(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual dysfunction. This review examined the impact of mode of birth on sexual function in the medium- (≥6 months and <12 months postpartum) and longer-term (≥12 months postpartum). (2) Methods: Literature published after January 2000 were identified in PubMed, Embase and CINAHL. Studies that compared at least two modes of birth and used valid sexual function measures were included. Systematic reviews, unpublished articles, protocols and articles not written in English were excluded. Quality was assessed using the Newcastle Ottawa Scale. (3) Results: In the medium-term, assisted vaginal birth and vaginal birth with episiotomy were associated with worse sexual function, compared to caesarean section. In the longer-term, assisted vaginal birth was associated with worse sexual function, compared with spontaneous vaginal birth and caesarean section; and planned caesarean section was associated with worse sexual function in several domains, compared to spontaneous vaginal birth. (4) Conclusions: Sexual function, in the medium- and longer-term, can be affected by mode of birth. Women should be encouraged to seek support should their sexual function be affected after birth.
- MeSH
- císařský řez * škodlivé účinky MeSH
- epiziotomie * škodlivé účinky MeSH
- lidé MeSH
- poporodní období MeSH
- porod MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- systematický přehled MeSH
OF RECOMMENDATIONS1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++-; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation)2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation).3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++-; Strong recommendation).4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation).
- MeSH
- anální kanál zranění MeSH
- bolest MeSH
- dítě MeSH
- epiziotomie * škodlivé účinky metody MeSH
- komplikace porodu * etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- perinatální péče MeSH
- perineum zranění MeSH
- peripartální období MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- bolesti hlavy etiologie MeSH
- dospělí MeSH
- epiziotomie škodlivé účinky MeSH
- fyzioterapie (techniky) * MeSH
- lidé MeSH
- nemoci nohy (od hlezna dolů) diagnóza etiologie rehabilitace MeSH
- pánev * anatomie a histologie fyziologie MeSH
- senioři MeSH
- svalová hypertonie etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíl studie: Přiblížení problematiky porodního poranění konečníku (OASI – obstetric anal sphincter injuries) s rizikem následné anální inkontinence a prevence tohoto poranění. Metodika: Rešerše a analýza článků v recenzovaných periodikách, využití funkcí Google Scholar a PubMed a syntéza získaných informací. Závěr: OASI je závažné poranění při porodu, kterému nelze zcela předejít, ale lze jeho incidenci ovlivnit ať již selektivním prováděním mediolaterální epiziotomie, či jinými preventivními opatřeními u rizikových pacientek. Léčba anální inkontinence po OASI vyžaduje komplexní přístup a důkladné vyšetření. OASI u prvního porodu není dle současné odborné literatury striktní indikací k císařskému řezu při dalším těhotenství.
Objective: The aim of our study is to clarify the problems of OASI (obstetric anal sphincter injuries) and anal incontinence and prevention of this injury. Methods: Review of articles in peer reviewed journals with the usage of Google Scholar function and PubMed. Conclusion: OASI is a severe injury which is more commonly associated with assisted vaginal delivery. This injury cannot be fully prevented, but its incidence can be averted by the usage of selective mediolateral episiotomy, or by other precautionary moves in high risk patients. The treatment of anal incontinence after OASI requires a complex approach and thorough examination. At first delivery, OASI is not a stern indication for caesarean section in accordance with current state of knowledge.
- MeSH
- anální kanál * zranění MeSH
- epiziotomie * škodlivé účinky MeSH
- fekální inkontinence * etiologie MeSH
- komplikace porodu etiologie prevence a kontrola MeSH
- lacerace * komplikace MeSH
- lidé MeSH
- perineum * zranění MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
OBJECTIVE: To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery. METHODS: The present prospective follow-up study enrolled primiparous patients who underwent vaginal delivery including mediolateral or lateral episiotomy between April 1, 2010 and March 31, 2012. Participants completed interviews before delivery, and were given anal-incontinence questionnaires to be returned for analysis at 3 months and 6 months postpartum. Anal incontinence was defined as a St Mark's incontinence score above four and individual anal-incontinence components were analyzed separately; results were compared between the two episiotomy techniques. RESULTS: Questionnaires were returned by 300 and 366 patients who underwent mediolateral and lateral episiotomies, respectively; baseline characteristics were similar. Anal incontinence at 3 months and 6 months was recorded among 21 (7.0%) and 9 (3.0%) patients who underwent mediolateral and 27 (7.4%) and 20 (5.5%) who underwent lateral episiotomy, respectively. The study was underpowered to confirm equivalence between the groups; however, no statistically significant differences were observed in the rates of anal incontinence, flatus, solid or liquid incontinence, and de novo incontinence. Fecal urgency (P=0.017) and de novo fecal urgency (P=0.008) were more prevalent among patients who underwent lateral episiotomies at 6 months. CONCLUSION: Anal incontinence was comparable between primiparous patients who underwent mediolateral or lateral episiotomy. The association between lateral episiotomy and fecal urgency merits further scientific interest.
