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The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women
Author(s) -
Leeman Lawrence,
Rogers Rebecca,
Borders Noelle,
Teaf Dusty,
Qualls Clifford
Publication year - 2016
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12258
Subject(s) - medicine , perineum , pelvic floor , urinary incontinence , sexual function , episiotomy , prospective cohort study , cohort , obstetrics , fecal incontinence , pelvic floor dysfunction , pelvic pain , vaginal delivery , surgery , pregnancy , biology , genetics
Objective To determine the effect of perineal lacerations on pelvic floor outcomes, including urinary and anal incontinence, sexual function, and perineal pain in a nulliparous cohort with low incidence of episiotomy. Methods Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination, and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with second‐, third‐, or fourth‐degree lacerations. Results Four hundred and forty‐eight women had vaginal deliveries. One hundred and fifty‐one sustained second‐degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. Three hundred and thirty‐six (74.8%) presented for 6‐month follow‐up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity; however, they had slightly lower sexual function scores (27.3 vs 29.1). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2 centimeter) perineal trauma demonstrated increased likelihood of perineal pain (15.5% vs 6.2%) and weaker pelvic floor muscle strength (61.0% vs 44.3%) compared with women with more superficial trauma. Conclusion Women having second‐degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.