The association between postpartum perineal laceration with anatomy and pelvic floor muscle strength

Gledies Theresye Gosal; Trika Irianta; David Lotisna; Isharyah Sunarno; Imam Ahmadi Farid; Nugraha Utama Pelupessy

doi:10.15562/bmj.v12i3.4724

The association between postpartum perineal laceration with anatomy and pelvic floor muscle strength

Gledies Theresye Gosal ,

Trika Irianta ,

David Lotisna ,

Isharyah Sunarno ,

Imam Ahmadi Farid ,

Nugraha Utama Pelupessy ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i3.4724 |
Published: 2023-11-06

Abstract

Link of Video Abstract: https://youtu.be/lrnQiVZyH8Q

Background: Perineal lacerations damage the tissues around the vagina and rectum and can cause disruption of the anatomy and function of the pelvic floor. The incidence of perineal lacerations after vaginal delivery ranges from 53-89%. This anatomical damage and muscle dysfunction can cause urinary incontinence, anal incontinence, and uterovaginal prolapse. This study aims to evaluate the effects of postpartum perineal lacerations on the anatomy and strength of the pelvic floor muscles.

Methods: The sample of this study is primiparous women who experienced perineal lacerations. Sampling was carried out prospectively using the consecutive sampling method. Pelvic floor anatomy and strength were measured using a POP-Q system and a perineometer. The 1^st and 2^nd degree laceration group measurements will be compared using the chi-square, and Mann-Whitney tests will be carried out.

Results: Of the 123 research samples that met the criteria, a significant difference was found in the strength of the pelvic floor muscles in the first-degree perineal laceration and second-degree perineal laceration groups at 1st day and 12 weeks postpartum (p = 0.000 and p = 0.042). The only significant difference found for pelvic floor muscle anatomy is in perineal body length at 12 weeks postpartum.

Conclusion: The degree of perineal laceration is related to the strength of the pelvic floor muscles after delivery and the length of the perineal body 12 weeks postpartum.

References

Ugwu EO, Iferikigwe ES, Obi SN, Eleje GU, Ozumba BC. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. J Obstet Gynaecol Res. 2018;44(7):1252-1258.
Goh R, Goh D, Ellepola H. Perineal tears - A review. Aust J Gen Pract. 2018;47(1):35-38.
Riesco MLG, Caroci A de S, Oliveira SMJV de, Lopes MHB de M. Perineal Muscle Strength During Pregnancy and Postpartum: the Correlation Between Perineometry and Digital Vaginal Palpation. Rev Lat Am Enfermagem. 2010;18(6):1138–1144.
Wai CY, McIntire DD, Atnip SD, Schaffer JI, Bloom SL, Leveno KJ. Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. Int Urogynecology J. 2011;22(10):1293–1298.
Palmezoni VP, Santos MD, Pereira JM, Bernardes BT, Pereira-Baldon VS, Resende APM. Pelvic floor muscle strength in primigravidae and non-pregnant nulliparous women: a comparative study. Int Urogynecol J. 2017;28(1):131–137.
Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth. 2016;43(4):293-302.
D’Souza JC, Monga A, Tincello DG, Sultan AH, Thakar R, Hillard TC, et al. Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study. Int Urogynecol J. 2020;31(1):627-633.
Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: Effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;1(1):1-9.
Rahman MN, Sukarsa MRA, Rinaldi A, Achmad ED, Sasotya RMS, Armawan E, et al. Obstetrical ballooning and avulsion of levator ani muscle after vaginal delivery: a literature review. Bali Medical Journal. 2023;12(2):2070–2073.
Megadhana IW, Indrawan IGS, Sanjaya INH, Aryana MBD. The prevalence and characteristics of perineal rupture during vaginal delivery at Sanglah General Hospital and Regional Hospitals in Bali from January 2018 until December 2019 period. Bali Medical Journal. 2022;11(1):356–359.
Priyatini T, Santoso BI, Irianta T, Herqutanto, Siregar N, Harahap A, et al. Profile of matrix metalloproteinase activity, markers of collagen and elastin degradation and remodeling during pregnancy, delivery, and puerperium in pelvic organ prolapse 3 months after childbirth. Bali Medical Journal. 2023;12(1):255–260.
MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Br J Obstet Gynaecol. 2000;107(1):1460-1470.
Mendes Ede P, Oliveira SM, Caroci Ade S, Francisco AA, Oliveira SG, Silva RL. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study. Rev Lat Am Enfermagem. 2016;24(0)-1-10.
Urbankova I, Grohregin K, Hanacek J, Krcmar M, Feyereisl J, Deprest J, et al. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecology J. 2019;30(10):1689–1696.
Lawrence L, Rebecca R, Noelle B, Dusty T, Clifford Q. The effect of perineal lacerations on pelvic floor function and anatomy at six months postpartum in a prospective cohort of nulliparous women. Birth Berkeley Calif. 2016;43(4):293–302.
Adnyana IBP, Liwang F, Negara KS, Manuaba IBP, Bhargah A, Prabawa IPY. Clinical risk factor of preeclampsia: a five-year retrospective study in Bali Royal Hospital, Bali-Indonesia. Gineco. Eu. 2018;14(3):89-93.
Friedman S, Blomquist JL, Nugent JM, McDermott KC, Muñoz A, Handa VL. Pelvic muscle strength after childbirth. Obstet Gynecol. 2012;120(5):1021.