- MeSH
- dospělí MeSH
- epiziotomie škodlivé účinky MeSH
- fekální inkontinence epidemiologie etiologie MeSH
- komplikace porodu epidemiologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- následné studie MeSH
- parita MeSH
- perineum chirurgie MeSH
- poporodní období MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Východiska: Vysoká prevalence močové inkontinence u žen představuje celosvětový problém. Častější výskyt problémů s únikem moči byl zaznamenán u žen po porodu. Některé studie zjistily souvislost mezi močovou inkontinencí a porodním poraněním. Cíl: Zjistit vliv porodního poranění hráze (epiziotomie, spontánní ruptury) na pánevní dno a močovou inkontinenci. Metody: K vyhledávání literárních zdrojů byly využity elektronické databáze Medline, Cinahl, Pub Med, Science Direct, Scopus, Medvik a elektronické vyhledávače Google a Google Scholar. Byly vyhledávány články v českém nebo anglickém jazyce. Při vyhledávání byla zadána klíčová slova: perineal trauma, episiotomy, childbirth, urinary incontinence. Celkem bylo dohledáno 21 studií: 1 metaanalýza, 3 systematická review, 2 randomizované kontrolované studie a 15 kohortových studií. Výsledky: Ženy s intaktní hrází měly silnější pánevní dno než ženy s porodním poraněním, přestože se významně nelišily ve výskytu močové inkontinence. Nebyla prokázána souvislost mezi močovou inkontinencí a rozsahem spontánního poranění. Epiziotomie nechrání pánevní dno a neredukuje výskyt močové inkontinence u žen po porodu. Závěr: Snahou porodníků a porodních asistentek by měla být maximální redukce porodních poranění hráze. V žádné studii nebyl ale prokázán pozitivní vliv epiziotomie na pánevní dno a snížení výskytu močové inkontinence, proto by v praxi měly být epiziotomie prováděny jen v indikovaných případech.
Background: High prevalence of urinary incontinence in women is a worldwide problem. Higher incidence of problems with urinary incontinence was observed in women after childbirth. Some studies have found a connection between urinary incontinence and perineal trauma. Aim: To determine the influence of perineal trauma (episiotomy, spontaneous rupture) on the pelvic floor and urinary incontinence. Methods: In search for sources we used the electronic databases Medline, CINAHL, PubMed, Science Direct, Scopus, Medvik, and the electronic search engines Google and Google Scholar. We searched for articles in Czech or English. The following keywords were used: perineal trauma, episiotomy, childbirth, urinary incontinence. A total of 21 studies were found: 1 meta-analysis, 3 systematic reviews, 2 randomized controlled trials, and 15 cohort studies. Results: Women with an intact perineum had a stronger pelvic floor than women with a perineal injury, although they did not differ significantly in the incidence of urinary incontinence. A relationship between urinary incontinence and the extent of a spontaneous injury has not been proved. Episiotomy does not protect the pelvic floor and does not reduce the incidence of urinary incontinence in women after childbirth. Conclusion: Obstetricians and midwives should maximally reduce perineal injuries. No study has yet proven a positive effect of episiotomy on the pelvic floor and a reduction in the incidence of urinary incontinence, therefore episiotomy should be performed in clinical practice only when medically indicated.
OBJECTIVE: To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy. METHODS: In a prospective randomized study at University Hospital Pilsen, Czech Republic, 790 consecutive primiparous women were enrolled between April 2010 and April 2012. Mediolateral episiotomy (MLE) followed an angle of at least 60° from the midline. Lateral episiotomy (LE) started 1-2 cm laterally from the midline and was directed toward the ischial tuberosity. A rectal examination was performed before episiotomy repair. RESULTS: MLE was performed for 390 women, and LE for 400. The groups did not differ in maternal or neonatal characteristics. No difference was found in incidence or extent of vaginal and perineal trauma; or in additional perineal (1.8% vs 1.5%, P=0.6) or vaginal (8.5% vs 10.6%, P=0.2) trauma continuing along the episiotomy incision. The incidence of anal sphincter injury did not differ between MLE and LE (1.5% vs 1.3%, P=0.7). MLE was associated with shorter repair times (P<0.05), less suturing material (P<0.05), and shorter distances from the anus (P<0.001). CONCLUSION: Risk of additional vaginal and perineal trauma, and anal sphincter injury after adequately performed mediolateral episiotomy is relatively low and corresponds to that of lateral episiotomy.
