Perineal injuries in childbirth. Analysis of causes
Marina V. Koval , Marina G. Askerova , Marina N. Ermolina , Michail A. Romanov , Marina A. Yachmeneva
Perm Medical Journal ›› 2023, Vol. 40 ›› Issue (3) : 51 -59.
Perineal injuries in childbirth. Analysis of causes
One of the most significant problems of obstetrics are perineal injuries, in the structure of which dominate ruptures. According to Russian and world literature data, the frequency of perineal ruptures ranges from 7 to 25 % of all the childbirths. The article considers the most significant predictors of this condition, including violation of vaginal microbiocenosis, perineal injuries in the anamnesis and instrumental birth. In addition, perineal injuries lead to immediate and long-term complications that significantly reduces the quality of women's life. Among the consequences of ruptures, most often pain and discomfort in the perineum area, impaired urination and fecal incontinence, as well as the development of infectious complications are observed.
Perineal injury / episiotomy / ruptured labor / genital prolapse / pelvic floor insufficiency
| [1] |
Yvonne L. Hauck, Lucy Lewis, Elizabeth A. Nathan, Christine White, Dorota A. Doherty. Risk factors for severe perineal trauma during vaginal childbirth: A Western Australian retrospective cohort study. Women and Birth 2015; 28 (1): 16–20. |
| [2] |
Kazhina M.V. Obstetric problems of the pelvic floor. Clinical lectures. Protection of motherhood and childhood 2017; 29: 47–51 (in Russian). |
| [3] |
Кажина М.В. Акушерские проблемы тазового дна. Охрана материнства и детства 2017; 1 (29): 47–51. |
| [4] |
Kagan I. Clinical anatomy of the female pelvis: illustrated by the author. Ed. G.T. Sukhikh. Moscow: GEOTAR-Media 2017; 152 (in Russian). |
| [5] |
Каган И. Клиническая анатомия женского таза: иллюстрированный авторский атлас. Под ред. Г.Т. Сухих. М.: ГЭОТАР-Медиа 2017; 152. |
| [6] |
Petrov S.B., Kurenkov A.V., SHkarupa D.D., Karnauhov I.V. Mekhanizm uderzhaniya mochi pri napryazhenii u zhenshchin i predposylki klinicheskoj effektivnosti sinteticheskogo sredneuretral'nogo slinga. ZHurnal" akusherstva i zhenskih boleznej 2009; 3: 86–94. |
| [7] |
Петров С.Б., Куренков А.В., Шкарупа Д.Д., Карнаухов И.В. Механизм удержания мочи при напряжении у женщин и предпосылки клинической эффективности синтетического среднеуретрального слинга. Журналъ акушерства и женских болезней 2009; 3: 86–94. |
| [8] |
Vorontsova N.A., Sennikova Zh.V., Bakanach E.F., Dautova D.N. Obstetric trauma of the perineum in modern obstetrics. Young scientist 2019; 23 (261): 161–162 (in Russian). |
| [9] |
Воронцова Н.А., Сенникова Ж.В., Баканач Е.Ф., Даутова Д.Н. Акушерская травма промежности в современном акушерстве. Молодой ученый 2019; 23 (261): 161–162. |
| [10] |
Obstetrics: Handbook of the University of California. Edited by K. Nisvander, A. Evans; translated from English by N.A. Timonina; edited by D.D. Protsenko and V.M. Nechushkin. Moscow: Praktika 1999; 703 (in Russian). |
| [11] |
Акушерство: справочник Калифорнийского университета. Под ред. К. Нисвандера, А. Эванса; пер. с англ. Н.А. Тимониной; ред. пер. Д.Д. Проценко и В.М. Нечушкина. М.: Практика 1999; 703. |
| [12] |
Toktar L.V., Orazov M.R., Tazhetdinov E.Kh., Li K.I., Pak V.E., Samsonova I.A. "How to avoid perineal trauma in childbirth?" – a topical issue of modern obstetrics. Obstetrics and gynecology: news, opinions, training 2021; 9 (3): 14–19 (in Russian). |
| [13] |
Токтар Л.В., Оразов М.Р., Тажетдинов Е.Х., Ли К.И., Пак В.Е, Самсонова И.А. «Как избежать перинеальной травмы в родах?» – злободневный вопрос современного акушерства. Акушерство и гинекология: новости, мнения, обучение 2021; 9 (3): 14–19. |
| [14] |
Toktar L.V., Orazov M.R., Li K.I., Pak V.E., Samsonova I.A., Krestinin M.V. Obstetric trauma of the perineum: a modern view of the problem. Prospective study. Gynecology 2022; 24: 57–64 (in Russian). |
| [15] |
Токтар Л.В., Оразов М.Р., Ли К.И., Пак В.Е., Самсонова И.А., Крестинин М.В. Акушерская травма промежности: современный взгляд на проблему. Проспективное исследование. Гинекология 2022; 24: 57–64. |
