目的采用Meta分析评价会阴按摩对预防分娩时会阴损伤的影响。方法计算机检索PubMed、CINAHL、Web of Science、中国知网、万方数据库相关文献,检索时间为1950年1月—2018年3月。根据纳入标准查找会阴按摩对分娩时会阴结局影响文献,采用R...目的采用Meta分析评价会阴按摩对预防分娩时会阴损伤的影响。方法计算机检索PubMed、CINAHL、Web of Science、中国知网、万方数据库相关文献,检索时间为1950年1月—2018年3月。根据纳入标准查找会阴按摩对分娩时会阴结局影响文献,采用Rev Man 5.3软件对文献数据进行分析。结果最终共纳入14项研究,共纳入病例数6 119例。分为妊娠晚期会阴按摩初产妇组,妊娠晚期会阴按摩经产妇组及分娩期会阴按摩初产妇组3个亚组进行分析,分析结果示:妊娠晚期会阴按摩保持初产妇会阴完整性的作用和分娩时会阴按摩预防初产妇3度以上会阴撕裂的发生率,差异有统计学意义;统计值分别是[RR:1.43,95%CI(1.28,1.61),P<0.00001];[RR:0.45,95%CI(0.23,0.89),P=0.02]。在人群亚组分析结果显示:妊娠晚期会阴按摩对经产妇的会阴完整[RR:1.08,95%CI(0.84,1.39)]、会阴侧切率[RR:0.83,95%CI(0.51,1.35)]、会阴1度撕裂[RR:1.03,95%CI(0.67,1.59)]、2度撕裂[RR:0.98,95%CI(0.73,1.31)]及3度以上会阴撕裂[RR:0.51,95%CI(0.05,5.67)]差异均无统计学意义;妊娠晚期会阴按摩对初产妇的会阴侧切率[RR:0.97,95%CI(0.79,1.18)]、会阴1度撕裂[RR:1.01,95%CI(0.82,1.25)]、2度撕裂[RR:0.95,95%CI(0.78,1.14)]及3度以上会阴撕裂[RR:0.86,95%CI(0.62,1.18)];分娩时会阴按摩对初产妇的会阴侧切率[RR:0.84,95%CI(0.68,1.04)]、会阴完整率[RR:1.03,95%CI(0.87,1.23)]及会阴1度撕裂[RR:1.13,95%CI(0.89,1.42)]、2度撕裂[RR:1.04,95%CI(0.88,1.25)]均无统计学意义。结论妊娠晚期会阴按摩有利于保持初产妇会阴的完整性,分娩时会阴按摩可预防初产妇的严重会阴撕裂,但妊娠晚期会阴按摩对降低初产妇会阴侧切率和预防1度、2度会阴撕裂;对保持经产妇的会阴完整性及预防会阴撕裂作用效果不明显。展开更多
Perineal trauma following childbirth affects over two-thirds of women in low and medium-income countries (LMICs) birthing in health facilities. Although it is an unfavourable outcome with the potential to affect many ...Perineal trauma following childbirth affects over two-thirds of women in low and medium-income countries (LMICs) birthing in health facilities. Although it is an unfavourable outcome with the potential to affect many aspects of a woman’s well-being in both the immediate and long-term, it is still a neglected phenomenon of women’s health, particularly in sub-Saharan African countries like Zambia. This study sought to understand the impact of birth perineal trauma on postnatal women at Ndola Teaching Hospital (NTH). This study employed a cross-sectional qualitative design using a descriptive phenomenological approach. Fifteen women who had birthed at NTH and sustained birth perineal trauma were purposively sampled as study participants. Data were collected through face-to-face interviews aided by an interview guide. Four themes, namely, perineal pain, substandard perineal wound management, fear of future reproductive health outcomes and diversion from reality, emerged from the study. Most women experiencing childbirth perineal trauma do not receive adequate care to manage their condition effectively. Therefore, midwives should utilise their professional knowledge and skills when providing postnatal care because morbidity affects women. Thus, it has the potential to negatively affect mother-infant bonding. The study concluded that birth perineal trauma is a distressing phenomenon of childbirth;hence, skillful repair, pain management and sexual counselling can greatly reduce its negative impacts.展开更多
Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane ...Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane and blood vessel permeability. This review discusses the indication, usage, effects, and safety of hyaluronidases in obstetrics. Materials and Methods: MEDLINE/</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">PubMed and the Cochrane Library were searched using the following terms: </span><span style="font-family:Verdana;">(“hyaluronidase” [Title/Abstract]) OR (“hyaluronidases” [Title/Abstract]) AND </span><span style="font-family:Verdana;">(“therapeutic use” [Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical ripening” [Title/Abstract]). Results: This review included four randomized controlled trials (RCT) that randomized a total of 642 pregnant women and two interventional non-RCTs that included a total of 2824 pregnant women. The data from two RCTs suggested that the incidence of perineal trauma was significantly lower in the intervention (perineal hyaluronidase injection in stage two of labor) than the control group (no intervention). However, both groups did not differ significantly in the incidence of first- and second-degree tears. Similarly, no significant difference in the incidence </span><span style="font-family:Verdana;">of episiotomy was found between both groups. In one interventional non-RCT, </span><span style="font-family:Verdana;">the administration of intracervical hyaluronidase was associated with a statistically significant acceleration and shortening of labor by approximately 1.95 hours after the injection of intracervical hyaluronidase. However, it had no effect on uterine contractions or the duration of stages two and three labor. Conclusions: While it is safe, clinicians should consider patient a展开更多
Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are...Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. 展开更多
We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sa...We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.展开更多
Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Partici...Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.展开更多
Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of...Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of a clinical tool that could assist with clinical decisions regarding obstetrical procedures and mode of delivery. Objective: To assess intraobserver reproducibility of measurements of perineal elasticity and pubic bone-perineal critical distance with a novel tactile probe in pregnant women. Methods: An Antepartum Tactile Imager (ATI) was designed with a vaginal probe resembling a fetal skull. The probe comprises 128 tactile sensors on a double curved surface and measures 46 mm in width and 72 mm in length. The probe has a motion tracking sensor that allows acquisition of 3D tactile images. There were two arms of the study. In the first arm, biomechanical mapping of the perineum and pelvic bone location was performed in 10 non-pregnant women for purposes of demonstrating safety and feasibility. In the second arm, biomechanical mapping was performed in 10 pregnant women to explore intraobserver reproducibility. Each subject had two standardized examinations over 3 - 5 minutes by the same observer. Examination comfort and pain levels were assessed by post-procedure survey. Reproducibility was analyzed by intraclass correlation coefficients (ICC) with 95% confidence intervals and Bland-Altman plots. Bias and the 95% limits of agreement were also calculated. Results: The safety and feasibility arm of the study demonstrated high degree of safety and tolerability and reliable acquisition of tactile signals. In the reproducibility arm, 10 pregnant women were recruited at mean gestational age of 34.2 ± 6.5 weeks. The mean perineum elasticity (Young’s modulus, E) was 9.8 ± 5.9 kPa, and the mean pubic bone-perineal critical distance (D) at 20 kPa load was 34.6 ± 6.2 mm. The ICC was 0.97 [95% confidence interval (CI) 0.91, 0.99] and 0.82 [CI 0.44, 0.95] for E and D respectively, consistent with excellent in展开更多
文摘目的采用Meta分析评价会阴按摩对预防分娩时会阴损伤的影响。方法计算机检索PubMed、CINAHL、Web of Science、中国知网、万方数据库相关文献,检索时间为1950年1月—2018年3月。根据纳入标准查找会阴按摩对分娩时会阴结局影响文献,采用Rev Man 5.3软件对文献数据进行分析。结果最终共纳入14项研究,共纳入病例数6 119例。分为妊娠晚期会阴按摩初产妇组,妊娠晚期会阴按摩经产妇组及分娩期会阴按摩初产妇组3个亚组进行分析,分析结果示:妊娠晚期会阴按摩保持初产妇会阴完整性的作用和分娩时会阴按摩预防初产妇3度以上会阴撕裂的发生率,差异有统计学意义;统计值分别是[RR:1.43,95%CI(1.28,1.61),P<0.00001];[RR:0.45,95%CI(0.23,0.89),P=0.02]。在人群亚组分析结果显示:妊娠晚期会阴按摩对经产妇的会阴完整[RR:1.08,95%CI(0.84,1.39)]、会阴侧切率[RR:0.83,95%CI(0.51,1.35)]、会阴1度撕裂[RR:1.03,95%CI(0.67,1.59)]、2度撕裂[RR:0.98,95%CI(0.73,1.31)]及3度以上会阴撕裂[RR:0.51,95%CI(0.05,5.67)]差异均无统计学意义;妊娠晚期会阴按摩对初产妇的会阴侧切率[RR:0.97,95%CI(0.79,1.18)]、会阴1度撕裂[RR:1.01,95%CI(0.82,1.25)]、2度撕裂[RR:0.95,95%CI(0.78,1.14)]及3度以上会阴撕裂[RR:0.86,95%CI(0.62,1.18)];分娩时会阴按摩对初产妇的会阴侧切率[RR:0.84,95%CI(0.68,1.04)]、会阴完整率[RR:1.03,95%CI(0.87,1.23)]及会阴1度撕裂[RR:1.13,95%CI(0.89,1.42)]、2度撕裂[RR:1.04,95%CI(0.88,1.25)]均无统计学意义。结论妊娠晚期会阴按摩有利于保持初产妇会阴的完整性,分娩时会阴按摩可预防初产妇的严重会阴撕裂,但妊娠晚期会阴按摩对降低初产妇会阴侧切率和预防1度、2度会阴撕裂;对保持经产妇的会阴完整性及预防会阴撕裂作用效果不明显。
文摘Perineal trauma following childbirth affects over two-thirds of women in low and medium-income countries (LMICs) birthing in health facilities. Although it is an unfavourable outcome with the potential to affect many aspects of a woman’s well-being in both the immediate and long-term, it is still a neglected phenomenon of women’s health, particularly in sub-Saharan African countries like Zambia. This study sought to understand the impact of birth perineal trauma on postnatal women at Ndola Teaching Hospital (NTH). This study employed a cross-sectional qualitative design using a descriptive phenomenological approach. Fifteen women who had birthed at NTH and sustained birth perineal trauma were purposively sampled as study participants. Data were collected through face-to-face interviews aided by an interview guide. Four themes, namely, perineal pain, substandard perineal wound management, fear of future reproductive health outcomes and diversion from reality, emerged from the study. Most women experiencing childbirth perineal trauma do not receive adequate care to manage their condition effectively. Therefore, midwives should utilise their professional knowledge and skills when providing postnatal care because morbidity affects women. Thus, it has the potential to negatively affect mother-infant bonding. The study concluded that birth perineal trauma is a distressing phenomenon of childbirth;hence, skillful repair, pain management and sexual counselling can greatly reduce its negative impacts.
