Incidence, severity, and determinants of perineal pain after vaginal delivery: A prospective cohort study

Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 11/2004; 191(4):1199-204. DOI: 10.1016/j.ajog.2004.02.064
Source: PubMed


The purpose of this study was to determine the frequency of perineal pain in the 6 weeks after vaginal delivery and to assess the association between perineal trauma and perineal pain. Study design This was a prospective cohort study of parturients at 1 day, 7 days,' and 6 weeks' post partum in an academic tertiary obstetric unit in Toronto, Canada. Four hundred forty-four women were followed up, including women with an intact perineum (n=84), first-/second-degree tears (n=220), episiotomies (n=97), or third-/fourth-degree tears (n=46). Primary outcome was the incidence of perineal pain on day of interview; secondary outcomes were pain score measurements and interference with daily activities.
Perineal trauma was more common among primiparous women, those with operative vaginal deliveries, and those with epidural analgesia during the second stage of labor. The incidence of perineal pain among the groups during the first week was intact perineum 75% (day 1) and 38% (day 7); first-/second-degree tears 95% and 60%; episiotomies 97% and 71%; and third-/fourth-degree tears 100% and 91%. By 6 weeks, the frequency of perineal pain was not statistically different between trauma groups.
Acute postpartum perineal pain is common among all women. However, perineal pain was more frequent and severe for women with increased perineal trauma.

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    • "Genital tract pain is common after vaginal delivery. In one study [11], 38% of 84 women reported perineal pain 1 week after delivery even with an intact perineum. "
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    ABSTRACT: Objective To assess the characteristics of patients seen at a postpartum perineal clinic in the USA during the first 4 years of its existence, and to identify factors contributing to the clinic’s success. Methods In a retrospective study, the charts of patients presenting to the clinic between July 1, 2007, and June 30, 2011, were reviewed for presenting complaint, findings, treatment, number of visits, and referral source. Strategies that led to successful clinic implementation were reviewed. Results A total of 247 patients were seen during the 4-year period. Indications for referral included lacerations, pain, urinary and fecal incontinence, and fistulas. The most common referral indication was a third- or fourth-degree laceration, which affected 154 (62.3%) patients. Overall, 53 (21.5%) patients required a procedure, of whom 20 (8.1%) underwent surgery. Most women were counseled about pelvic floor exercises, and 39 (15.8%) were referred for pelvic floor physical therapy. Nurse-led triage, patient education, and follow-up were key to the success of the program. Conclusion The postpartum perineal clinic is sustainable and offers an opportunity for early assessment and treatment of pelvic floor dysfunction after a complicated vaginal delivery.
    International Journal of Gynecology & Obstetrics 09/2014; 128(1). DOI:10.1016/j.ijgo.2014.07.026 · 1.54 Impact Factor
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    • "Episiotomy is associated with significant pain during postpartum period. Perineal pain on the first day following vaginal delivery occurs in 97% of women with episiotomies (10). Although the use of episiotomy is often debated, it remains the most common surgical procedure experienced by women (6). "
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    ABSTRACT: Pain is a worldwide problem that often originates from disease process, and diagnostic and treatment procedures such as surgical operations. This trial was performed to compare the effectiveness of two analgesics for the management of perineal pain caused by episiotomy. A total of 170 nulliparous women who gave birth vaginally with episiotomy between March 2009 and November 2010 were randomly assigned to receive either ibuprofen or celecoxib which were given orally every 6 or 12 hours, respectively. Pain levels were measured before the intervention, and at 1, 2, 4, 8 and 12 hours after providing the first dose on a 10-cm visual analogue scale. The results showed that the two groups had no significant differences regarding demographic characteristics, maternal, neonatal, and post-delivery factors, and mean premedication pain severity. Means of pain severity were different between the two groups as patients in the celecoxib group had lower means than the other group at 1,2,4,8 and 12 hours (4.01 ± 1.8 vs. 4.46 ± 1.9, 3.17 ± 1.9 vs. 3.79 ± 1.7, 2.89 ± 1.3 vs. 2.96 ± 1.5, 2.19 ± 1.8 vs. 2.55 ± 1.4, and 1.98 ± 1.1 vs. 2.45 ± 1.2, respectively) after administration of analgesics. Patients who received celecoxib had lower VAS in comparison with others. Although these differences were not significant, as celecoxib has longer half-life, fewer upper GI symptoms, and is better tolerated based on the previous studies, and this study is in favor of using it.
    12/2013; 15(12):e9980. DOI:10.5812/ircmj.9980
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    • "Not all of them required suturing [4]. Pain in the perineum is common after vaginal birth whether the woman had a tear or not [7] [8]. Women can experience pain and discomfort related to perineal tears for weeks and even months after delivery [9] [10]. "
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    ABSTRACT: Perineal tears are one of the most common complications of vaginal births and may cause discomfort and pain long time after childbirth. Visual and digital examination of perineal tears is the most common way to assess and classify a perineal tear. Recent research indicates that many tears diagnosed are misclassified. The aim of this systematic literature review was to outline research that investigates healthcare professionals’ clinical knowledge in assessment and classification of perineal tears in connection with childbirth. Searches were performed in PubMed and CINAHL. Six studies on the topic were identified and all used questionnaires to collect data. An integrative review was used in the analysis. Poor knowledge in perineal anatomy and lack of training in clinical assessment and classification of perineal trauma was evident among both physicians and midwives. These findings indicate that healthcare providers lack adequate knowledge and that they make incorrect assessments and errors in classification of perineal tears. The training in assessment and classification is crucial. Midwives are in a unique position to improve the standard of care in this field since they are often the first and many times the only to assess the injury.
    Open Journal of Obstetrics and Gynecology 06/2013; 3(4A). DOI:10.4236/ojog.2013.34A002
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