| [16] |
Rumyantseva Z.S., Lyashchenko E.N., Basnaeva A.D., Abibullaeva N.K. Vulvovaginitis as a risk factor for rupture of the soft tissues of the birth canal. Innovations in medicine and pharmacology 2017; 7–9 (in Russian). |
| [17] |
Румянцева З.С., Лященко Е.Н., Баснаева А.Д., Абибуллаева Н.К. Вульвовагинит, как фактор риска разрыва мягких тканей родовых путей. Новшества в медицине и фармакологии 2017; 7–9. |
| [18] |
Raluca Datcu. Characterization of the vaginal microflora in health and disease. Dan. Med. J. 2014; 61 (4): B4830. |
| [19] |
Raluca Datcu. Characterization of the vaginal microflora in health and disease. Dan. Med. J. 2014; 61 (4): B4830 |
| [20] |
Zharkin N.A., Laipanova Kh.M. Injuries of the perineum during childbirth: causes and consequences. Bulletin of VolGMU 2019; 4 (72): 9–14 (in Russian). |
| [21] |
Жаркин Н.А., Лайпанова Х.М. Травмы промежности в родах: причины и следствия. Вестник ВолГМУ 2019; 4 (72): 9–14. |
| [22] |
Savelyeva G.M., Shalina R.I., Sichinava L.G., Panina O.B., Kurtser M.A. Obstetrics: textbook. Moscow: GEOTAR-Media 2020; 576 (in Russian). |
| [23] |
Савельева Г.М., Шалина Р.И., Сичинава Л.Г., Панина О.Б., Курцер М.А. Акушерство: учебник. М.: ГЭОТАР-Медиа 2020; 576. |
| [24] |
Goldberg J., Purfield P., Roberts N. et al. The Philadelphia Episiotomy Intervention Study. J. Reprod. Med. 2006; 51 (8): 603–609. |
| [25] |
Goh R., Goh D., Ellepola H. Perineal tears – A review. Aust J Gen Pract. 2018; 47 (1–2): 35–38. DOI: 10.31128/AFP-09-17-4333. |
| [26] |
Simic M., Cnattingius S., Petersson G., Sandström A., Stephansson O. Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC Pregnancy Childbirth. 2017; 17 (1): 72. DOI: 10.1186/s12884-017-1251-6. |
| [27] |
Hyland G., Hay-Smith J., Treharne G. Women’s experiences of doing long-term pelvic floor muscle exercises for the treatment of pelvic organ prolapse symptoms. Int. Urogynecol. J. 2014; 25: 265–271. |
| [28] |
Duda Vl.I., Duda V.I., Drazina O.G. Obstetrics: textbook. Moscow: Oniks 2015; 464 (in Russian). |
| [29] |
Дуда Вл.И., Дуда В.И., Дражина О.Г. Акушерство: учебник. М.: Оникс 2015; 464. |
| [30] |
Tuzlukov I.I., Kovalenko M.S., Naumova N.V., Agayan R.A. Perineal rupture and episiotomy. Medical and social aspects. Science of the Young 2019; 7 (2): 255–260 (in Russian). |
| [31] |
Тузлуков И.И., Коваленко М.С., Наумова Н.В., Агаян Р.А. Разрыв промежности и эпизиотомия. Медико-социальные аспекты. Наука молодых 2019; 7 (2): 255–260. |
| [32] |
Norton P., Boyd C., Deak S. Collagen synthesis in women with genital prolapsed or stress urinary incontinence. Neurourol. Urodyne. 1992; 11: 300–301. |
| [33] |
Norton P., Boyd C., Deak S. Collagen synthesis in women with genital prolapsed or stress urinary incontinence. Neurourol. Urodyn. 1992; 11: 300–301. |
| [34] |
Edqvist M., Hildingsson I., Mollberg M., Lundgren I., Lindgren H. Midwives' Management during the second stage of labor in relation to second-degree tears-an experimental study. Birth. 2017; 44 (1): 86–94. |
| [35] |
Chernenkov Yu.V., Nechaev V.N., Lisitsyna A.S. Assessment of the state of health of newborns depending on the duration of the anhydrous period and the infectious process in the mother. Saratov Scientific Medical Journal 2014; 10 (3): 427–431 (in Russian). |
| [36] |
Черненков Ю.В., Нечаев В.Н., Лисицына А.С. Оценка состояния здоровья новорожденных в зависимости от длительности безводного промежутка и инфекционного процесса у матери. Саратовский научно-медицинский журнал 2014; 10 (3): 427–431. |
| [37] |
Obstetrics. National leadership. Brief edition. Ed. E.K. Ailamazyan, V.N. Serov, V.E. Radzinsky, G.M. Savelieva. Moscow: GEOTAR-Media 2021; 466 (in Russian). |
| [38] |
Акушерство. Национальное руководство: краткое издание. Под ред. Э.К. Айламазяна, В.Н. Серова, В.Е. Радзинского, Г.М. Савельевой. М.: ГЭОТАР-Медиа 2021; 466. |
| [39] |
Savelyeva G.M. and others. Obstetrics: textbook. Moscow: GEOTAR Media 2011; 656 (in Russian). |
| [40] |
Савельева Г.М. и др. Акушерство: учебник. М.: ГЭОТАР Медиа 2011; 656. |
| [41] |
Romina S., Ramezani F., Falah N., Mafi M., Ranjkesh F. Effect of Perineal Massage with Ostrich Oil on the Episiotomy and Lacerations in Nulliparous Women: A Randomized Controlled Clinical Trial. Iran J Nurs Midwifery Res. 2020; 25 (2): 134–138. |
| [42] |
Romina S., Ramezani F., Falah N., Mafi M., Ranjkesh F. Effect of Perineal Massage with Ostrich Oil on the Episiotomy and Lacerations in Nulliparous Women: A Randomized Controlled Clinical Trial. Iran J Nurs Midwifery Res 2020; 25 (2): 134–138. |
| [43] |
Enyindah C.E., Fiebai P.O., Anya S.E., Okpani A.O. Episiotomy and perineal trauma prevalence and obstetric risk factors in Port Harcourt. Nigeria. Niger J Med. 2007; 16 (3): 242–245. |
| [44] |
Enyindah C.E., Fiebai P.O., Anya S.E., Okpani A.O. Episiotomy and perineal trauma prevalence and obstetric risk factors in Port Harcourt, Nigeria. Niger J Med. 2007; 16 (3): 242–245. |
| [45] |
Royal College of Obstetricians and Gynaecologists (PROG). The management of third- and fourth, degree of perineal tears. London (UK): RCOG; 2007; 29: 11. |
| [46] |
Royal College of Obstetricians and Gynaecologists (PROG). The management of third- and fourth, degree perineal tears. London (UK): RCOG; 2007; 29: 11. |
| [47] |
Buyanova S.N., Shchukina N.A., Zubova E.S., Sibryaeva V.A., Rizhinashvili I.D. Prolapse of the genitals. Russian Bulletin of an obstetrician-gynecologist. 2017; 17 (1): 37 45 (in Russian). |
| [48] |
Буянова С.Н., Щукина Н.А., Зубова Е.С., Сибряева В.А., Рижинашвили И.Д. Пролапс гениталий. Российский вестник акушера-гинеколога. 2017; 17 (1): 37–45. |
| [49] |
Vazenmiller D.V., Abatov N.T., Bashzhanova Zh.O. Obstetric injuries in the genesis of urogenital prolapse. Medicine and Ecology 2015; 4: 16–23 (in Russian). |
| [50] |
Вазенмиллер Д.В., Абатов Н.Т., Бащжанова Ж.О. Акушерский травматизм в генезе урогенитального пролапса. Медицина и экология 2015; 4: 16–23. |
| [51] |
Milyaeva N.M., Kovalev V.V., Bortnik E.A., Sivov E.V., Kudryavtseva E.V., Bayazitova N.N., Korovina A.V. Clinical and anamnestic and biological candidates for participation in the mechanisms of genital prolapse formation in women. Ural Medical Journal 2021; 20 (1): 82–88 (in Russian). |
| [52] |
Миляева Н.М., Ковалев В.В., Бортник Е.А., Сивов Е.В., Кудрявцева Е.В., Баязитова Н.Н., Коровина А.В. Клинико-анамнестические и биологические претенденты на участие в механизмах формирования пролапса гениталий у женщин. Уральский медицинский журнал 2021; 20 (1): 82–88. |
| [53] |
Tayupova I.M., Sakhautdinova I.V., Zulkarneev E.M. Genital prolapse. High-tech methods of surgical treatment: a textbook for independent extracurricular work of students. Ufa: BashNIPIneft Publishing House 2015; 57 (in Russian). |
| [54] |
Таюпова И.М., Сахаутдинова И.В., Зулкарнеева Э.М. Пролапс гениталий. Высокотехнологичные методы хирургического лечения: учебное пособие для самостоятельной внеаудиторной работы обучающихся. Уфа: Изд-во БашНИПИнефть 2015; 57. |
| [55] |
Selikhova M.S., Kotovskaya M.V. Management of the postpartum period in women with soft tissue injuries of the birth canal. Volgograd: Volgograd State Medical University 2009 (in Russian). |
| [56] |
Селихова М.С, Котовская М.В. Ведение послеродового периода у женщин с травмами мягких тканей родовых путей. Волгоград: Волгоградский государственный медицинский университет 2009. |
| [57] |
Sukhanov A.A., Kukarekaya I.I. Early prevention and treatment of pelvic floor dysfunction. The scale of the disease in the modern world. Ural Medical Journal 2018; (6): 107–117 (in Russian). |
| [58] |
Суханов А.А., Кукарекая И.И. Ранняя профилактика и лечение дисфункции тазового дна. Масштаб заболевания в современном мире. Уральский медицинский журнал 2018; 6: 107–117. |
| [59] |
Sharshova O.A., Grigorieva Yu.V. Pathology of the cervix: a textbook. Blagoveshchensk 2019; 102 (in Russian). |
| [60] |
Шаршова О.А., Григорьева Ю.В. Патология шейки матки: учебное пособие. Благовещенск 2019: 102. |
Koval M.V., Askerova M.G., Ermolina M.N., Romanov M.A., Yachmeneva M.A.
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