文摘Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane and blood vessel permeability. This review discusses the indication, usage, effects, and safety of hyaluronidases in obstetrics. Materials and Methods: MEDLINE/</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">PubMed and the Cochrane Library were searched using the following terms: </span><span style="font-family:Verdana;">(“hyaluronidase” [Title/Abstract]) OR (“hyaluronidases” [Title/Abstract]) AND </span><span style="font-family:Verdana;">(“therapeutic use” [Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical ripening” [Title/Abstract]). Results: This review included four randomized controlled trials (RCT) that randomized a total of 642 pregnant women and two interventional non-RCTs that included a total of 2824 pregnant women. The data from two RCTs suggested that the incidence of perineal trauma was significantly lower in the intervention (perineal hyaluronidase injection in stage two of labor) than the control group (no intervention). However, both groups did not differ significantly in the incidence of first- and second-degree tears. Similarly, no significant difference in the incidence </span><span style="font-family:Verdana;">of episiotomy was found between both groups. In one interventional non-RCT, </span><span style="font-family:Verdana;">the administration of intracervical hyaluronidase was associated with a statistically significant acceleration and shortening of labor by approximately 1.95 hours after the injection of intracervical hyaluronidase. However, it had no effect on uterine contractions or the duration of stages two and three labor. Conclusions: While it is safe, clinicians should consider patient a
文摘Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma.
文摘We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.
文摘Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.
文摘Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of a clinical tool that could assist with clinical decisions regarding obstetrical procedures and mode of delivery. Objective: To assess intraobserver reproducibility of measurements of perineal elasticity and pubic bone-perineal critical distance with a novel tactile probe in pregnant women. Methods: An Antepartum Tactile Imager (ATI) was designed with a vaginal probe resembling a fetal skull. The probe comprises 128 tactile sensors on a double curved surface and measures 46 mm in width and 72 mm in length. The probe has a motion tracking sensor that allows acquisition of 3D tactile images. There were two arms of the study. In the first arm, biomechanical mapping of the perineum and pelvic bone location was performed in 10 non-pregnant women for purposes of demonstrating safety and feasibility. In the second arm, biomechanical mapping was performed in 10 pregnant women to explore intraobserver reproducibility. Each subject had two standardized examinations over 3 - 5 minutes by the same observer. Examination comfort and pain levels were assessed by post-procedure survey. Reproducibility was analyzed by intraclass correlation coefficients (ICC) with 95% confidence intervals and Bland-Altman plots. Bias and the 95% limits of agreement were also calculated. Results: The safety and feasibility arm of the study demonstrated high degree of safety and tolerability and reliable acquisition of tactile signals. In the reproducibility arm, 10 pregnant women were recruited at mean gestational age of 34.2 ± 6.5 weeks. The mean perineum elasticity (Young’s modulus, E) was 9.8 ± 5.9 kPa, and the mean pubic bone-perineal critical distance (D) at 20 kPa load was 34.6 ± 6.2 mm. The ICC was 0.97 [95% confidence interval (CI) 0.91, 0.99] and 0.82 [CI 0.44, 0.95] for E and D respectively, consistent with excellent in