- MeSH
- anální kanál zranění MeSH
- délka operace MeSH
- dospělí MeSH
- epiziotomie škodlivé účinky metody MeSH
- krvácení při operaci statistika a číselné údaje MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- perineum zranění MeSH
- těhotenství MeSH
- vagina zranění MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
OBJECTIVE: To evaluate short-term perineal pain among primiparous women after mediolateral episiotomy (MLE) and lateral episiotomy (LE). METHODS: The prospective randomized study was conducted in the Czech Republic during 2010-2012. Consecutive primiparous women who gave birth at or after 37 weeks of pregnancy and had indications for an episiotomy were enrolled and randomly assigned to undergo MLE or LE. Patients were unaware of the episiotomy type performed. The primary outcomes were pain at 24 hours, 72 hours, and 10 days post partum, measured by a visual analog scale, verbal rating scale, interference with activities of daily living, and amount of analgesic use. RESULTS: The analysis included 266 women who underwent MLE and 297 women who underwent LE. Complete relief of pain was observed in 6 (2.3%) of 266 women after 24 hours, 21 (8.0%) of 264 after 72 hours, and 77 (29.1%) of 265 after 10 days in the MLE group, and in 11 (3.9%) of 285, 23 (7.7%) of 297, and 78 (26.4%) of 295 in the LE group, respectively (P=0.36). There were no significant differences in overall pain scores from any rating system or in the amount of analgesics used. CONCLUSION: Incidence and extent of pain in the first 10 days after LE correspond to those after adequately performed MLE.
- MeSH
- analgetika terapeutické užití MeSH
- bolest farmakoterapie etiologie MeSH
- epiziotomie škodlivé účinky metody MeSH
- lidé MeSH
- měření bolesti MeSH
- poporodní období MeSH
- průzkumy a dotazníky MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Cíl: Cílem práce bylo zjistit vliv episiotomie na výskyt močové inkontinence u žen. Získané výsledky jsme porovnávali s ženami, které během porodu utrpěly spontánní ruptury hráze I. a II. stupně a skupinou žen bez porodního poranění hráze. Metodika: Výzkumný soubor tvořilo 211 žen, které byly 2-5 let po spontánním termínovém porodu. Data byla získávána pomocí dotazníku International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Výsledky: Nebyly zjištěny rozdíly ve výskytu močové inkontinence mezi ženami s epiziotomií a ženami se spontánními rupturami hráze nebo bez porodního poranění hráze. Výskyt močové inkontinence ovlivňuje BMI ženy, parita a přítomnost problémů s únikem moče již před porodem. Závěr: Nebylo prokázáno, že by epiziotomie zvyšovala nebo snižovala výskyt močové inkontinence u žen 2-5 let po porodu.
Aim: The aim of the study was to find a relationship between episiotomy and prevalence of urinary incontinence in women. The obtained results were compared with those in women who suffered 1st- or 2nd-degree perineal tears during childbirth and those with an intact perineum. Design: Cross sectional study. Methods: The sample was made up of 211 women, who were 2-5 years after a spontaneous term childbirth. The data were collected using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Results: No differences were found in the prevalence of urinary incontinence between women with episiotomy and those with spontaneous perineal tears or with an intact perineum. The prevalence of urinary incontinence is affected by a woman’s BMI, parity and the presence of incontinence before childbirth. Conclusion: The study did not find episiotomy to either increase or decrease the prevalence of urinary incontinence at 2-5 years postpartum.
- MeSH
- dospělí MeSH
- epiziotomie * škodlivé účinky MeSH
- index tělesné hmotnosti MeSH
- inkontinence moči * epidemiologie etiologie MeSH
- lidé MeSH
- perineum zranění MeSH
- průřezové studie statistika a číselné údaje MeSH
- průzkumy a dotazníky MeSH
- rizikové faktory MeSH
- vedení porodu MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
OBJECTIVE: To study the angle of mediolateral episiotomy at the time of cut, after primary repair, and 6 months postpartum; and the incidence and severity of perineal pain and anal incontinence 6 months after delivery. METHODS: The study group comprised 60 consecutively recruited primiparous women who required episiotomy during delivery assisted by 2 obstetricians. The incision angle of episiotomy (defined as 60°) was measured before cutting, after primary repair, and after 6 months. At follow-up, perineal pain was evaluated by a verbal rating score; anal incontinence was assessed by St Mark's score. RESULTS: The angles differed significantly among the incision (60°), repair (45°), and 6-month (48°) measurements (P < 0.001). There was a poor correlation between the suture angle and the angle measured at 6 months postpartum. No severe perineal tear was diagnosed in the cohort. At 6 months postpartum, only 1 woman reported mild symptoms of de novo anal incontinence, whereas 7 women reported perineal pain related to episiotomy. CONCLUSION: An incision angle of mediolateral episiotomy of 60° resulted in a low incidence of anal sphincter tearing, anal incontinence and perineal pain. A randomized controlled trial is needed to assess the outcome when different angles of episiotomy are used.
- MeSH
- anální kanál zranění MeSH
- bolest etiologie MeSH
- dospělí MeSH
- epiziotomie škodlivé účinky metody MeSH
- fekální inkontinence etiologie MeSH
- index tělesné hmotnosti MeSH
- kohortové studie MeSH
- lidé MeSH
- mladý dospělý MeSH
- parita MeSH
- perineum zranění MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH