Νικόλαος Παπαντωνίου, Ομότιμος Καθηγητής, Ιατρική Σχολή , ΕΚΠΑ
Δημήτριος Κασσάνος, Ομότιμος Καθηγητής, Ιατρική Σχολή , ΕΚΠΑ
Χαράλαμπος Χρέλιας, Ομότιμος Αναπληρωτής Καθηγητής, Ιατρική Σχολή , ΕΚΠΑ
An injured perineum has been viewed as a negative aspect and somewhat accepted as part of vaginal birth. However, an increasing rate of severe perineal injuries, obstetric anal sphincter injuries as well as growing awareness of potential of perineal injury have focused attention on finding methods to prevent such injury. Severe degree of perineal lacerations are the main causative mechanism for anal incontinence as well as other immediate and long-term complications than significantly affect women’s quality of life.
The role of episiotomy has been subject for debate. Whereas there is evidence that midline episiotomy is associated with increased risk of third and fourth degree perineal lacerations, consensus is lacking regarding the role of mediolateral episiotomy. While recent studies have indicated that mediolateral episiotomy is protective against severe degree perineal injuries both during operative vaginal deliveries and for primiparous women, other studies have shown that mediolateral episiotomy is a risk factor for third and fourth degree perineal lacerations.
As mentioned, third and fourth degree perineal lacerations might cause anal incontinence, but is also associated with perineal pain, rectovaginal fistulas, urinary incontinence and sexual problems.
The purpose of this study is to educate the obstetric care providers, with the epidemiology, risk factors, clinical diagnosis, the prevention and protection of perineum, and management of perineal lacerations according to new data, reviews, meta-analyses and guidelines from the world's finest obstetric societies.
The best case-by-case treatment of these incidents is analyzed; the possible complications that may arise, and the actions required to remedy and repair them.Articles from the electronic databases were used to create this literature review: PubMed, Google Scholar, Cochrane Library, UpToDate et al. Obstetrics - Gynecology, Surgical Atlas and Anatomy textbooks were also studied. The review resulted in 208 foreign-language publications including articles, systematic reviews, and meta- analyzes.
Keywords were used such as: perineum, obstetric injuries, perineal injuries, episiotomy, anal sphincter injury, anal incontinence.
The analysis of the literature and the conclusions drawn after a detailed study constitute the content of this thesis.
Perineum, Obstetric injuries, Perineal injuries, Episiotomy, Anal sphincter injury, Anal incontinence