Counseling after perineal laceration: does it improve functional outcome?

Details

Ressource 1Download: Vasseur et al 2018_Int_Urogyn_J_accepted.pdf (329.92 [Ko])
State: Public
Version: Author's accepted manuscript
License: Not specified
Serval ID
serval:BIB_ECFF8F5E5F25
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Counseling after perineal laceration: does it improve functional outcome?
Journal
International urogynecology journal
Author(s)
Vasseur A., Lepigeon K., Baud D., Horsch A., Meyer S., Vial Y., Achtari C.
ISSN
1433-3023 (Electronic)
ISSN-L
0937-3462
Publication state
Published
Issued date
06/2019
Peer-reviewed
Oui
Volume
30
Number
6
Pages
925-931
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Since 2006, the Lausanne University Hospital (CHUV) has offered a 12-week post-partum perineum consultation for patients with third-/fourth-degree tears, providing advice for future deliveries. This study consisted of a retrospective follow-up of these patients, focused on subsequent deliveries and current urinary and anorectal incontinence symptoms.
Patients meeting eligibility criteria were invited to complete a questionnaire on their deliveries, along with validated questionnaires grading urinary (UDI-6 and IIQ-7) and anorectal (Wexner-Vaizey score) incontinence.
Sixty-two percent of third-/fourth-degree tears occurred following operative vaginal deliveries. Of 160 participants, 45.6% did not redeliver, 5.6% of whom felt traumatized by their first delivery and reluctant to have another children; 33.2% had a second vaginal delivery, 19.4% had a cesarean section (CS), and 1.2% had both vaginal and CS deliveries; 28% of the CS were not medically indicated. The recurrence rate of third-/fourth-degree tears for subsequent vaginal deliveries was 3.6%. Most patients were mildly or not affected by incontinence symptoms. Symptomatic patients reported urinary incontinence during physical activity and gas leakages; 50-60% saw no change of symptoms since the consultation, 30-40% reported partial or complete recovery. Patients redelivering by CS reported significantly less urinary incontinence (p = 0.046) and less anorectal incontinence (p = 0.069).
Anal sphincter laceration is associated with urinary and anorectal incontinence, but symptoms improve or disappear in most cases and are globally not invalidating. Perineal physiotherapy seems to contribute to this positive evolution. Fertility rate among these patients is unaffected, but the CS rate is higher than average. Further consideration of sexual and emotional sequelae could improve our current service.
Keywords
Adult, Cesarean Section/statistics & numerical data, Delivery, Obstetric/statistics & numerical data, Directive Counseling, Fecal Incontinence/etiology, Female, Follow-Up Studies, Humans, Lacerations/etiology, Parturition, Perineum/injuries, Postpartum Period, Retrospective Studies, Surveys and Questionnaires, Trauma Severity Indices, Urinary Incontinence/etiology, Anal sphincter laceration, Incontinence, Recurrence, Risk
Pubmed
Web of science
Open Access
Yes
Create date
10/07/2018 11:02
Last modification date
07/02/2020 6:19
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