showed in this study, the need for conducting a randomized controlled study is at its highest level before further inclusion of such manoeuvre to be a part of the current medical practice and before considering it as an evident tool to decrease the burden of PPH.

Keywords: maternal mortality, new manoeuvre, post-partum haemorrhage, uterine atony

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Authors: Katarzyna Kwiatkowska, Izabela Walasik, Katarzyna Kosińska-Kaczyńska, Olga Płaza, Kinga Żebrowska

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Introduction Adequate physical activity of a pregnant woman has been proven to decrease the risk of pregnancy complications. The knowledge of women regarding physical exercise in pregnancy is a part of conscious motherhood, while a lack of it may lead to not taking up any form of physical activity during pregnancy. Aim: The aim of the study was to assess the knowledge and experience of women regarding physical activity during their latest pregnancy. Material and methodology: An anonymous questionnaire, consisting of 57 questions, was completed electronically in 2018 by women who gave birth at least once. The respondents were qualified as 'physically active during pregnancy' if they performed physical exercises such as regular walks, marching, jogging, working out at a gym, swimming, yoga, pilates, fitness, exercise-ball workouts or home gymnastics. Results: The study group consisted of 9345 women. 52% of them performed exercises during pregnancy. The main reasons for the lack of physical activity were: lack of interest in physical activity (45%), lack of energy (40%), lack of knowledge regarding proper exercise during pregnancy (34%), lack of time (27%) and medical contraindications (25%). Non-active respondents suffered from gestational hypertension (6,7% vs 9,2%; p<00,1) and gave birth prematurely (11% vs 15%; p < 001) to newborns with a lower birth weight significantly more often ( < 2500g vs > 2500g; p < 0,001). Physically active women reported suffering from pregnancy-related ailments such as fatigue, back pain or constipation significantly less often. 22% of all respondents were unable to identify reliable sources of information regarding exercise during pregnancy. A majority of the exercising women used the Internet to obtain gain information on physical activity during pregnancy (69,1%). 4% of women thought that exercising during pregnancy is forbidden, while 20% thought it is not allowed in the 3rd trimester. Physically active women had vaginal delivery more often (61% vs 55%; p < 0,05). Episiotomy was performed most often on non-active primiparous respondents (77,5% vs 71% active primiparous, p < 0,001). 13% of women felt discriminated due to their physical activity during pregnancy. 22% of respondents’ physical activity was not accepted by their environment. 39,1% of the women were told by others to stop physical exercise because it was bad for the baby’s health. Conclusion: The knowledge of Polish women regarding proper physical activity during pregnancy is insufficient, which may influence a lack of will to initiate such activity among pregnant women. Physical activity of a pregnant woman may have an impact on the course of pregnancy and birth.

Keywords: childbirth, discrimination, physical activity, pregnancy

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Authors: Pei-Ru Yang, Yu-Chen Lin, Jia-Min Wu

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Background: A 58-year-old man with a history of osteoporosis and diabetes presented with chronic pain in his left knee due to severe knee joint degeneration. The knee replacement surgery was recommended by the doctor. But the patient suffered from low pain tolerance and wondered if virtual reality could relieve acute postoperative wound pain. Methods: We used the PICO (patient, intervention, comparison, and outcome) approach to generate indexed keywords and searched systematic review articles from 2017 to 2021 on the Cochran Library, PubMed, and Clinical Key databases. Results: The initial literature results included 38 articles, including 12 Cochrane library articles and 26 PubMed articles. One article was selected for further analysis after removing duplicates and off-topic articles. The eight trials included in this article were published between 2013 and 2019 and recruited a total of 723 participants. The studies, conducted in India, Lebanon, Iran, South Korea, Spain, and China, included adults who underwent hemorrhoidectomy, dental surgery, craniotomy or spine surgery, episiotomy repair, and knee surgery, with a mean age (24.1 ± 4.1 to 73.3 ± 6.5). Virtual reality is an emerging non-drug postoperative analgesia method. The findings showed that pain control was reduced by a mean of 1.48 points (95% CI: -2.02 to -0.95, p-value < 0.0001) in minor surgery and 0.32 points in major surgery (95% CI: -0.53 to -0.11, p-value < 0.03), and the overall postoperative satisfaction has improved. Discussion: Postoperative pain is a common clinical problem in surgical patients. Research has confirmed that virtual reality can create an immersive interactive environment, communicate with patients, and effectively relieve postoperative pain. However, virtual reality requires the purchase of hardware and software and other related computer equipment, and its high cost is a disadvantage. We selected the best literature based on clinical questions to answer the patient's question and used share decision making (SDM) to help the patient make decisions based on the clinical situation after knee replacement surgery to improve the quality of patient-centered care.

Keywords: knee replacement surgery, postoperative pain, share decision making, virtual reality

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Authors: A/Prof Marjan Khajehei

Abstract:

In the last century, the role of fathers in the birth has changed exponentially. Before the 1970s, the principal view was that birth was a female business and not a man’s place. Changing cultural and professional attitudes around the emotional bond between a man and a woman, family structure and the more proactive involved role of men in the family have encouraged fathers’ attendance at birth. There is evidence that fathers’ support can make birthing less traumatic for some women and can make couples closer. This has made some clinicians to believe the fathers should be more involved throughout the birth process. Some clinicians even go further and ask the fathers to watch the medical procedures, such as inserting vaginal speculum, forceps or vacuum, episiotomy and stitches. Although birth can unfold like a beautiful picture captured by birth photographers, with fathers massaging women’s backs by candle light and the miraculous moment of birth, it can be overshadowed by less attractive images of cervical mucous, emptying bowels and the invasive medical procedures. What happens in the birth room and the fathers’ reaction to the graphic experience of birthing can be unpredictable. Despite the fact that most men are absolutely thrilled to be in the delivery room, for some men, a very intimate body part can become completely desexualised, and they can experience psychological and sexual scarring. They see someone they cherish dramatically sliced open and can then associate their partners with a disturbing scene, and it can dramatically affect their relationships. While most women want the expectant fathers by their side for this life-changing event, not all of them may be happy for their partners to watch the perineum to be cut or stitched or when large blades of forceps are inserted inside the vagina. Anecdotal reports have shown that consent is not sought from the labouring women as to whether they want their partners to watch these procedures. The majority of research1, 2, 3 focuses on men’s and women’s retrospective attitudes towards their birth experience. However, the effect of witnessing invasive procedures during childbirth on a man's attraction to his partner, while she is most vulnerable, and also an increased risk of post-traumatic stress disorder in fathers have not been widely investigated. There is a lack of sufficient research investigating whether women need to be asked for their consent before inviting their partners to closely watch medical procedures during childbirth. Future research is required to provide a basis for better awareness and involve the consumers to understanding the men’s and women’s experience and their expectations for labour and birth.

Keywords: birth, childbirth, father, labour, men, women

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Authors: Farhana Karim, Abdullah N. S. Khan, Mohiuddin A. K. Chowdhury, Nabila Zaka, Alexander Manu, Shams El Arifeen, Sk Masum Billah

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Breastfeeding, an integral part of newborn care, can reduce 55-87% of all-cause neonatal mortality and morbidity. Early initiation of breastfeeding within 1 hour of birth can avert 22% of newborn mortality. Only 45% of world’s newborns and 42% of newborns in South-Asia are put to the breast within one hour of birth. In Bangladesh, only a half of the mothers practice early initiation of breastfeeding which is less likely to be practiced if the baby is born in a health facility. This study aims to generate strong evidence for early initiation of breastfeeding practices in the government health facilities and to explore the associated factors influencing the practice. The study was conducted in selected health facilities in three neighbouring districts of Northern Bangladesh. Total 249 normal vaginal delivery cases were observed for 24 hours since the time of birth. The outcome variable was initiation of breastfeeding within 1 hour while the explanatory variables included type of health facility, privacy, presence of support person, stage of labour at admission, need for augmentation of labour, complications during delivery, need for episiotomy, spontaneous cry of the newborn, skin-to-skin contact with mother, post-natal contact with the service provider, receiving a post-natal examination and counselling on breastfeeding during postnatal contact. The simple descriptive statistics were employed to see the distribution of samples according to socio-demographic characteristics. Kruskal-Wallis test was carried out for testing the equality of medians among two or more categories of each variable and P-value is reported. A series of simple logistic regressions were conducted with all the potential explanatory variables to identify the determining factors for breastfeeding within 1 hour in a health facility. Finally, multiple logistic regression was conducted including the variables found significant at bi-variate analyses. Almost 90% participants initiated breastfeeding at the health facility and median time to initiate breastfeeding was 38 minutes. However, delivering in a sub-district hospital significantly delayed the breastfeeding initiation in comparison to delivering in a district hospital. Maintenance of adequate privacy and presence of separate staff for taking care of newborn significantly reduced the time in early breastfeeding initiation. Initiation time was found longer if the mother had an augmented labour, obstetric complications, and the newborn needed resuscitation. However, the initiation time was significantly early if the baby was put skin-to-skin on mother’s abdomen and received a postnatal examination by a provider. After controlling for the potential confounders, the odds of initiating breastfeeding within one hour of birth is higher if mother gives birth in a district hospital (AOR 3.0: 95% CI 1.5, 6.2), privacy is well-maintained (AOR 2.3: 95% CI 1.1, 4.5), babies cry spontaneously (AOR 7.7: 95% CI 3.3, 17.8), babies are put to skin-to-skin contact with mother (AOR 4.6: 95% CI 1.9, 11.2) and if the baby is examined by a provider in the facility (AOR 4.4: 95% CI 1.4, 14.2). The evidence generated by this study will hopefully direct the policymakers to identify and prioritize the scopes for creating and supporting early initiation of breastfeeding in the health facilities.

Keywords: Bangladesh, early initiation of breastfeeding, health facility, normal vaginal delivery, skin to skin contact

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