Impact of episiotomy on pelvic floor disorders and their influence on women's wellness after the sixth month postpartum: a retrospective study

<p>Abstract</p> <p>Background</p> <p>The role of episiotomy as a protective factor against pelvic floor disorders postpartum has been debated for many years, but its routine use has been hitherto discouraged in the literature. Comparisons between restrictive and routine use of episiotomy in existent literature, however, fail to include any consideration relating to quality of life. The aim of this study, therefore, is to state the role of episiotomy in preserving the perineum from damage, in order to prevent the influence of pelvic floor disorders on women's psycho-physical wellness after the sixth month postpartum.</p> <p>Methods</p> <p>A follow-up telephone interview was performed among 377 primiparous and secondiparous Caucasian women who had a child by spontaneous or operative vaginal delivery in 2006 using a self-created questionnaire and King's Health Questionnaire (KHQ).</p> <p>Results</p> <p>The mean age at delivery was 35.26 (±4.68) years and episiotomy was performed in 59.2% of women. Multivariate linear regression shows episiotomy associated to higher quality of life after the sixth month postpartum by correlating with inferior values of King's Health Questionnaire (p < 0.05).</p> <p>Conclusions</p> <p>Episiotomy appears to be a protective factor for women's wellness. Women who had episiotomy and who experienced perineal symptoms have a better psycho-physical health status in the 12.79 months (±3.3) follow-up.</p

Randomized controlled clinical trial on two perineal trauma suture techniques in normal delivery Ensayo aleatorio clínico controlado para dos técnicas de sutura perineal en parto normal Ensaio clínico controlado aleatório sobre duas técnicas de sutura do trauma perineal no parto normal

The aim was to compare healing and perineal pain with the use of continuous and interrupted suture techniques in women after normal delivery. A randomized controlled trial was carried out at a hospital birth center in Itapecirica da Serra, Sao Paulo, Brazil. A total of 61 women participated with episiotomy or second degree perineal tear, allocated in two groups according to the continuous (n=31) or interrupted (n=30) suture techniques. The main outcomes evaluated were edema, ecchymosis, hyperemia, secretion, dehiscence, fibrosis, frequency and degree of pain (evaluated by numerical scale from 1 to 10). Data were collected during hospitalization and after discharge (four and 41 days after birth). Healing occurred by first intention in 100% of cases in both suture techniques. There were no statistically significant differences for the occurrence of morbidities, except for perineal pain due to palpation at four days after delivery, which was more frequent among women with interrupted suture.<br>El objetivo fue comparar la cicatrización y el dolor perineal utilizando técnicas de sutura continua y separada, en mujeres que realizaron parto normal. El estudio fue controlado aleatorio, realizado en un centro para parto normal en Itapecerica de la Sierra, Sao Paulo. Participaron 61 mujeres con episiotomía o desgarro perineal de segundo grado, distribuidas en dos grupos (sutura continua n=31 y sutura separada n=30). Las principales medidas evaluadas fueron edema, equimosis, hiperemia, secreción, dehiscencia de herida, fibrosis, frecuencia y magnitud del dolor (evaluada por escala numérica de 1 a 10). Los datos fueron recolectados durante la hospitalización y después del alta (de 4 a 41 días post-parto). La cicatrización fue por primera intención en 100% de los casos, para las dos técnicas de sutura. No se encontró diferencia estadísticamente significativa en los casos de morbilidad, con excepción del dolor perineal a la palpación al cuarto día post-parto, el que fue más frecuente en mujeres con sutura separada.<br>O objetivo foi comparar a cicatrização e a dor perineal com a utilização das técnicas de sutura contínua e separada em mulheres com parto normal. Realizou-se estudo controlado aleatório, em centro de parto normal, em Itapecerica da Serra, São Paulo. Participaram 61 mulheres com episiotomia ou rotura perineal de segundo grau, alocadas em dois grupos, segundo a técnica de sutura contínua (n=31) ou separada (n=30). Os principais desfechos avaliados foram edema, equimose, hiperemia, secreção, deiscência, fibrose, freqüência e magnitude da dor (avaliada pela escala numérica de 1 a 10). Os dados foram coletados na internação e após a alta (quatro e 41 dias pós-parto). A cicatrização foi por primeira intenção em 100% dos casos, nas duas técnicas de sutura. Não houve diferença estatisticamente significante para a ocorrência de morbidades, exceto na dor perineal à palpação, com quatro dias de pós-parto, que foi mais freqüente entre as mulheres com sutura separada