[1] Ugwu EO, Iferikigwe ES, Obi SN, Eleje GU, Ozumba BC. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. J Obstet Gynaecol Res. 2018;44(7):1252-1258.

[2] Goh R, Goh D, Ellepola H. Perineal tears - A review. Aust J Gen Pract. 2018;47(1):35-38.

[3] Riesco MLG, Caroci A de S, Oliveira SMJV de, Lopes MHB de M. Perineal Muscle Strength During Pregnancy and Postpartum: the Correlation Between Perineometry and Digital Vaginal Palpation. Rev Lat Am Enfermagem. 2010;18(6):1138–1144.

[4] Wai CY, McIntire DD, Atnip SD, Schaffer JI, Bloom SL, Leveno KJ. Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. Int Urogynecology J. 2011;22(10):1293–1298.

[5] Palmezoni VP, Santos MD, Pereira JM, Bernardes BT, Pereira-Baldon VS, Resende APM. Pelvic floor muscle strength in primigravidae and non-pregnant nulliparous women: a comparative study. Int Urogynecol J. 2017;28(1):131–137.

[6] Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth. 2016;43(4):293-302.

[7] D’Souza JC, Monga A, Tincello DG, Sultan AH, Thakar R, Hillard TC, et al. Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study. Int Urogynecol J. 2020;31(1):627-633.

[8] Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: Effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;1(1):1-9.

[9] Rahman MN, Sukarsa MRA, Rinaldi A, Achmad ED, Sasotya RMS, Armawan E, et al. Obstetrical ballooning and avulsion of levator ani muscle after vaginal delivery: a literature review. Bali Medical Journal. 2023;12(2):2070–2073.

[10] Megadhana IW, Indrawan IGS, Sanjaya INH, Aryana MBD. The prevalence and characteristics of perineal rupture during vaginal delivery at Sanglah General Hospital and Regional Hospitals in Bali from January 2018 until December 2019 period. Bali Medical Journal. 2022;11(1):356–359.

[11] Priyatini T, Santoso BI, Irianta T, Herqutanto, Siregar N, Harahap A, et al. Profile of matrix metalloproteinase activity, markers of collagen and elastin degradation and remodeling during pregnancy, delivery, and puerperium in pelvic organ prolapse 3 months after childbirth. Bali Medical Journal. 2023;12(1):255–260.

[12] MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Br J Obstet Gynaecol. 2000;107(1):1460-1470.

[13] Mendes Ede P, Oliveira SM, Caroci Ade S, Francisco AA, Oliveira SG, Silva RL. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study. Rev Lat Am Enfermagem. 2016;24(0)-1-10.

[14] Urbankova I, Grohregin K, Hanacek J, Krcmar M, Feyereisl J, Deprest J, et al. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecology J. 2019;30(10):1689–1696.

[15] Lawrence L, Rebecca R, Noelle B, Dusty T, Clifford Q. The effect of perineal lacerations on pelvic floor function and anatomy at six months postpartum in a prospective cohort of nulliparous women. Birth Berkeley Calif. 2016;43(4):293–302.

[16] Adnyana IBP, Liwang F, Negara KS, Manuaba IBP, Bhargah A, Prabawa IPY. Clinical risk factor of preeclampsia: a five-year retrospective study in Bali Royal Hospital, Bali-Indonesia. Gineco. Eu. 2018;14(3):89-93.

[17] Friedman S, Blomquist JL, Nugent JM, McDermott KC, Muñoz A, Handa VL. Pelvic muscle strength after childbirth. Obstet Gynecol. 2012;120(5):1021.

The association between postpartum perineal laceration with anatomy and pelvic floor muscle strength

Abstract

References

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