ASSESSMENT OF ANAL SYMPTOMS IN PRIMIPAROUS WOMEN FOLLOWING SPONTANEOUS VAGINAL BIRTH AT TERM

Background: The purpose of this prospective survey‐design study of primiparas was to assess anal symptoms following spontaneous vaginal birth at term. Methods: A survey was designed for the study using the Wexner Scale. Inclusion criteria: primiparas undergoing spontaneous vaginal birth with either intact, first or second‐degree laceration; read and write English; and no previous anal injury or defect. P < .05 was statistically significant. Demographic and labor variables along with Wexner Scale results were collected. Results: 322 postpartum women were enrolled with 164 responding for a 51% return rate. Two demographic and labor‐related variables by laceration severity proved significant: maternal age (P= .001) and fetal weight at birth (P= .01). Within the Wexner Scale, when frequency of items was grouped, the odds of frequent liquid stool incontinence were 1.3 times higher in the second‐degree laceration group although not statistically significant. The odds of frequent uncontrollable flatus were 1.5 times higher in the second‐degree laceration group although not statistically significant (P= 0.2). Conclusion: The significant findings of age and fetal size are consistent with other studies assessing anal symptoms. Uncontrollable flatus needs a larger power analysis to show any significance. In women without significant perineal tears, age and fetal size can add to anal symptoms postpartum, and with increased laceration severity, more anal symptoms were noted.     

Perineal Outcomes and Maternal Comfort Related to the Application of Perineal Warm Packs in the Second Stage of Labor: A Randomized Controlled Trial

ABSTRACT: Background: Perineal warm packs are widely used during childbirth in the belief that they reduce perineal trauma and increase comfort during late second stage of labor. The aim of this study was to determine the effects of applying warm packs to the perineum on perineal trauma and maternal comfort during the late second stage of labor. Methods: A randomized controlled trial was undertaken. In the late second stage of labor, nulliparous women (n = 717) giving birth were randomly allocated to have warm packs (n = 360) applied to their perineum or to receive standard care (n = 357). Standard care was defined as any second‐stage practice carried out by midwives that did not include the application of warm packs to the perineum. Analysis was on an intention‐to‐treat basis, and the primary outcome measures were requirement for perineal suturing and maternal comfort. Results: The difference in the number of women who required suturing after birth was not significant. Women in the warm pack group had significantly fewer third‐ and fourth‐degree tears and they had significantly lower perineal pain scores when giving birth and on “day 1” and “day 2” after the birth compared with the standard care group. At 3 months, they were significantly less likely to have urinary incontinence compared with women in the standard care group. Conclusions: The application of perineal warm packs in late second stage does not reduce the likelihood of nulliparous women requiring perineal suturing but significantly reduces third‐ and fourth‐degree lacerations, pain during the birth and on days 1 and 2, and urinary incontinence. This simple, inexpensive practice should be incorporated into second stage labor care. (BIRTH 34:4 December 2007)     

Prevention of Perineal Trauma by Perineal Massage During Pregnancy: A Pilot Study

ABSTRACT: Although the performance of perineal massage by a woman or her partner during the last weeks of pregnancy may help to prevent perineal trauma at delivery, the technique has never been evaluated rigorously. This study examined the feasibility of a randomized, controlled trial, and more specifically assessed the participation rate, the acceptability of the intervention, and whether or not an attending physician could remain blind to participants' groups. The pilot study was a single-blinded, randomized, controlled trial. Nulliparous women, 32 to 34 weeks pregnant, were recruited from June 8 to July 31, 1992, at the offices of family physicians and obstetricians who practice at the Hôpital du Saint-Sacrement in Quebec City. Women assigned to the intervention group practiced daily 10-minute perineal massage and completed a diary, and those in the control group had standard care. Women and attending physicians completed a questionnaire about the aspect of blindness. Among the 174 women who delivered during the study period, 104 (59.8%) were approached by a midwife and 46 (26.4%) were randomized. Twenty (91.0%) of the 22 women in the massage group returned their perineal massage diaries. Based on the postpartum questionnaire, 20 women practiced the technique at least four times a week for three weeks or longer. No woman in the control group practiced massage. The attending physician was aware of the woman's group in only three instances (6.7%). Based on the results of this pilot study, a randomized, controlled trial to evaluate the efficacy of perineal massage in preventing perineal trauma at birth appears feasible.     

Perineal trauma: prevention and treatment

This article examines two aspects of routine midwifery practice: management of the perineum at the end of the second stage of labor and management and repair of perineal injury. Although some aspects of perineal management and repair have been researched and there is reliable evidence on which to base practice, there remains a considerable and urgent collaborative clinical research agenda that midwives should actively pursue.